Publications by authors named "Peggy Reynolds"

148 Publications

Integrating electronic health record, cancer registry, and geospatial data to study lung cancer in Asian American, Native Hawaiian and Pacific Islander ethnic groups.

Cancer Epidemiol Biomarkers Prev 2021 May 17. Epub 2021 May 17.

Epidemiology & Biostatistics, University of California, San Francisco.

Background: A relatively high proportion of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) females with lung cancer have never smoked. We used an integrative data approach to assemble a large-scale cohort to study lung cancer risk among AANHPI by smoking status with attention to representation of specific AANHPI ethnic groups.

Methods: We leveraged electronic health records (EHRs) from two healthcare systems-Sutter Health in northern California and Kaiser Permanente Hawai'i- that have high representation of AANHPI populations. We linked EHR data on lung cancer risk factors (i.e., smoking, lung diseases, infections, reproductive factors, and body size) to data on incident lung cancer diagnoses from statewide population-based cancer registries of California and Hawai'i for the period 2000-2013. Geocoded address data were linked to data on neighborhood contextual factors and regional air pollutants.

Results: The dataset comprises over 2.2 million adult females and males of any race/ethnicity. Over 250,000 are AANHPI females (19.6% of the female study population). Smoking status is available for over 95% of individuals. The dataset includes 7,274 lung cancer cases, including 613 cases among AANHPI females. Prevalence of never-smoking status varied greatly among AANHPI females with incident lung cancer, from 85.7% among Asian Indian to 14.4% among Native Hawaiian females.

Conclusion: We have developed a large, multilevel dataset particularly well-suited to conduct prospective studies of lung cancer risk among AANHPI females who never smoked.

Impact: The integrative data approach is an effective way to conduct cancer research assessing multilevel factors on cancer outcomes among small populations.
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http://dx.doi.org/10.1158/1055-9965.EPI-21-0019DOI Listing
May 2021

Dairy foods, calcium, and risk of breast cancer overall and for subtypes defined by estrogen receptor status: a pooled analysis of 21 cohort studies.

Am J Clin Nutr 2021 May 8. Epub 2021 May 8.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA.

Background: Epidemiologic studies examining the relations between dairy product and calcium intakes and breast cancer have been inconclusive, especially for tumor subtypes.

Objective: To evaluate the associations between intakes of specific dairy products and calcium and risk of breast cancer overall and for subtypes defined by estrogen receptor (ER) status.

Method: We pooled the individual-level data of over 1 million women who were followed for a maximum of 8-20 years across studies. Associations were evaluated for dairy product and calcium intakes and risk of incident invasive breast cancer overall (n = 37,861 cases) and by subtypes defined by ER status. Study-specific multivariable hazard ratios (HRs) were estimated and then combined using random-effects models.

Results: Overall, no clear association was observed between the consumption of specific dairy foods, dietary (from foods only) calcium, and total (from foods and supplements) calcium, and risk of overall breast cancer. Although each dairy product showed a null or very weak inverse association with risk of overall breast cancer (P, test for trend >0.05 for all), differences by ER status were suggested for yogurt and cottage/ricotta cheese with associations observed for ER-negative tumors only (pooled HR = 0.90, 95% CI: 0.83, 0.98 comparing ≥60 g/d with <1 g/d of yogurt and 0.85, 95% CI: 0.76, 0.95 comparing ≥25 g/d with <1 g/d of cottage/ricotta cheese). Dietary calcium intake was only weakly associated with breast cancer risk (pooled HR = 0.98, 95% CI: 0.97, 0.99 per 350 mg/d).

Conclusion: Our study shows that adult dairy or calcium consumption is unlikely to associate with a higher risk of breast cancer and that higher yogurt and cottage/ricotta cheese intakes were inversely associated with the risk of ER-negative breast cancer, a less hormonally dependent subtype with poor prognosis. Future studies on fermented dairy products, earlier life exposures, ER-negative breast cancer, and different racial/ethnic populations may further elucidate the relation.
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http://dx.doi.org/10.1093/ajcn/nqab097DOI Listing
May 2021

Chronotype and risk of post-menopausal endometrial cancer in the California Teachers Study.

Chronobiol Int 2021 Apr 27:1-11. Epub 2021 Apr 27.

Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.

Working at night causes circadian disruption and it has been classified as a probable carcinogen. An evening chronotype, or preference for late day activity, has been shown to increase risk for several adverse health effects, such as metabolic disorders and recently, breast cancer. To further explore this emerging area of interest, we examined the association between endometrial cancer (EC) risk, another common cancer in women, and chronotype. The women in this study were members of the California Teachers Study cohort, which was established in 1995. Chronotype was reported on a subsequent questionnaire (Q5), administered in 2012-2013. The women included in this analysis were under age 90 years, were post-menopausal at Q5, and had no hysterectomy. The cancer cases, identified through linkages to the California Cancer Registry, were diagnosed between 1996 and 2014. We used unconditional logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the associations between chronotype and EC diagnosis. There were 437 EC cases and 26,753 cancer-free controls included in this analysis. Controls were more likely to classify themselves as current morning chronotypes than were cases (39% and 34%, respectively). Compared to morning types, women who were definite evening types had a statistically significantly elevated OR of 1.44 (95% CI 1.09-1.91). This association was more pronounced among obese women as compared to non-obese women. For evening type compared to morning type, the OR among obese women was 2.01 (95% CI 1.23, 3.29) while the OR for non-obese women was 1.12 (95% CI 0.77, 1.63). To our knowledge, the association between EC risk and evening chronotype has not been previously reported, but is consistent with the small body of literature which suggests increased breast cancer risks among evening chronotypes. Because this study was based on a retrospective analysis in a cohort of mostly white female teachers in California, further analysis of chronotype as a potential EC risk factor should be considered in other cohorts and in prospective analyses in order to further explore this relationship.
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http://dx.doi.org/10.1080/07420528.2021.1912073DOI Listing
April 2021

Pregnancy outcomes and risk of endometrial cancer: A pooled analysis of individual participant data in the Epidemiology of Endometrial Cancer Consortium.

