Sezavar Ahmad Habibian, Rastegar-Pouyani Nima, Rahimi Kakavandi Nader, Fakhari Fatemeh, Jafarzadeh Emad, Aliebrahimi Shima, Ostad Seyed Nasser
Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Department of Occupational Health Engineering, School of Health, Ilam University of Medical Sciences, Ilam, Iran.
Crit Rev Toxicol. 2024 Nov;54(10):981-995. doi: 10.1080/10408444.2024.2425669. Epub 2024 Dec 5.
Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals used widely in industrial and commercial applications. Concerns exist about their potential link to cancer risk as possible endocrine-disrupting chemicals. We conducted a meta-analysis to evaluate the dose-response relationship between PFAS, perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluorohexanesulfonic acid (PFHxS) exposure and risk of breast, prostate, colorectal, and ovarian cancers. We systematically searched major databases through May 2022 and identified 13 observational studies for inclusion. Using random-effects models, we calculated summary odds ratios (ORs) and 95% confidence intervals (CIs) comparing the highest versus lowest PFAS exposure categories. Additionally, we analyzed the dose-response correlation between PFAS and cancer risk in a subset of studies. The study revealed no substantial correlation between exposure to PFASs and the incidence of breast cancer (BC) (OR = 1.15, 95% CI = 0.91-1.46, OR = 1.01, 95% CI = 0.68-1.50, OR = 0.88, 95% CI = 0.64-1.21, OR = 1.22, 95% CI = 0.40-3.77, and OR = 1.29, 95% CI = 0.41-4.10), ovarian cancer (OR = 1.43, 95% CI = 0.84-2.42), prostate cancer (OR = 1.05, 95% CI = 0.88-1.26), and colorectal cancer (OR = 0.77, 95% CI = 0.53-1.12) in the highest versus lowest exposure analysis. However, dose-response analysis showed that for every 1 ng/ml increase in PFNA and 2 ng/ml increase in PFOA, the relative risk for BC decreased significantly (RR 0.67, 95% CI 0.45-0.99 and RR 0.94, 95% CI 0.89-0.98, respectively). Non-linear dose-response analysis found no significant changes in BC risk with increasing PFAS levels. In conclusion, while the highest versus lowest analysis does not support associations between PFAS exposure and the risk of these cancers, linear dose-response analysis suggests potential inverse relationships between PFNA/PFOA levels and BC risk. Further research is warranted on these potential protective effects.
全氟和多氟烷基物质（PFAS）是广泛应用于工业和商业领域的合成化学品。由于它们可能是内分泌干扰物，人们对其与癌症风险之间的潜在联系表示担忧。我们进行了一项荟萃分析，以评估PFAS、全氟辛烷磺酸（PFOS）、全氟辛酸（PFOA）、全氟壬酸（PFNA）、全氟癸酸（PFDA）、全氟己烷磺酸（PFHxS）暴露与乳腺癌、前列腺癌、结直肠癌和卵巢癌风险之间的剂量反应关系。我们系统检索了截至2022年5月的主要数据库，并确定了13项观察性研究纳入分析。使用随机效应模型，我们计算了最高与最低PFAS暴露类别比较的汇总比值比（OR）和95%置信区间（CI）。此外，我们在一部分研究中分析了PFAS与癌症风险之间的剂量反应相关性。研究显示，在最高与最低暴露分析中，PFAS暴露与乳腺癌（BC）发病率之间无显著相关性（OR = 1.15，95% CI = 0.91 - 1.46，OR = 1.01，95% CI = 0.68 - 1.50，OR = 0.88，95% CI = 0.64 - 1.21，OR = 1.22，95% CI = 0.40 - 3.77，OR = 1.29，95% CI = 0.41 - 4.10）、卵巢癌（OR = 1.43，95% CI = 0.84 - 2.42）、前列腺癌（OR = 1.05，95% CI = 0.88 - 1.26）和结直肠癌（OR = 0.77，95% CI = 0.53 - 1.12）。然而，剂量反应分析表明，PFNA每增加1 ng/ml和PFOA每增加2 ng/ml，BC的相对风险显著降低（RR分别为0.67，95% CI 0.45 - 0.99和RR 0.94，95% CI 0.89 - 0.98）。非线性剂量反应分析发现，随着PFAS水平升高，BC风险无显著变化。总之，虽然最高与最低分析不支持PFAS暴露与这些癌症风险之间的关联，但线性剂量反应分析表明PFNA/PFOA水平与BC风险之间可能存在反向关系。有必要对这些潜在的保护作用进行进一步研究。
