Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Environ Int. 2024 Nov;193:109140. doi: 10.1016/j.envint.2024.109140. Epub 2024 Nov 10.
Perfluoroalkyl substances (PFAS) are persisting chemicals with endocrine disruptive and carcinogenic properties. Previous studies involving cohorts with high PFAS exposure have not shown an increased risk of breast cancer. Research on PFAS and breast cancer according to hormone receptor status is limited. This study aims to investigate the association between PFAS exposure and hormone receptor-positive breast cancer.
In 2013, high levels of PFAS (sum of PFAS >10,000 ng/L), dominated by perfluorooctane sulfonic acid (PFOS) and perfluorohexane sulfonic acid (PFHxS) were found in the drinking water from one of the two waterworks in Ronneby, Sweden. Breast cancer diagnoses and information of adjuvant endocrine therapy were retrieved from the Swedish Cancer Register and The Prescribed Drug Register 2006-2016 for a cohort of women residing in the municipality between 1985 and 2013 (n=24,509). Individual exposure was assessed based on municipality waterworks distribution data linked to annual residential addresses. Cox proportional hazards models were used in the analysis. The highest achieved educational level was used as an indicator of socioeconomic position. Sensitivity and subgroup analysis were performed for prepubertal exposure and diagnosis before or after age 50 (assumed menopause).
There were 313 cases of malignant breast cancer among women ≤85 years between 2006 and 2016. Of these, 224 cases (72%) were considered hormone receptor-positive based on the first prescription of adjuvant endocrine therapy, antiestrogens (40%) or aromatase inhibitor (60%). Among women ever living at a residential address with high PFAS exposure, the hazard ratio (HR) for breast cancer classified as hormone receptor-positive was 0.84; 95% confidence interval (CI) 0.61, 1.14. Findings were similar before and after menopause.
High PFAS exposure from drinking water, dominated by PFOS and PFHxS, was not associated with an elevated risk of hormone receptor-positive breast cancer.
全氟烷基物质（PFAS）是具有内分泌干扰和致癌特性的持久性化学物质。此前涉及高 PFAS 暴露队列的研究并未显示乳腺癌风险增加。根据激素受体状态研究 PFAS 与乳腺癌的相关性研究有限。本研究旨在调查 PFAS 暴露与激素受体阳性乳腺癌之间的关系。
2013 年，在瑞典罗讷比的两个自来水厂之一的自来水中发现高水平的 PFAS（>10,000ng/L 的 PFAS 总和，主要由全氟辛烷磺酸（PFOS）和全氟己烷磺酸（PFHxS）组成）。2006 年至 2016 年，从瑞典癌症登记处和处方药物登记处检索了居住在该市的女性乳腺癌诊断和辅助内分泌治疗信息（n=24,509）。根据市自来水厂分布数据，结合年度居住地址，评估个体暴露情况。在分析中使用了 Cox 比例风险模型。最高获得的教育水平用作社会经济地位的指标。进行了敏感性和亚组分析，用于青春期前暴露和诊断，以及 50 岁之前或之后（假设绝经）。
2006 年至 2016 年间，≤85 岁的女性中有 313 例恶性乳腺癌病例。其中，根据辅助内分泌治疗、抗雌激素（40%）或芳香酶抑制剂（60%）的首次处方，224 例（72%）被认为是激素受体阳性。在曾经居住在高 PFAS 暴露住宅地址的女性中，激素受体阳性乳腺癌的风险比（HR）为 0.84；95%置信区间（CI）为 0.61，1.14。绝经前后的发现相似。
饮用水中 PFAS 暴露水平较高，主要由 PFOS 和 PFHxS 组成，与激素受体阳性乳腺癌的风险增加无关。