Int J Cancer 2021 May 17;148(9):2068-2078. Epub 2020 Nov 17.

Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy.

A full-term pregnancy is associated with reduced endometrial cancer risk; however, whether the effect of additional pregnancies is independent of age at last pregnancy is unknown. The associations between other pregnancy-related factors and endometrial cancer risk are less clear. We pooled individual participant data from 11 cohort and 19 case-control studies participating in the Epidemiology of Endometrial Cancer Consortium (E2C2) including 16 986 women with endometrial cancer and 39 538 control women. We used one- and two-stage meta-analytic approaches to estimate pooled odds ratios (ORs) for the association between exposures and endometrial cancer risk. Ever having a full-term pregnancy was associated with a 41% reduction in risk of endometrial cancer compared to never having a full-term pregnancy (OR = 0.59, 95% confidence interval [CI] 0.56-0.63). The risk reduction appeared the greatest for the first full-term pregnancy (OR = 0.78, 95% CI 0.72-0.84), with a further ~15% reduction per pregnancy up to eight pregnancies (OR = 0.20, 95% CI 0.14-0.28) that was independent of age at last full-term pregnancy. Incomplete pregnancy was also associated with decreased endometrial cancer risk (7%-9% reduction per pregnancy). Twin births appeared to have the same effect as singleton pregnancies. Our pooled analysis shows that, while the magnitude of the risk reduction is greater for a full-term pregnancy than an incomplete pregnancy, each additional pregnancy is associated with further reduction in endometrial cancer risk, independent of age at last full-term pregnancy. These results suggest that the very high progesterone level in the last trimester of pregnancy is not the sole explanation for the protective effect of pregnancy.
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http://dx.doi.org/10.1002/ijc.33360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969437PMC
May 2021

Urinary cadmium and timing of menarche and pubertal development in girls.

Environ Res 2020 04 4;183:109224. Epub 2020 Feb 4.

Cancer Prevention Institute of California, Fremont, CA, USA; School of Community Health Sciences, University of Nevada, Reno, NV, USA.

Background: Cadmium (Cd) is a developmental toxicant that is released into the environment during industrial processes. Previous animal studies suggest that Cd may impact the onset of puberty.

Objectives: To determine whether Cd exposure, measured as urinary Cd concentration, was associated with ages at menarche and pubertal development.

Methods: A cohort of 211 girls, ages 10-13 years at baseline, was followed for up to two years. Girls completed an interview and self-assessment of Tanner stages of breast development and pubic hair growth. They were followed monthly until menarche. Urinary Cd concentrations were measured in overnight urine specimens. Multivariable Cox regression was used to evaluate the association between urinary Cd and age at menarche and cumulative logit regression was used to evaluate the associations between urinary Cd and breast development and pubic hair growth.

Results: The baseline geometric mean creatinine-adjusted Cd concentration was 0.22 μg/g creatinine (geometric standard deviation = 1.6) and decreased with increasing age (p-trend = 0.04). Cd levels were higher among Asian than White girls or girls of other/mixed race/ethnicity (p = 0.04). In multivariable analyses, girls with urinary Cd ≥ 0.4 μg/L were less likely to have attained menarche than girls with urinary Cd < 0.2 μg/L (hazard ratio = 0.42; 95% confidence interval, 0.23-0.78). Urinary Cd was negatively associated with pubic hair growth (p-trend = 0.01) but not with breast development (p-trend = 0.72) at baseline.

Conclusions: These findings suggest that a higher Cd body burden may delay some aspects of pubertal development among girls.
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http://dx.doi.org/10.1016/j.envres.2020.109224DOI Listing
April 2020

Serum Levels of Commonly Detected Persistent Organic Pollutants and Per- and Polyfluoroalkyl Substances (PFASs) and Mammographic Density in Postmenopausal Women.

Int J Environ Res Public Health 2020 01 17;17(2). Epub 2020 Jan 17.

Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94704, USA.

