Abstract

Background:

The epidemiological literature of associations between atmospheric pollutant exposure and breast cancer incidence has recently strongly evolved.

Objectives:

We aimed to perform a) a meta-analysis of studies considering this relationship, correcting for publication bias and taking menopausal status and cancer hormone responsiveness into account; and b) for the pollutants most likely to affect breast cancer, an assessment of the corresponding number of attributable cases in France and of the related economic costs.

Methods:

We conducted a literature review and random-effects meta-analyses of epidemiological studies examining the association of fine particulate matter with aerodynamic diameter less than or equal to $2.5\mathrm{\mu }\mathrm{m}$ (${\mathrm{PM}}_{2.5}$), particulate matter with aerodynamic diameter less than or equal to 10 μm (${\mathrm{PM}}_{10}$), and ${\mathrm{NO}}_2$ long-term exposure with breast cancer incidence; additional analyses were stratified on menopausal status and on tumor hormone responsiveness status. The resulting dose–response functions were combined with modeled atmospheric pollutant exposures in 2013 for France, cancer treatments costs, lost productivity, and years of life lost, to estimate the number of breast cancers attributable to atmospheric pollution and related economic costs in France.

Results:

The review identified 32, 27, and 36 effect estimates for ${\mathrm{PM}}_{2.5}$, ${\mathrm{PM}}_{10}$, and ${\mathrm{NO}}_2$, respectively. The meta-analytical relative risk estimates of breast cancer corrected for publication bias were 1.006 [95% confidence interval (CI): 0.941, 1.076], 1.047 (95% CI: 0.984, 1.113), and 1.023 (95% CI: 1.005, 1.041), respectively. ${\mathrm{NO}}_2$ estimated effects appeared higher in premenopausal than in postmenopausal women and higher for hormone responsive positive ($\text{ER}+/\text{PR}+$) than negative ($\text{ER}–/\text{PR}–$) breast cancers. Assuming a causal effect of ${\mathrm{NO}}_2$, we estimated that 1,677 (95% CI: 374, 2,914) new breast cancer cases were attributable to ${\mathrm{NO}}_2$ annually in France, or 3.15% (95% CI: 0.70, 5.48) of the incident cases. The corresponding tangible and intangible costs were estimated to be €$825\text{\hspace{0.17em}million}$ (low, high: 570, 1,080) per year.

Conclusion:

These findings suggest that decreasing long-term ${\mathrm{NO}}_2$ exposure or correlated air pollutant exposures could lower breast cancer risk. https://doi.org/10.1289/EHP8419

中文翻译：

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与大气污染暴露相关的乳腺癌风险：效应估计的元分析，然后是健康影响评估

摘要

背景：

关于大气污染物暴露与乳腺癌发病率之间关联的流行病学文献最近有了很大的发展。

目标：

我们的目标是a ) 对考虑这种关系的研究进行荟萃分析，纠正发表偏倚并考虑更年期状态和癌症激素反应性；和b）对污染物最有可能影响乳腺癌，在法国和相关的经济成本归属的情况下相应数量的评估。

方法：

我们对流行病学研究进行了文献综述和随机效应荟萃分析，检查细颗粒物与空气动力学直径小于或等于 $2.5\mathrm{\mu }\mathrm{米}$ (${\mathrm{下午}}_{2.5}$), 空气动力学直径小于或等于 10 μm 的颗粒物 (${\mathrm{下午}}_{10}$）， 和 ${\mathrm{不}}_2$长期暴露于乳腺癌发病率；进一步的分析是对更年期状态和肿瘤激素反应状态进行分层的。由此产生的剂量反应函数与法国 2013 年模拟的大气污染物暴露、癌症治疗成本、生产力损失和生命损失年数相结合，以估计法国因大气污染和相关经济成本而导致的乳腺癌数量。

结果：

该审查确定了 32、27 和 36 个对 ${\mathrm{下午}}_{2.5}$, ${\mathrm{下午}}_{10}$， 和 ${\mathrm{不}}_2$， 分别。经发表偏倚校正后的乳腺癌荟萃分析相对风险估计值为 1.006 [95% CI：0.941、1.076]、1.047（95% CI：0.984、1.113）和 1.023（95% CI：1.005， 1.041），分别。${\mathrm{不}}_2$ 绝经前的估计效应似乎高于绝经后妇女，激素反应阳性的效应更高。$\text{急诊室}+/\text{公关}+$) 比负 ($\text{急诊室}——/\text{公关}——$) 乳腺癌。假设因果关系${\mathrm{不}}_2$, 我们估计 1,677 (95% CI: 374, 2,914) 新乳腺癌病例可归因于 ${\mathrm{不}}_2$每年在法国，或 3.15% (95% CI: 0.70, 5.48) 的事件案例。相应的有形和无形成本估计为€$825\text{\hspace{0.17em}百万}$ （低、高：570、1,080）每年。

结论：

这些发现表明，降低长期 ${\mathrm{不}}_2$暴露或相关的空气污染物暴露可以降低患乳腺癌的风险。https://doi.org/10.1289/EHP8419