Estimating exposure to polycyclic aromatic hydrocarbons: a comparison of survey, biological monitoring, and geographic information system-based methods.

Our objective was to compare polycyclic aromatic hydrocarbon (PAH) exposure estimates based on survey, biological monitoring, and geographic information system (GIS) methods. The 304 participants in this study supplied a urine sample and completed questionnaires about exposure to potential PAH sources. We assayed urine samples for 1-hydroxypyrene-O-glucuronide (1-OHPG), the major metabolite of pyrene, a common PAH. We used a GIS to estimate traffic exhaust exposure using vehicle count data at the residence and workplace. The five subjects who reported smoking during the 48-hour period had median 1-OHPG concentrations 10-fold that of nonsmokers (1.6 versus 0.16 pmol/mL; P = 0.01). Among nonsmokers, those who reported eating grilled, roasted, or broiled meat had significantly higher 1-OHPG concentrations than those who did not reported eating meat prepared by these methods (0.25 versus 0.06 pmol/mL; P = 0.02). Nonsmokers who reported traveling on roads for > or =3 hours during the 48-hour period also had significantly higher 1-OHPG levels than those who traveled <3 hours (0.23 versus 0.11 pmol/mL; P = 0.03). 1-OHPG levels were also correlated with hours of secondhand smoke exposure among nonsmokers (P = 0.04). In this study, 1-OHPG urine concentrations were not associated with self-reported exposures to cooking smoke, wood burning, or traffic levels near the home or to traffic density or urban/rural status determined using a GIS. Self-reported indicators of residential proximity to high traffic volume were, however, associated with GIS traffic density measures.

Residential proximity to agricultural pesticide use and incidence of breast cancer in California, 1988-1997.

California is the largest agricultural state in the United States and home to some of the world's highest breast cancer rates. The objective of our study was to evaluate whether California breast cancer rates were elevated in areas with recent high agricultural pesticide use. We identified population-based invasive breast cancer cases from the California Cancer Registry for 1988-1997. We used California's pesticide use reporting data to select pesticides for analysis based on use volume, carcinogenic potential, and exposure potential. Using 1990 and 2000 U.S. Census data, we derived age- and race-specific population counts for the time period of interest. We used a geographic information system to aggregate cases, population counts, and pesticide use data for all block groups in the state. To evaluate whether breast cancer rates were related to recent agricultural pesticide use, we computed rate ratios and 95% confidence intervals using Poisson regression models, adjusting for age, race/ethnicity, and neighborhood socioeconomic status and urbanization. This ecologic (aggregative) analysis included 176,302 invasive breast cancer cases and 70,968,598 person-years of observation. The rate ratios did not significantly differ from 1 for any of the selected pesticide categories or individual agents. The results from this study provide no evidence that California women living in areas of recent, high agricultural pesticide use experience higher rates of breast cancer.

Adipose levels of dioxins and risk of breast cancer.

OBJECTIVE: Our objective was to evaluate the breast cancer risk associated with body burden levels of polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs). METHODS: We conducted a hospital-based case-control study among 79 women diagnosed with invasive breast cancer and 52 controls diagnosed with benign breast conditions. We collected breast adipose tissue and analyzed it for all 17 2,3,7,8-substitituted PCDD/PCDFs. We used unconditional logistic regression to calculate age- and race-adjusted exposure-specific odds ratios (ORs) and 95% confidence intervals (CI) for each individual PCDD/PCDF congener as well as for the summary measures (I-TEQ, Adj-TEQ). RESULTS: Dioxin levels were consistent with reports from other small, contemporary studies of body burdens in the U.S. None of the odds ratios for any of the congeners or summary measures differed significantly from one. Especially for the PCDF congeners, point estimates tended to be below one. One notable exception was octachlorodibenzo-p-dioxin (OCDD), for which the odds ratio for the second and third tertiles appeared modestly elevated (OR = 1.22, 95% CI: 0.47:3.16 and OR = 1.62, 95% CI: 0.64:4.12, respectively), though the test for trend was not significant (p = 0.36). CONCLUSION: Breast cancer risk was not associated with adipose levels of PCDD/PCDFs. More study is suggested among women of color who may have higher body burden levels of these compounds.