There are little epidemiological data on the impact of persistent organic pollutants (POPs) and endocrine disruptors on mammographic density (MD), a strong predictor of breast cancer. We assessed MD in 116 non-Hispanic white post-menopausal women for whom serum concentrations of 23 commonly detected chemicals including 3 polybrominated diphenyl ethers (PBDEs), 8 per- and polyfluoroalkyl substances (PFASs), and 12 polychlorinated biphenyls (PCBs) had been measured. Linear regression analyses adjusting for potential confounders were used to examine the associations between the levels of the chemical compounds, modeled as continuous and dichotomized (above/below median) variables, and square-root-transformed MD. None of the associations were statistically significant after correcting for multiple testing. Prior to correction for multiple testing, all chemicals with un-corrected values < 0.05 had regression coefficients less than zero, suggesting inverse associations between increased levels and MD, if any. The smallest value was observed for PCB-153 (regression coefficient for above-median vs. below-median levels: -0.87, un-corrected 0.008). Neither parity nor body mass index modified the associations. Our results do not support an association between higher MD and serum levels of PBDEs, PCBs, or PFASs commonly detected in postmenopausal women.
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http://dx.doi.org/10.3390/ijerph17020606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013395PMC
January 2020

Immigration history, lifestyle characteristics, and breast density in the Vietnamese American Women's Health Study: a cross-sectional analysis.

Cancer Causes Control 2020 Feb 8;31(2):127-138. Epub 2020 Jan 8.

Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.

Purpose: Breast density is an important risk factor for breast cancer and varies substantially across racial-ethnic groups. However, determinants of breast density in Vietnamese immigrants in the United States (US) have not been studied. We investigated whether reproductive factors, immigration history, and other demographic and lifestyle factors were associated with breast density in Vietnamese Americans.

Methods: We collected information on demographics, immigration history, and other lifestyle factors and mammogram reports from a convenience sample of 380 Vietnamese American women in California aged 40 to 70 years. Breast Imaging Reporting and Data System (BI-RADS) breast density was abstracted from mammogram reports. Multivariable logistic regression was used to investigate the association between lifestyle factors and having dense breasts (BI-RADS 3 or 4).

Results: All participants were born in Viet Nam and 82% had lived in the US for 10 years or longer. Younger age, lower body mass index, nulliparity/lower number of deliveries, and longer US residence (or younger age at migration) were associated with having dense breasts. Compared to women who migrated at age 40 or later, the odds ratios and 95% confidence intervals for having dense breasts among women who migrated between the ages of 30 and 39 and before age 30 were 1.72 (0.96-3.07) and 2.48 (1.43-4.32), respectively.

Conclusions: Longer US residence and younger age at migration were associated with greater breast density in Vietnamese American women. Identifying modifiable mediating factors to reduce lifestyle changes that adversely impact breast density in this traditionally low-risk population for breast cancer is warranted.
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http://dx.doi.org/10.1007/s10552-019-01264-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842111PMC
February 2020

A Pilot Biomonitoring Study of Cumulative Phthalates Exposure among Vietnamese American Nail Salon Workers.

Int J Environ Res Public Health 2020 01 2;17(1). Epub 2020 Jan 2.

Cancer Prevention Institute of California, Berkeley, CA 94720, USA.

Many California nail salon workers are low-income Vietnamese women of reproductive age who use nail products daily that contain androgen-disrupting phthalates, which may increase risk of male reproductive tract abnormalities during pregnancy. Yet, few studies have characterized phthalate exposures among this workforce. To characterize individual metabolites and cumulative phthalates exposure among a potentially vulnerable occupational group of nail salon workers, we collected 17 post-shift urine samples from Vietnamese workers at six San Francisco Bay Area nail salons in 2011, which were analyzed for four primary phthalate metabolites: mono--butyl-, mono-isobutyl-, mono(2-Ethylhexyl)-, and monoethyl phthalates (MnBP, MiBP, MEHP, and MEP, respectively; μg/L). Phthalate metabolite concentrations and a potency-weighted sum of parent compound daily intake (Σandrogen-disruptor, μg/kg/day) were compared to 203 Asian Americans from the 2011-2012 National Health and Nutritional Examination Survey (NHANES) using Student's -test and Wilcoxin signed rank test. Creatinine-corrected MnBP, MiBP, MEHP (μg/g), and cumulative phthalates exposure (Σandrogen-disruptor, μg/kg/day) levels were 2.9 ( < 0.0001), 1.6 ( = 0.015), 2.6 ( < 0.0001), and 2.0 ( < 0.0001) times higher, respectively, in our nail salon worker population compared to NHANES Asian Americans. Levels exceeded the NHANES 95th or 75th percentiles among some workers. This pilot study suggests that nail salon workers are disproportionately exposed to multiple phthalates, a finding that warrants further investigation to assess their potential health significance.
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http://dx.doi.org/10.3390/ijerph17010325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6981895PMC
January 2020

Chronotype and postmenopausal breast cancer risk among women in the California Teachers Study.

Chronobiol Int 2019 11 27;36(11):1504-1514. Epub 2019 Aug 27.

Department of Epidemiology and Biostatistics, University of California San Francisco , San Francisco , CA , USA.

