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Night Work and Breast Cancer Risk in Nurses: Multifactorial Risk Analysis

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The incidence of breast cancer worldwide has increased in recent decades in women, and shift work, which implies night work, has been identified as a likely carcinogenic factor for humans due to the biological and lifestyle alterations it entails. Nurses, mainly represented by the female collective, undertake working conditions with intensive rotative and night shifts. Therefore, it is appropriate to describe the association between breast cancer and rotating night shifts in nurses, analysing the effect of consecutive night shifts, sleep disruption, work-family stress and medication intake, among others. This article demonstrates that preventive measures must be considered from healthcare managers to reduce occupational breast cancer hazards. In this way, it is important to consider the constant exposition of nurses to a stressing environment while stopping their biological clock to maintain the continuity of care “24/7”.

Abstract

Night work has been highlighted by the International Agency for Research on Cancer (IARC) as a likely carcinogenic factor for humans, associated with breast cancer and professions that require continuity of work. Knowing the impact that short and long-term night work has on the nurses’ collective seems a priority, therefore, this study aims to analyse the relationship between night work and the development of breast cancer risk factors in nurses. For this, a cross-sectional study through an online questionnaire on breast cancer risk variables and working life was designed. The study was conducted in Spain and the sample consisted of 966 nurses, of whom 502 were healthy participants and 56 were breast cancer patients. These two groups were compared in the analyses. A descriptive analysis was performed, and the relationship was tested using χ2 independence test and OR calculation. The CHAID (Chi Square Automatic Interaction Detection) data mining method allowed for the creation of a segmentation tree for the main risk variables. The most significant risk variables related to working life have been the number of years worked, nights worked throughout life, and years working more than 3 nights per month. Exceeding 16 years of work has been significant for women and men. When the time worked is less than 16 years, the number of cases increases if there is a family history of cancer and if there have been more than 500 nights of work. High-intensity night work seems more harmful at an early age. The accumulation of years and nights worked increase the risk of breast cancer when factors such as sleep disturbance, physical stress, or family responsibilities come together.

SUBMITTER: Gomez-Salgado J

PROVIDER: S-EPMC8004617 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:INTRODUCTION: Some studies have suggested that night work may be associated with an increased risk of breast cancer in nurses. We aimed to explore the role of circadian gene polymorphisms in the susceptibility to night work-related breast cancer risk. METHODS: We conducted a nested case-control study of Norwegian nurses comprising 563 breast cancer cases and 619 controls within a cohort of 49,402 Norwegian nurses ages 35 to 74 years. We studied 60 single-nucleotide polymorphisms (SNPs) in 17 genes involved in the regulation of the circadian rhythm in cases and controls. The data were analyzed in relation to the two exposure variables "maximum number of consecutive night shifts ever worked" and "maximum number of consecutive night shifts worked for at least 5 years." The odds of breast cancer associated with each SNP was calculated in the main effects analysis and in relation to night shift work. The statistically significant odds ratios were tested for noteworthiness using two Bayesian tests: false positive report probability (FPRP) and Bayesian false discovery probability (BFDP). RESULTS: In the main effects analysis, CC carriers of rs4238989 and GG carriers of rs3760138 in the AANAT gene had increased risk of breast cancer, whereas TT carriers of BMAL1 rs2278749 and TT carriers of CLOCK rs3749474 had reduced risk. The associations were found to be noteworthy using both the FPRP and BFDP tests. With regard to the effect of polymorphisms and night work, several significant associations were observed. After applying FPRP and BFDP in women with at least four night shifts, an increased risk of breast cancer was associated with variant alleles of SNPs in the genes AANAT (rs3760138, rs4238989), BMAL1 (rs2290035, rs2278749, rs969485) and ROR-b (rs3750420). In women with three consecutive night shifts, a reduced risk of breast cancer was associated with carriage of variant alleles of SNPs in CLOCK (rs3749474), BMAL1 (rs2278749), BMAL2 (rs2306074), CSNK1E (rs5757037), NPAS2 (rs17024926), ROR-b (rs3903529, rs3750420), MTNR1A (rs131113549) and PER3 (rs1012477). CONCLUSIONS: Significant and noteworthy associations between several polymorphisms in circadian genes, night work and breast cancer risk were found among nurses who had worked at least three consecutive night shifts.