Regional variations in breast cancer incidence among California women, 1988-1997.

BACKGROUND: Internationally, California has some of the highest breast cancer rates; these rates also show substantial regional variations within the state. This study describes geographic breast cancer incidence patterns within California and evaluates the degree to which socioeconomic status (SES) and urbanization explain the regional variability. METHODS: Invasive breast cancer cases in women > or =20 year of age were identified from the California Cancer Registry, for 1988-1997, then assigned to one of three regions (San Francisco Bay Area, Southern Coastal Area and the rest of California), based on residence at diagnosis. Neighborhood SES and urbanization were derived from U.S. Census data. Rate ratios (RR) and 95% confidence intervals (CI) were computed using Poisson regression. Analyses were conducted for all invasive breast cancer cases (n=176,302) and by selected histologic subtypes: ductal (n=121,619); lobular (n=13,410); mixed ductal and lobular (n=9744). RESULTS: Compared to block groups with the lowest quartile of SES, rates were highest in block groups with high SES. Rates also were higher in suburban and city areas than in small town/rural areas. Compared to the rest of California, age- and race-adjusted rates for all breast cancer were approximately 20% higher in the San Francisco Bay Area and 10% higher in the Southern Coastal Area. After adjusting for SES and urbanization the rate ratios were reduced to near unity (RR=1.06, 95% CI: 1.03-1.09 for San Francisco Bay Area; RR=1.02, 95% CI: 0.99-1.04 for Southern Coastal Area). Rates ratios for ductal carcinomas mirrored those for all cases. For lobular cases, rate ratios remained elevated after adjustment for age, race/ethnicity, neighborhood SES and urbanization (RR=1.18, 95% CI: 1.11-1.27 for San Francisco Bay Area; RR=1.10, 95% CI: 1.04-1.17 for Southern Coastal Area). For the subset of cases with mixed ductal and lobular histologies, the rate ratio for the San Francisco Bay Area was no longer elevated after adjusting for age, race/ethnicity, SES and urbanization (RR=0.92, 95% CI: 0.84-1.01); the adjusted rate ratio for the Southern Coastal Area, however, remained elevated (RR=1.22, 95% CI: 1.12-1.32). CONCLUSIONS: Regional differences in neighborhood SES and urbanization appear to largely explain regional rate differences in California for all breast cancers and ductal carcinomas but do not fully explain geographic patterns of breast cancer with a lobular component.

Residential mobility in the California Teachers Study: implications for geographic differences in disease rates.

BACKGROUND: Especially for cancers with long latency periods, such as breast cancer, the issue of residential mobility hinders ecologic analyses seeking to examine the role of environmental contaminants in chronic disease etiology. This study describes and evaluates characteristics associated with residential mobility in a sub-sample of the California Teachers Study (CTS) cohort. METHODS: In 2000, lifetime residential histories were collected for a sub-sample of 328 women enrolled in the CTS; women's degree of residential mobility and associated factors were analyzed. RESULTS: While most women moved many times during their lives (average = 8.9), the average number of years at their residence when they enrolled in the study was reasonably long (15.1 years). Age strongly predicted duration at current residence but was not related to the number of lifetime residences. After adjusting for age, California-born women and women living in high socioeconomic status (SES) neighborhoods were significantly more residentially stable. Agreement between self-reported urbanization of recent residences and that based on census data of the geocoded residences was very good (80% concordant). Among women currently living in urban areas, an average of 43.3 years, or 77%, of their lifetimes were spent in urban residences; among women currently living in a rural area, an average of 37.3 years, or 67% of their lifetimes were spent in rural residences. CONCLUSIONS: This suggests that analyses of incidence rates based on current residence, while not capturing a woman's full exposure history, may reasonably reflect some aspect of longer term chronic exposures, especially those related to urbanization, at least in professional women.

Correlates of active and passive smoking in the California Teachers Study cohort.

