Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
J Natl Cancer Inst. 2023 Apr 11;115(4):405-412. doi: 10.1093/jnci/djad004.
Ethylene oxide (EtO) is a carcinogenic gas used in chemical production and to sterilize medical equipment that has been linked to risk of breast and lymphohematopoietic cancers in a small number of occupational studies. We investigated the relationship between environmental EtO exposure and risk of these cancers.
Using the US Environmental Protection Agency's Toxics Release Inventory, we estimated historical exposures for National Institutes of Health-AARP Diet and Health Study participants enrolled in 1995-1996. We constructed 2 metrics at 3, 5, and 10 km: 1) distance between residences and EtO-emitting facilities, weighted by the proportion of time the home was downwind of each facility, and 2) distance-weighted, wind direction-adjusted average airborne emissions index (AEI=∑[lbs EtO/km2]). We estimated risk (hazard ratio [HR], 95% confidence interval [CI]) of incident breast cancer (in situ and invasive) among postmenopausal women (n = 173 670) overall and by tumor estrogen receptor status and non-Hodgkin lymphoma in the full cohort (n = 451 945).
We observed an increased risk of breast cancer associated with EtO-emitting facilities within 10 km (HR[≤10vs>10] = 1.05, 95% CI = 1.00 to 1.10) that appeared stronger for in situ (HR[≤10vs>10] = 1.13, 95% CI = 1.00 to 1.27) than invasive (HR[≤10vs>10] = 1.03, 95% CI = 0.97 to 1.09) disease. Risk of breast cancer in situ was also increased in the top AEI quartiles, and associations weakened with larger distances (HR[Q4vs0] = 1.60, 95% CI = 0.98 to 2.61; HR[Q4vs0] = 1.28, 95% CI = 0.92 to 1.79; HR[Q4vs0] = 1.25, 95% CI = 1.02 to 1.53 at 3, 5, and 10 km, respectively). No differences in breast cancer risk were observed by estrogen receptor status. We found no clear pattern of increased non-Hodgkin lymphoma risk.
A novel potential association between EtO emissions and risk of in situ, but not invasive, breast cancer warrants additional evaluation.
环氧乙烷（EtO）是一种用于化学生产和医疗器械灭菌的致癌气体，在少数职业研究中，它与乳腺癌和淋巴血液系统癌症的风险有关。我们研究了环境中 EtO 暴露与这些癌症风险之间的关系。
使用美国环境保护署的有毒物质释放清单，我们估计了参加 1995-1996 年美国国家卫生研究院-美国退休人员协会饮食与健康研究的参与者的历史暴露情况。我们构建了两个指标，在 3、5 和 10 公里处：1）住所与排放 EtO 设施之间的距离，根据家庭处于每个设施下风的时间比例进行加权，2）距离加权、风向调整的平均空气传播排放指数（AEI=∑[lbs EtO/km2]）。我们估计了绝经后妇女（n=173670）中总体乳腺癌（原位和浸润性）和全队列（n=451945）中非霍奇金淋巴瘤的发病风险（危险比[HR]，95%置信区间[CI]），按肿瘤雌激素受体状态进行分层。
我们观察到与 10 公里内排放 EtO 的设施相关的乳腺癌风险增加（≤10 与>10 相比，HR[≤10 与>10] = 1.05，95%CI = 1.00 至 1.10），原位疾病（HR[≤10 与>10] = 1.13，95%CI = 1.00 至 1.27）的风险似乎强于浸润性疾病（HR[≤10 与>10] = 1.03，95%CI = 0.97 至 1.09）。AEI 四分位组较高的乳腺癌原位风险也增加，且风险随距离增大而减弱（HR[Q4 与 0] = 1.60，95%CI = 0.98 至 2.61；HR[Q4 与 0] = 1.28，95%CI = 0.92 至 1.79；HR[Q4 与 0] = 1.25，95%CI = 1.02 至 1.53，分别在 3、5 和 10 公里处）。雌激素受体状态无差异。我们没有发现非霍奇金淋巴瘤风险增加的明显模式。
环氧乙烷排放与原位乳腺癌（但非浸润性乳腺癌）风险之间存在潜在的新关联，值得进一步评估。
