Diddier Prada1,2, Andrea A Baccarelli3, Mary Beth Terry4,5, Leonora Valdéz6, Paula Cabrera7, Allan Just8, Itai Kloog9, Haydee Caro10, Claudia García-Cuellar6, Yesennia Sánchez-Pérez6, Rodrigo Cruz6, Jose Diaz-Chávez6, Carlo Cortés6, Delia Pérez6, Abelardo Meneses-García6, David Cantú-de-León6, Luis A Herrera6,11, Enrique Bargalló7. 1. Instituto Nacional de Cancerología, San Fernando 22, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico. dpradao@incan.edu.mx. 2. Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA. dpradao@incan.edu.mx. 3. Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA. 4. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA. 5. Herbert Irving Comprehensive Cancer Center, Columbia University, 1130 St Nicholas Ave, New York, NY, 10032, USA. 6. Instituto Nacional de Cancerología, San Fernando 22, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico. 7. Unit for Breast Cancer Oncology, Instituto Nacional de Cancerología, San Fernando 22, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico. 8. Department of Environmental Medicine and Public Health, Mont Sinai Health System, 1 Gustave L. Levy Place, New York, NY, 10029-6574, USA. 9. Department of Geography and Environmental Development, Ben-Gurion University of the Negev, POB 663, Beer-Sheva, Israel. 10. Unit of Pathological Oncology, Instituto Nacional de Cancerología, San Fernando 22, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico. 11. Instituto Nacional de Medicina Genómica-INMEGEN, Periferico Sur 4809, Arenal Tepepan, Tlalpan, 14610, Mexico, Mexico.
Abstract
PURPOSE: Increasingly epidemiological evidence supports that environmental factors are associated with breast cancer (BC) outcomes after a BC diagnosis. Although evidence suggests that air pollution exposure is associated with higher mortality in women with BC, studies investigating potential mechanisms have been lacking. METHODS: We evaluated women with BC (N = 151) attended at the National Cancer Institute-Mexico from 2012 to 2015. We calculated 1-year average exposures to particulate matter < 2.5 μm (PM2.5) at home address before diagnosis. We used linear and logistic regression models to determine the associations between PM2.5 exposure and BC aggressiveness (tumor size, molecular phenotype). RESULTS: Average annual PM2.5 exposure of this population was 23.0 μg/m3 [standard deviation (SD)]: 1.90 μg/m3]. PM2.5 levels were positively correlated with tumor size at diagnosis (r = 0.22; p = 0.007). Multivariable linear models had a similar inference [risk ratio (RR): 1.32; 95% confidence interval (95% CI): 1.04, 1.674]. We did not observe differences in this association by age or menopause status. Further, women with triple-negative BC (TNBC) had significantly higher PM2.5 levels compared with other phenotypes (p = 0.015). Multivariable-adjusted logistic regression models assessing the association between PM2.5 and tumor size had a similar inference (RR 1.41; 95% CI 1.05, 1.89) overall for all ages and also for women who were ≤ 50 years old at diagnosis (RR 1.63; 95% CI 1.036, 2.57). CONCLUSIONS: Our findings suggest a significant association between long-term PM2.5 exposure and BC aggressiveness based on tumor size and phenotype, as well as a worse outcome.
PURPOSE: Increasingly epidemiological evidence supports that environmental factors are associated with breast cancer (BC) outcomes after a BC diagnosis. Although evidence suggests that air pollution exposure is associated with higher mortality in women with BC, studies investigating potential mechanisms have been lacking. METHODS: We evaluated women with BC (N = 151) attended at the National Cancer Institute-Mexico from 2012 to 2015. We calculated 1-year average exposures to particulate matter < 2.5 μm (PM2.5) at home address before diagnosis. We used linear and logistic regression models to determine the associations between PM2.5 exposure and BC aggressiveness (tumor size, molecular phenotype). RESULTS: Average annual PM2.5 exposure of this population was 23.0 μg/m3 [standard deviation (SD)]: 1.90 μg/m3]. PM2.5 levels were positively correlated with tumor size at diagnosis (r = 0.22; p = 0.007). Multivariable linear models had a similar inference [risk ratio (RR): 1.32; 95% confidence interval (95% CI): 1.04, 1.674]. We did not observe differences in this association by age or menopause status. Further, women with triple-negative BC (TNBC) had significantly higher PM2.5 levels compared with other phenotypes (p = 0.015). Multivariable-adjusted logistic regression models assessing the association between PM2.5 and tumor size had a similar inference (RR 1.41; 95% CI 1.05, 1.89) overall for all ages and also for women who were ≤ 50 years old at diagnosis (RR 1.63; 95% CI 1.036, 2.57). CONCLUSIONS: Our findings suggest a significant association between long-term PM2.5 exposure and BC aggressiveness based on tumor size and phenotype, as well as a worse outcome.
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