Project description:Background: Nightshift work introduces light at night and causes circadian rhythm among night workers, who are considered to be at increased risk of cancer. However, in the last 2 years, nine population-based studies reported insignificant associations between night-shift work and cancer risks. We aimed to conduct an updated systematic review and meta-analysis to ascertain the effect of night-shift work on the incidence of cancers. Methods: Our protocol was registered in PROSPERO and complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Embase, PubMed, and Web of Science databases were used to comprehensively search studies published up to May 31, 2019. The random-effect model (Der Simonian-Laird method) was carried out to combine the risk estimates of night-shift work for cancers. The dose-response meta-analysis was performed to verify whether the association was in a dose-dependent manner. Results: Our literature searching retrieved 1,660 publications. Included in the meta-analyses were 57 eligible studies with 8,477,849 participants (mean age 55 years; 2,560,886 men, 4,220,154 women, and 1,696,809 not mentioned). The pooled results showed that night-shift work was not associated with the risk of breast cancer (OR = 1.009, 95% CI = 0.984-1.033), prostate cancer (OR = 1.027, 95% CI = 0.982-1.071), ovarian cancer (OR = 1.027, 95% CI = 0.942-1.113), pancreatic cancer (OR = 1.007, 95% CI = 0.910-1.104), colorectal cancer (OR = 1.016, 95% CI = 0.964-1.068), non-Hodgkin's lymph (OR = 1.046, 95% CI = 0.994-1.098), and stomach cancer (OR = 1.064, 95% CI = 0.971-1.157), while night-shift work was associated with a reduction of lung cancer (OR = 0.949, 95% CI = 0.903-0.996), and skin cancer (OR = 0.916, 95% CI = 0.879-0.953). The dose-response meta-analysis found that cancer risk was not significantly elevated with the increased light exposure of night- shift work. Conclusion: This systematic review of 57 observational studies did not find an overall association between ever-exposure to night-shift work and the risk of breast, prostate ovarian, pancreatic, colorectal, non-Hodgkin's lymph, and stomach cancers.

Project description:It has been proposed that night shift work could increase breast cancer incidence. A 2007 World Health Organization review concluded, mainly from animal evidence, that shift work involving circadian disruption is probably carcinogenic to humans. We therefore aimed to generate prospective epidemiological evidence on night shift work and breast cancer incidence.Overall, 522 246 Million Women Study, 22 559 EPIC-Oxford, and 251 045 UK Biobank participants answered questions on shift work and were followed for incident cancer. Cox regression yielded multivariable-adjusted breast cancer incidence rate ratios (RRs) and 95% confidence intervals (CIs) for night shift work vs no night shift work, and likelihood ratio tests for interaction were used to assess heterogeneity. Our meta-analyses combined these and relative risks from the seven previously published prospective studies (1.4 million women in total), using inverse-variance weighted averages of the study-specific log RRs.In the Million Women Study, EPIC-Oxford, and UK Biobank, respectively, 673, 28, and 67 women who reported night shift work developed breast cancer, and the RRs for any vs no night shift work were 1.00 (95% CI?=?0.92 to 1.08), 1.07 (95% CI?=?0.71 to 1.62), and 0.78 (95% CI?=?0.61 to 1.00). In the Million Women Study, the RR for 20 or more years of night shift work was 1.00 (95% CI?=?0.81 to 1.23), with no statistically significant heterogeneity by sleep patterns or breast cancer risk factors. Our meta-analysis of all 10 prospective studies included 4660 breast cancers in women reporting night shift work; compared with other women, the combined relative risks were 0.99 (95% CI?=?0.95 to 1.03) for any night shift work, 1.01 (95% CI?=?0.93 to 1.10) for 20 or more years of night shift work, and 1.00 (95% CI?=?0.87 to 1.14) for 30 or more years.The totality of the prospective evidence shows that night shift work, including long-term shift work, has little or no effect on breast cancer incidence.

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Night Work and Breast Cancer Risk in Nurses: Multifactorial Risk Analysis

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