Perfluoroalkyl substances (PFASs) as risk factors for breast cancer: a case–control study in Chinese population

Abstract

Background Perfluoroalkyl substances (PFASs) are a large family of synthetic chemicals, some of which are mammary toxicants and endocrine disruptors. Recent studies have implicated exposure to PFASs as a risk factor for breast cancer in Europe and America. Little is known about the role of PFASs with respect to breast cancer in the Chinese population. Methods Participants who were initially diagnosed with breast cancer at Tianjin Medical University Cancer Institute and Hospital between 2012 and 2016 were recruited as cases. The controls were randomly selected from the participants with available blood samples in the Chinese National Breast Cancer Screening Program (CNBCSP) cohort. Ultimately, we enrolled 373 breast cancer patients and 657 controls. Plasma PFASs were measured by an ultra-performance liquid chromatography (UPLC) system coupled to a 5500 Q-Trap triple quadrupole mass spectrometer. A logistic regression model with least absolute shrinkage and selection operator (LASSO) regularization was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to assess the relationships between PFASs and breast cancer. The three most predictive variables in the LASSO model were selected from 17 PFASs, which was based on the optimal penalty coefficient (λ = 0.0218) identified with the minimum criterion. Additionally, Bayesian kernel machine regression (BKMR) and quantile g-computation models were applied to evaluate the associations between separate and mixed exposure to PFASs and breast cancer. Results Perfluorooctanesulfonic acid (PFOS) exhibited the highest concentration in both the cases and controls. Perfluorooctanoic acid (PFOA) and perfluoro-n-decanoic acid (PFDA) were positively associated with breast cancer, and perfluoro-n-tridecanoic acid (PFTrDA) was negatively associated with breast cancer according to both the continuous-PFASs and the quartile-PFASs logistic regression models. Of note, PFOA was associated with the occurrence of estrogen receptor (ER)-, progesterone receptor (PR)-, and human epidermal growth factor receptor 2 (HER2)-positive breast cancer (ORER+ = 1.47, 95% CI: 1.19, 1.80; ORPR+ = 1.36, 95% CI: 1.09, 1.69; ORHER2 = 1.62, 95% CI: 1.19, 2.21). Conclusions Overall, we observed that PFASs were associated with breast cancer in Chinese women. Prospective cohort studies and mechanistic experiments are warranted to elucidate whether these associations are causal.

Case–Cohort Study of the Association between PFAS and Selected Cancers among Participants in the American Cancer Society’s Cancer Prevention Study II LifeLink Cohort

“… 30 To have sufficient power for detection of effects that are potentially small in magnitude at lower exposure levels, such general-population studies need to include a large number of cases. To date, studies of PFAS and cancer in the general population have been primarily case-control studies (nested 37 , 47 , 55 , 57 – 60 or nonnested 40 , 44 , 45 , 49 , 51 , 56 , 61 – 63 ) focusing on single cancer sites (most commonly breast cancer, 44 , 45 , 47 , 49 , 51 , 57 – 59 , 61 , 63 but also prostate, 40 , 60 kidney, 37 liver, 55 , 56 and thyroid 62 cancer). One general-population cross-sectional study considered breast, uterine, ovarian, and prostate cancer.…”

Involvement of per- and polyfluoroalkyl compounds in tumor development

“…This study provides evidence that high and low PFAS exposures may affect differently the hormone-dependent tissues (Mancini et al 2020 ). In addition, a relationship between serum PFAS-levels and the risk of breast cancer has been reported among women from Asian countries (Table 2 ; Tsai et al 2020 ; Feng et al 2022 ; Li et al 2022a , b ; Velarde et al 2022 ).…”

Racial disparities in cancer care, an eyeopener for developing better global cancer management strategies

“…Based on socioeconomic background, race, level of education, and unemployment, prostate cancer survival vary dramatically. The adverse relationship between social assistance and the advanced stage of prostate cancer detection may be explained by several causes 42–45 . Men may be persuaded to get screened for prostate malignancy by their partner, other family members, or friends in their network.…”

“…The adverse relationship between social assistance and the advanced stage of prostate cancer detection may be explained by several causes. 42 , 43 , 44 , 45 Men may be persuaded to get screened for prostate malignancy by their partner, other family members, or friends in their network. Married men are better at prostate cancer management due to early screening and better therapy than unmarried men.…”