Chronotype is the behavioral manifestation of an individual's underlying circadian rhythm, generally characterized by one's propensity to sleep at a particular time during the 24 hour cycle. Evening chronotypes ("night owls") generally suffer from worse physical and mental health compared to morning chronotypes ("morning larks") - for reasons that have yet to be explained. One hypothesis is that evening chronotypes may be more susceptible to circadian disruption, a condition where the coordinated timing of biologic processes breaks down. The role of chronotype as an independent or modifying risk factor for cancer has not been widely explored. The objective of the current study was to evaluate the risk of breast cancer associated with chronotype in a case-control study nested within the California Teachers Study (CTS) cohort. The study population consisted of 39686 post-menopausal CTS participants who provided information on chronotype by completing a questionnaire in 2012-2013. 2719 cases of primary invasive breast cancer diagnosed from 1995/1996 through completion of the chronotype questionnaire were identified by linkage of the CTS to the California Cancer Registry. 36967 CTS participants who had remained cancer-free during this same time period served as controls. Chronotype was ascertained by responses to an abbreviated version of the Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ) and was characterized into five categories: definite morning, more morning than evening, neither morning or evening, more evening than morning, definite evening. Multivariable unconditional logistic regression analyses were performed to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for each of the chronotypes, adjusted for established breast cancer risk factors. Compared to definite morning types, definite evening types had an increased risk of breast cancer with elevated ORs that were statistically significant in both the crude (OR = 1.24, 95% CI: 1.10-1.40) and fully-adjusted models (OR = 1.20, 95% CI: 1.06-1.35). The risk estimates in the fully-adjusted model for all other chronotypes did not significantly differ from one. These results suggest that evening chronotype may be an independent risk factor for breast cancer among a population of women who are not known to have engaged in any substantial night shift work. Further research in other populations of non-shift workers is warranted.
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http://dx.doi.org/10.1080/07420528.2019.1658113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818501PMC
November 2019

Heavy Metals in California Women Living in a Gold Mining-Impacted Community.

Int J Environ Res Public Health 2019 06 26;16(13). Epub 2019 Jun 26.

Cancer Prevention Institute of California, Fremont, CA 94538, USA.

Gold mining activities occurred throughout the foothills of the Sierra Nevada Mountains in California, leaving behind persistent toxic contaminants in the soil, dust, and water that include arsenic and cadmium. Despite a high level of concern among local residents about potential exposure and high breast cancer rates, no biomonitoring data has been collected to evaluate the levels of heavy metals. We conducted a study to characterize the urinary levels of heavy metals among women in this region by working with the community in Nevada County. Sixty women provided urine samples and completed a questionnaire. We examined levels of arsenic, cadmium, and other metals in relation to the length of residency in the area, age, dietary factors, recreational activities, and smoking. We compared urinary metal levels in participants to levels in the United States National Health and Nutrition Examination Survey (NHANES). Overall, study participants had higher urinary levels of arsenic than women in the national sample. Cadmium levels were similar to the national average, although they were elevated in women ≥35 years who had lived in the region for 10 years or more. Arsenic levels were higher among women who smoked, ate fish, ate home-grown produce, and who reported frequent hiking or trail running, although these differences were not statistically significant. This study established a successful community-research partnership, which facilitated community dialogue about possible human health consequences of living in a mining-impacted area.
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http://dx.doi.org/10.3390/ijerph16132252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6651337PMC
June 2019

The California Safer Consumer Products Program: Evaluating a Novel Chemical Policy Strategy.

New Solut 2019 08 27;29(2):224-241. Epub 2019 May 27.

2 University of California, San Francisco, CA, USA.

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http://dx.doi.org/10.1177/1048291119850105DOI Listing
August 2019

A breast cancer case-control study of polybrominated diphenyl ether (PBDE) serum levels among California women.

Environ Int 2019 06 5;127:412-419. Epub 2019 Apr 5.

Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA; Cancer Prevention Institute of California, Berkeley, CA, USA; Stanford University School of Medicine, Department of Health Research and Policy, Stanford, CA, USA.

Purpose: Polybrominated diphenyl ethers (PBDEs) are among the most persistent and pervasive global environmental contaminants. Their toxic and endocrine-disrupting properties have made them a focus of concern for breast cancer. Our objective was to evaluate the risk of breast cancer associated with serum PBDE levels in a case-control study nested within the California Teachers Study.

Methods: Participants were 902 women with invasive breast cancer (cases) and 936 with no such diagnosis (controls) who provided 10 mL of blood and were interviewed between 2011 and 2015. Blood samples were collected from cases an average of 35 months after diagnosis. PBDEs were measured in serum using automated solid phase extraction and gas chromatography/high resolution mass spectrometry. Statistical analyses were restricted to the three congeners with detection frequencies ≥75%: 2,2',4,4'-tetrabromodiphenyl ether (BDE-47), 2,2',4,4',6-pentabromodiphenyl ether (BDE-100), and 2,2',4,4',5,5'-hexabromodiphenyl ether (BDE-153). Unconditional logistic regression was used to estimate multivariable-adjusted odds ratios (ORs) and their 95% confidence intervals (CI) for each BDE congener, adjusting for serum lipids and other potential confounders.

Results: The OR for each of the three BDE congeners was close to unity with a CI that included one. Analyses stratified by menopausal status, tumor hormone responsiveness, BMI, and changes in body weight yielded similarly null results.

Conclusions: Our findings provide no evidence that serum levels of BDE-47, BDE-100 or BDE-153 are associated with breast cancer risk. These results should be interpreted in the context of study limitations which include the reliance on PBDE measurements that may not represent pre-diagnostic, early-life or chronic exposures and a lack of information on genetic polymorphisms and other factors which may affect endogenous estrogen levels.
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http://dx.doi.org/10.1016/j.envint.2019.03.043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522143PMC
June 2019

Secondhand smoke, obesity, and risk of type II diabetes among California teachers.

Ann Epidemiol 2019 04 25;32:35-42. Epub 2019 Jan 25.

Department of Epidemiology, School of Medicine, University of California Irvine, Irvine.

