Humberto Parada1, Xuezheng Sun2, Chiu-Kit Tse3, Lawrence S Engel4, Andrew F Olshan5, Melissa A Troester6. 1. Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA; UCSD Moores Cancer Center, La Jolla, CA, USA. Electronic address: hparada@sdsu.edu. 2. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: amysun@email.unc.edu. 3. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: jessica_tse@unc.edu. 4. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA. Electronic address: larry.engel@unc.edu. 5. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA. Electronic address: andy_olshan@unc.edu. 6. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA. Electronic address: troester@unc.edu.
Abstract
OBJECTIVES: To examine plasma levels of dichlorodiphenyldichloroethene (DDE) and dichlorodiphenyltrichloroethane (DDT) in association with survival among women with breast cancer who participated in a population-based case-control study. METHODS: Participants included 456 white and 292 black women from the Carolina Breast Cancer Study Phase I who were diagnosed with primary invasive breast cancer from 1993 to 1996, and who had available DDE/DDT and lipid measurements from blood samples obtained on average 4.1 months after diagnosis. Using the National Death Index, we identified 392 deaths (210 from breast cancer) over a median follow-up of 20.6 years. We used Cox regression to estimate covariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and breast cancer-specific 5-year mortality, and 20-year mortality conditional on 5-year survival, for lipid-standardized DDE and DDT levels. Associations stratified by race and estrogen receptor (ER) status were also examined. RESULTS: The highest versus lowest DDE tertile and the highest vs non-detectable DDT quantile were associated with HRs of 1.95 (95% CI = 1.31-2.92) and 1.64 (95% CI = 1.10-2.44), respectively, for 20-year conditional all-cause mortality. DDE levels above versus below the median were associated with a HR of 1.69 (95% CI = 1.06-2.68) for 20-year conditional breast cancer-specific mortality among women overall, and HRs were 2.36 (95% CI = 1.03-5.42) among black women and 1.57 (95% CI = 0.86-2.89) among white women (PInteraction = 0.42), and 3.24 (95% CI = 1.38-7.58) among women with ER- tumors and 1.29 (95% CI = 0.73-2.28) among women with ER+ tumors (PInteraction = 0.03). CONCLUSION: Exposure to DDE/DDT may adversely impact overall and breast cancer-specific survival. DDE exposure may contribute to the racial disparities in breast cancer survival.
OBJECTIVES: To examine plasma levels of dichlorodiphenyldichloroethene (DDE) and dichlorodiphenyltrichloroethane (DDT) in association with survival among women with breast cancer who participated in a population-based case-control study. METHODS:Participants included 456 white and 292 black women from the Carolina Breast Cancer Study Phase I who were diagnosed with primary invasive breast cancer from 1993 to 1996, and who had available DDE/DDT and lipid measurements from blood samples obtained on average 4.1 months after diagnosis. Using the National Death Index, we identified 392 deaths (210 from breast cancer) over a median follow-up of 20.6 years. We used Cox regression to estimate covariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and breast cancer-specific 5-year mortality, and 20-year mortality conditional on 5-year survival, for lipid-standardized DDE and DDT levels. Associations stratified by race and estrogen receptor (ER) status were also examined. RESULTS: The highest versus lowest DDE tertile and the highest vs non-detectable DDT quantile were associated with HRs of 1.95 (95% CI = 1.31-2.92) and 1.64 (95% CI = 1.10-2.44), respectively, for 20-year conditional all-cause mortality. DDE levels above versus below the median were associated with a HR of 1.69 (95% CI = 1.06-2.68) for 20-year conditional breast cancer-specific mortality among women overall, and HRs were 2.36 (95% CI = 1.03-5.42) among black women and 1.57 (95% CI = 0.86-2.89) among white women (PInteraction = 0.42), and 3.24 (95% CI = 1.38-7.58) among women with ER- tumors and 1.29 (95% CI = 0.73-2.28) among women with ER+ tumors (PInteraction = 0.03). CONCLUSION: Exposure to DDE/DDT may adversely impact overall and breast cancer-specific survival. DDE exposure may contribute to the racial disparities in breast cancer survival.
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