OBJECTIVES: These analyses were designed to describe characteristics associated with active and passive smoking in a large cohort of women in order to identify possible confounders of the relationship between smoking exposures and breast cancer risk. METHODS: Analyses were based on 1995 data collected from the California Teachers Study (CTS) and were restricted to those with complete and usable tobacco data (n = 128,174). Age-adjusted and race-adjusted odds ratios (OR) were generated by unconditional logistic regression. RESULTS: Compared with never smokers, both current and former smokers experienced menarche at an earlier age. Current and former smokers also were more likely than their never smoking counterparts to be nulliparous. Among parous women, current, but not former smokers were less likely than never smokers to have had their first child at an older age. Similarly, among never smokers, those exposed to household passive smoking experienced menarche at an earlier age, were more likely to be nulliparous, and among parous women, were less likely to have had their first child at an older age than never smokers not exposed to passive smoking. Greater alcohol consumption was strongly associated with both active and passive smoking exposures. Compared with never smokers, current smokers were less likely to take antioxidant supplements, whereas former smokers were more likely to take antioxidant supplements. Among never smokers, antioxidant use did not differ depending on passive smoking exposure. A number of other dietary correlates of active and passive smoking were identified. CONCLUSIONS: We identified a number of reproductive and dietary correlates to smoking exposures that underscore the need to adjust for such factors in an analysis of smoking and breast cancer and potentially other disease entities. Furthermore, these findings may suggest potential mechanisms underlying an association between breast cancer and smoking.

Residential proximity to agricultural pesticide use and incidence of breast cancer in the California Teachers Study cohort.

We examined the association between residential proximity to agricultural pesticide use and breast cancer incidence among members of the California Teachers Study cohort, a large study of professional school employees with extensive information on breast cancer risk factors, followed for cancer incidence since 1995. We identified 1552 invasive breast cancer cases, diagnosed between 1996 and 1999, among 114,835 cohort members. We used California Pesticide Use Reporting data to select pesticides for analysis based on use volume, carcinogenic potential, and exposure potential; a Geographic Information System was used to estimate pesticide applications within a half-mile radius of subjects' residences. We applied Cox proportional hazard models to estimate hazard rate ratios (HR) for selected pesticides, adjusting for age, race, and socioeconomic status. We saw no association between residential proximity to recent agricultural pesticide use and invasive breast cancer incidence. HR estimates for the highest compared to the lowest exposure categories for groups of agents were as follows: probable or likely carcinogens (1.07, 95% confidence interval (CI): 0.86-1.32), possible or suggestive carcinogens (1.06, 95% CI: 0.87-1.29), mammary carcinogens (1.15, 95% CI: 0.90-1.48), and endocrine disruptors (1.03, 95% CI: 0.86-1.25). HR estimates for other groups and individual pesticides did not differ from unity, nor was there a trend for any groupings of or individual pesticides examined. Stratifying by menopausal status or family history of breast cancer did not substantially affect our results. Our analyses suggest that breast cancer incidence is not elevated in areas of recent, high agricultural pesticide use in California.

Post office box addresses: a challenge for geographic information system-based studies.

BACKGROUND: Geographic information system (GIS)-based health studies require information on the physical location of data points, such as subject addresses. In a study of California women diagnosed with breast cancer between 1988 and 1997, we needed to locate the residential addresses of 4,537 women with post office boxes (POBs). METHODS: We investigated the feasibility of tracing street addresses for the POBs and examined potential selection biases and case attribute misclassifications introduced by different methods of handling POBs in GIS-based health studies. RESULTS: Our tracing method yielded street addresses for only 34% of POBs in our study. Examination of subjects' case characteristics revealed that boxholders were not representative of the full population. Geocoding using a POB's delivery-weighted five-digit zip code centroid, as a proxy for street address, resulted in case attribute misclassification for 81% of boxholders. CONCLUSIONS: Disease registries should modernize their infrastructure to complement GIS technologies. Epidemiologists should understand GIS data limitations and consider potential biases introduced by incomplete or inaccurate geocoding.