Purpose: To examine if secondhand smoke (SHS) is associated with elevated risk of type II diabetes among California teachers. We also aim to determine if overall and central obesity are mediators or effect modifiers of this association.

Methods: Using data from the California Teachers Study, conducted in 1995-2013 in California public schools, we obtained information on SHS exposure among 39,887 lifetime nonsmokers. The association between SHS and incident diabetes after 17 years of follow-up was assessed using Cox regression models. The mediation and modification effects of BMI and waist circumference on this association were tested.

Results: At baseline, 70.2% of the nonsmokers reported exposure to SHS. Higher intensity, duration, and intensity-years of exposure to SHS were associated with higher multivariate adjusted risk of incident diabetes in a dose-response manner (hazard ratio = 1.28; 95% confidence interval, 1.11-1.48 for highest quartile vs. lowest quartile of exposure; P = .001 for trend). Participant's waist circumference (measured 2 years after baseline) could explain greater than 50% of the association between SHS and diabetes.

Conclusions: SHS exposure is associated with increased risk of type II diabetes among nonsmokers of California teachers with obesity being a potentially important mediator but not an effect modifier for this association.
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http://dx.doi.org/10.1016/j.annepidem.2019.01.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469797PMC
April 2019

Breast cancer risk and serum levels of per- and poly-fluoroalkyl substances: a case-control study nested in the California Teachers Study.

Environ Health 2018 11 27;17(1):83. Epub 2018 Nov 27.

Cancer Prevention Institute of California, Berkeley, CA, USA.

Background: Per- and poly- fluoroalkyl substances (PFASs) are a large family of synthetic chemicals, some of which are mammary toxicants and endocrine disruptors. Their potential as breast carcinogens is unclear. Our objective was to evaluate the risk of breast cancer associated with serum PFAS concentrations in a nested case-control study within the California Teachers Study.

Methods: Participants were 902 women with invasive breast cancer (cases) and 858 with no such diagnosis (controls) who provided 10 mL of blood and were interviewed during 2011-2015, an average of 35 months after case diagnosis. PFASs were measured using automated online SPE-HPLC-MS/MS methods. Statistical analyses were restricted to six PFASs with detection frequencies ≥ 95%: PFOA (Perfluorooctanoic acid), PFNA (Perfluorononanoic acid), PFUnDA (Perfluoroundecanoic acid), PFHxS (Perfluorohexane sulfonic acid), PFOS (Perfluorooctane sulfonic acid), and MeFOSAA (2-(N-Methyl-perfluorooctane sulfonamido) acetic acid. Unconditional logistic regression was used to calculate adjusted odds ratios (ORs), estimating the breast cancer risk associated with each PFAS.

Results: For all cases of invasive breast cancer, none of the adjusted ORs were statistically significant but marginally significant ORs < 1.0 were observed for PFUnDA and PFHxS (p-trend = 0.08). Adjusted ORs < 1.0 for PFUnDA and PFHxS were statistically significant (p ≤ 0.05) among the 107 cases with hormone-negative tumors but not the 743 with hormone-positive tumors.

Conclusion: Overall, these findings do not provide evidence that serum PFAS levels measured after diagnosis are related to breast cancer risk. The few inverse associations found may be due to chance or may be artifacts of study design. Future studies should incorporate information about genetic susceptibility, endogenous estrogen levels, and measurements of PFASs prior to diagnosis and treatment.
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http://dx.doi.org/10.1186/s12940-018-0426-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260688PMC
November 2018

Congenital heart disease complexity and childhood cancer risk.

Birth Defects Res 2018 10 16;110(17):1314-1321. Epub 2018 Oct 16.

Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California.

Background: Childhood cancer is increased in those with birth defects, including those with congenital heart disease (CHD). Lymphoma risk is increased in children with CHD. This study analyzes the effect of CHD and CHD severity on childhood cancer risk.

Methods: We analyzed cancer risk in a population-based cohort of children with and without CHD born between 1988 and 2004 by linking data from the California Birth Defects Monitoring Program with data from the California Cancer Registry. We compared cancer risk in children with and without CHD, excluding children with chromosomal anomalies.

Results: Of >3 million children in the birth cohort, 65,585 had birth defects (2%), 25,981 with CHD. Cancer occurred in 4,781 (0.15%) children, 43 (0.17%) with CHD. Cancer risk in CHD was increased (hazard ratio [HR]) 2.63, 95% CI: 1.95, 3.55). Leukemia was the most common cancer in those without CHD (1,722/4,738, 36%), central nervous system tumors were second (1,073/4,738, 23%), and lymphoma third (410/4,738, 9%). Among children with CHD, lymphoma and leukemia occurred with the same frequency (12/43, 28% for each). HR for lymphoma was 8.37 (CI: 4.71, 14.86) with CHD versus without. HR for leukemia was 2.05 (CI: 1.16, 3.61) with CHD versus without. CHD complexity was higher in lymphoma (3, interquartile range [IQR]: 2-3) than those with leukemia (1, IQR, 1-2; p < .02).

Conclusion: Cancer risk is increased in children with CHD. Lymphoma risk is increased in CHD and is correlated with more complex CHD. These results suggest a shared developmental origin for CHD and lymphoma may be present.
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http://dx.doi.org/10.1002/bdr2.1390DOI Listing
October 2018

Evaluating an owner-to-worker training intervention in California nail salons using personal air monitoring.

