Polychlorinated biphenyls and their association with survival following breast cancer.

ABSTRACT

BACKGROUND: Polychlorinated biphenyls (PCBs) are hypothesised to influence breast carcinogenesis due to their persistence and potential to induce oestrogenic and anti-oestrogenic effects. Whether PCBs influence survival following breast cancer is unknown. METHODS: A population-based cohort of women diagnosed with first primary invasive or in situ breast cancer in 1996-1997 and with blood-measured PCBs (n=627) collected shortly after diagnosis was followed for vital status through 2011. After 5 and 15 years, we identified 54 and 187 deaths, respectively, of which 36 and 74 were breast cancer related. Using Cox regression, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality for baseline PCB concentrations, individually and as oestrogenic (ΣGroup 1B PCB101, PCB174, PCB177, PCB187, and PCB199), anti-oestrogenic (ΣGroup 2A PCB66, PCB74, PCB105, and PCB118; ΣGroup 2B PCB138 and PCB170), and cytochrome P450 enzyme-inducing (ΣGroup 3 PCB99, PCB153, PCB180, PCB183, and PCB203) groups. RESULTS: The highest PCB174 tertile was associated with an increase in all-cause (HR=2.22, 95% CI 1.14-4.30) and breast cancer-specific (HR=3.15, 95% CI 1.23-8.09) mortalities within 5 years of diagnosis and remained associated with breast cancer-specific mortality (HR=1.88, 95% CI 1.05-3.36) at 15 years. At 5 years, the highest tertile of PCB177 was positively associated with all-cause mortality (HR=2.12, 95% CI 1.05-4.30). At 15 years, the highest tertiles of ΣGroup 2A congeners and PCB118 were inversely associated with all-cause mortality (HR=0.60, 95% CI 0.39-0.83; HR=0.63, 95% CI 0.43-0.92, respectively). CONCLUSIONS: In this first US study of PCBs and breast cancer survival, PCBs were associated with mortality in biologically plausible directions. The investigation of other, structurally similar, chemicals may be warranted.