The darkness at the end of the tunnel: summary and evaluation of an international symposium on light, endocrine systems and cancer.

Research on light at night and cancer is evolving at an accelerating pace, fueled largely by exciting results in rodent toxicology and basic human biology. Epidemiologic research is at a relatively early stage of development in which the exposure surrogates such as shift work and blindness predominate. Causal graphs for shift work, light at night and breast cancer illustrate some of the subtleties that can arise in the use of exposure surrogates of different kinds. Baseline data on circadian rhythms and melatonin cycles among human populations living at different latitudes are needed. Epidemiologic study of this topic is expected to mature soon as studies begin to incorporate quantitative and semiquantitative measurements and personal histories of exposure to light at night. The current emphasis on breast cancer should widen to include other cancers and intermediate outcomes. An advance in epidemiologic studies of blind persons would be to compare cancer rates between the "cortically blind" and the "retinally blind" within levels of visual impairment. Without a proposed intervention to reduce exposure to light at night, attributable fraction and attributable caseload estimates are meaningless. In the near future, both epidemiologic and laboratory research in this area are expected to grow appreciably in scope and scale.