Am J Ind Med 2018 10 12;61(10):831-841. Epub 2018 Aug 12.

Cancer Prevention Institute of California, Berkeley, California.

Background: Chemicals in nail products have been linked to numerous health concerns.

Methods: We recruited Vietnamese-American nail salon owners and workers in California and randomized salons into an intervention or control group. Owners in the intervention group received training and then provided education to workers in their salons on best practices to reduce workplace chemical exposures. Methyl methacrylate (MMA), toluene, and total volatile organic compounds (TVOCs) were measured using personal air monitors worn by workers during the work-shift.

Results: We enrolled 77 salons (37 intervention and 40 control) and 200 workers. There was no significant intervention effect between the two groups. However, MMA and TVOCs were higher for workers who used gel polish and acrylic nails as well as in busy salons.

Conclusions: Although the intervention did not show reductions in chemical levels, identifying worker tasks and salon characteristics that predict chemical levels can inform future interventions to reduce exposures.
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http://dx.doi.org/10.1002/ajim.22897DOI Listing
October 2018

Time Trends in Per- and Polyfluoroalkyl Substances (PFASs) in California Women: Declining Serum Levels, 2011-2015.

Environ Sci Technol 2018 01 19;52(1):277-287. Epub 2017 Dec 19.

Cancer Prevention Institute of California , Berkeley, California 94704, United States.

After several decades of widespread use, some per- and polyfluoroalkyl substances (PFASs) were phased-out of use due to concerns raised by their persistent, bioaccumulative, and toxic properties. Our objective was to evaluate temporal trends in serum PFAS levels among 1257 middle-aged and older California women (ages 40-94) during a four year period, beginning approximately 5-10 years after these phase-outs began. An online SPE-HPLC-MS/MS was used to measure 10 long-chain PFASs in serum from blood collected cross-sectionally during 2011-2015 from a subset of participants in the California Teachers Study. Results from multivariable linear regression analyses indicated that serum concentrations of nearly all PFASs declined on average 10% to 20% per year. Serum levels of perfluorohexanesulfonic acid (PFHxS) did not significantly decline. With the exception of PFHxS, the downward trend in serum concentrations was evident for all PFASs across all ages, although declines were comparatively steeper among the oldest women. These findings suggest that the phase-out of some common PFASs has resulted in reduced human exposures to them. The lack of a decline for PFHxS suggests that these exposures may be ongoing and underscores the importance of continued biomonitoring and research efforts to elucidate current pathways of exposure.
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http://dx.doi.org/10.1021/acs.est.7b04650DOI Listing
January 2018

Parental Age and Risk of Infant Leukaemia: A Pooled Analysis.

Paediatr Perinat Epidemiol 2017 11 22;31(6):563-572. Epub 2017 Sep 22.

Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN.

Background: Infant leukaemia (IL) is extremely rare with fewer than 150 cases occurring each year in the United States. Little is known about its causes. However, recent evidence supports a role of de novo mutations in IL aetiology. Parental age has been associated with several adverse outcomes in offspring, including childhood cancers. Given the role of older parental age in de novo mutations in offspring, we carried out an analysis of parental age and IL.

Methods: We evaluated the relationship between parental age and IL in a case-control study using registry data from New York, Minnesota, California, Texas, and Washington. Records from 402 cases [219 acute lymphoblastic leukaemia (ALL), 131 acute myeloid leukaemia (AML), and 52 other] and 45 392 controls born during 1981-2004 were analysed. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by logistic regression. Estimates were adjusted for infant sex, birth year category, maternal race, state, and mutually adjusted for paternal or maternal age, respectively.

Results: Infants with mothers' age ≥40 years had an increased risk of developing AML (OR 4.80, 95% CI 1.80, 12.76). In contrast, paternal age <20 was associated with increased risk of ALL (OR 3.69, 95% CI 1.62, 8.41).

Conclusion: This study demonstrates increased risk of infant ALL in relation to young paternal age. Given record linkage, there is little concern with recall or selection bias, although data are lacking on MLL gene status and other potentially important variables. Parent of origin effects, de novo mutations, and/or carcinogenic exposures may be involved in IL aetiology.
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http://dx.doi.org/10.1111/ppe.12412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5901723PMC
November 2017

Genome-Wide Testing of Exonic Variants and Breast Cancer Risk in the California Teachers Study.

Cancer Epidemiol Biomarkers Prev 2017 09;26(9):1462-1465

Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio.

Few studies have focused on the relationship of exonic variation with breast cancer and subtypes defined by tumor markers: estrogen receptor (ER), progesterone receptor (PR), and HER2. We genotyped 1,764 breast cancer patients and 1,400 controls from the California Teachers Study cohort using the Infinium HumanExome Beadchip. Individual variant and gene-based analyses were conducted for overall breast cancer and by individual tumor marker subtype. No exonic variants or gene-based analyses were statistically significantly associated with breast cancer overall or by ER-, PR-, or HER2-defined subtype. We did not detect any novel statistically significant exonic variants with overall breast cancer risk or by subtype. Exonic variants in the exome chip may not be associated with overall breast cancer or subtype susceptibility. .
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http://dx.doi.org/10.1158/1055-9965.EPI-17-0364DOI Listing
September 2017

Functional IGF1R variant predicts breast cancer risk in women with preeclampsia in California Teachers Study.

Cancer Causes Control 2017 Oct 18;28(10):1027-1032. Epub 2017 Aug 18.

Buck Institute for Research on Aging, Novato, CA, USA.

Purpose: Hypertension in pregnancy has been associated with decreased future risk of breast cancer in many but not all studies. In the Marin Women's Study, pregnancy-induced hypertension was shown to interact with the T allele of a functional IGF1R gene variant, rs2016347, to result in lower breast density, as well as decreased breast cancer risk. Our objective was to explore these findings in a larger sample of women from the California Teachers Study (CTS).

Methods: The CTS cohort consists of over 130,000 female educators. DNA was available from a nested case-control study, which included 2,030 non-Hispanic white women who developed breast cancer and 1,552 controls. The current study included all participants from the case-control group with a self-reported history of preeclampsia (80 cases/57 controls).

Results: Comparing TT to GG genotypes revealed adjusted odds ratios of 0.38 (CI 0.13, 1.14) for all invasive breast cancers, 0.26 (CI 0.07, 0.89) for hormone receptor-positive (HR+) breast cancers, 0.15 (CI 0.04, 0.56) for those with age at first birth (AFB) < 30, and 0.10 (CI 0.02, 0.49) for those with AFB < 30 and HR+ breast cancers. Trend analysis yielded p values of 0.09, 0.03, 0.005, and 0.004 respectively, suggesting a biological effect for each T allele.

Conclusion: Study findings indicate that the T allele of IGF1R variant rs2016347 is associated with a significant reduction in breast cancer risk in women with a history of preeclampsia, most marked for HR+ breast cancer and in women with AFB < 30.
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http://dx.doi.org/10.1007/s10552-017-0942-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613056PMC
October 2017

Impact of the environment on cancer: Seeing the forest for the trees.

Cancer 2017 08 8;123(15):2796-2797. Epub 2017 May 8.

Cancer Prevention Institute of California, Fremont, California.

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http://dx.doi.org/10.1002/cncr.30711DOI Listing
August 2017

Breast cancer in Asian Americans in California, 1988-2013: increasing incidence trends and recent data on breast cancer subtypes.

Breast Cancer Res Treat 2017 Jul 1;164(1):139-147. Epub 2017 Apr 1.

Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94538, USA.

Purpose: In contrast to other US racial/ethnic groups, Asian Americans (AA) have experienced steadily increasing breast cancer rates in recent decades. To better understand potential contributors to this increase, we examined incidence trends by age and stage among women from seven AA ethnic groups in California from 1988 to 2013, and incidence patterns by subtype and age at diagnosis for the years 2009 through 2013.

Methods: Joinpoint regression was applied to California Cancer Registry data to calculate annual percentage change (APC) for incidence trends. Incidence rate ratios were used to compare rates for AA ethnic groups relative to non-Hispanic whites (NHW).

Results: All AA groups except Japanese experienced incidence increases, with the largest among Koreans in 1988-2006 (APC 4.7, 95% CI 3.8, 5.7) and Southeast Asians in 1988-2013 (APC 2.5, 95% CI 0.8, 4.2). Among women younger than age 50, large increases occurred for Vietnamese and other Southeast Asians; among women over age 50, increasing trends occurred in all AA ethnic groups. Rates increased for distant-stage disease among Filipinas (2.2% per year, 95% CI 0.4, 3.9). Compared to NHW, Filipinas and older Vietnamese had higher incidence rates of some HER2+ subtypes.

Conclusions: Breast cancer incidence rates have risen rapidly among California AA, with the greatest increases in Koreans and Southeast Asians. Culturally tailored efforts to increase awareness of and attention to breast cancer risk factors are needed. Given the relatively higher rates of HER2-overexpressing subtypes in some AA ethnicities, research including these groups and their potentially unique exposures may help elucidate disease etiology.
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http://dx.doi.org/10.1007/s10549-017-4229-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484636PMC
July 2017

An Investigation of Connections between Birth Defects and Cancers Arising in Adolescence and Very Young Adulthood.

J Pediatr 2017 06 20;185:237-240. Epub 2017 Mar 20.

Cancer Prevention Institute of California, Berkeley, CA; Department of Health Research and Policy, Stanford University, Palo Alto, CA.

This study investigated the relationship between birth defects and cancer in adolescents and very young adults using California's population-based registries. Although overall cancer risk was elevated among individuals with chromosomal birth defects, this was not observed in those with nonchromosomal birth defects, as was demonstrated previously in younger children.
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http://dx.doi.org/10.1016/j.jpeds.2017.02.057DOI Listing
June 2017

Temporal Evaluation of Polybrominated Diphenyl Ether (PBDE) Serum Levels in Middle-Aged and Older California Women, 2011-2015.

Environ Sci Technol 2017 04 29;51(8):4697-4704. Epub 2017 Mar 29.

Cancer Prevention Institute of California , Berkeley, California 94704, United States.

In response to health concerns and widespread human exposures, two widely used commercial formulations of polybrominated diphenyl ethers (PBDEs) were banned in the United States in 2005. Initial biomonitoring data have provided early indications of reduced human exposures since these bans took effect. Our objective was to evaluate temporal trends in PBDE serum levels among a population of older California women during a four-year period, beginning approximately five years after these formulations were banned. Automated solid phase extraction and gas chromatography/high resolution mass spectrometry were used to measure PBDE levels in blood collected during 2011-2015 among 1253 women (ages 40-94) participating in the California Teachers Study. Only congeners with detection frequencies (DF) ≥ 75% were included in the present analysis: BDE-47 (DF = 88%); BDE-100 (DF = 78%); and BDE-153 (DF = 80%). Results from age- and race/ethnicity-adjusted linear regression analyses indicated modest, but statistically significant, average annual percent increases in the serum concentrations of all three PBDEs over the four-year study period. While not without limitations, these results, in the context of other biomonitoring data, suggest that earlier reported declines in PBDE levels may have plateaued and may now be starting to increase. Further biomonitoring to ascertain current trends and determinants of population exposures is warranted.
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http://dx.doi.org/10.1021/acs.est.7b00565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526086PMC
April 2017

Impact of Social and Built Environment Factors on Body Size among Breast Cancer Survivors: The Pathways Study.

Cancer Epidemiol Biomarkers Prev 2017 04 2;26(4):505-515. Epub 2017 Feb 2.

Cancer Prevention Institute of California, Fremont, California.

As social and built environment factors have been shown to be associated with physical activity, dietary patterns, and obesity in the general population, they likely also influence these health behaviors among cancer survivors and thereby impact survivorship outcomes. Enhancing the rich, individual-level survey and medical record data from 4,505 breast cancer survivors in the Pathways Study, a prospective cohort drawn from Kaiser Permanente Northern California, we geocoded baseline residential addresses and appended social and built environment data. With multinomial logistic models, we examined associations between neighborhood characteristics and body mass index and whether neighborhood factors explained racial/ethnic/nativity disparities in overweight/obesity. Low neighborhood socioeconomic status, high minority composition, high traffic density, high prevalence of commuting by car, and a higher number of fast food restaurants were independently associated with higher odds of overweight or obesity. The higher odds of overweight among African Americans, U.S.-born Asian Americans/Pacific Islanders, and foreign-born Hispanics and the higher odds of obesity among African Americans and U.S.-born Hispanics, compared with non-Hispanic whites, remained significant, although somewhat attenuated, when accounting for social and built environment features. Addressing aspects of neighborhood environments may help breast cancer survivors maintain a healthy body weight. Further research in this area, such as incorporating data on individuals' perceptions and use of their neighborhood environments, is needed to ultimately inform multilevel interventions that would ameliorate such disparities and improve outcomes for breast cancer survivors, regardless of their social status (e.g., race/ethnicity, socioeconomic status, nativity).
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http://dx.doi.org/10.1158/1055-9965.EPI-16-0932DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380478PMC
April 2017

Tracing a Path to the Past: Exploring the Use of Commercial Credit Reporting Data to Construct Residential Histories for Epidemiologic Studies of Environmental Exposures.

Am J Epidemiol 2017 02;185(3):238-246

Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, USA.

Large-scale environmental epidemiologic studies often rely on exposure estimates based on linkage to residential addresses. This approach, however, is limited by the lack of residential histories typically available for study participants. Our objective was to evaluate the feasibility of using address data from LexisNexis (a division of RELX, Inc., Dayton, Ohio), a commercially available credit reporting company, to construct residential histories for participants in the California Teachers Study (CTS), a prospective cohort study initiated in 1995-1996 to study breast cancer (n = 133,479). We evaluated the degree to which LexisNexis could provide retrospective addresses prior to study enrollment, as well as the concordance with existing prospective CTS addresses ascertained at the time of the completion of 4 self-administered questionnaires. For approximately 80% of CTS participants, LexisNexis provided at least 1 retrospective address, including nearly 25,000 addresses completely encompassed by time periods prior to enrollment. This approach more than doubled the proportion of the study population for whom we had an address of residence during the childbearing years-an important window of susceptibility for breast cancer risk. While overall concordance between the prospective addresses contained in these 2 data sources was good (85%), it was diminished among black women and women under the age of 40 years.
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http://dx.doi.org/10.1093/aje/kww108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5860230PMC
February 2017

Lifetime body size and estrogen-receptor-positive breast cancer risk in the California Teachers Study cohort.

Breast Cancer Res 2016 12 21;18(1):132. Epub 2016 Dec 21.

Cancer Prevention Institute of California, 2001 Center St, Suite 700, Berkeley, CA, 94704, USA.

Background: Obesity is a public health epidemic and an important breast cancer risk factor. The relationship between interrelated body measurements is complex and most studies fail to account for this complexity. We identified key aspects of body size which jointly, over the life-course (since adolescence), are associated with estrogen-receptor-positive (ER+) breast cancer risk.

Methods: Among 109,862 women participating in the California Teachers Study cohort, 3844 were diagnosed with invasive ER+ breast cancer between 1997-1998 and December 2011. Based on validated self-reported height and weight at age 18, baseline, and 10-year follow up and waist circumference at 2-year and 10-year follow up, we identified 16 a priori body-size phenotypes. Multivariable Cox proportional hazards models provided estimates of hazard rate ratios (HR) and 95% confidence intervals (CI).

Results: Premenopausal breast cancer was influenced by adolescent, but not adult, body size (HR = 0.51, 95% CI 0.31-0.86 for body mass index (BMI; kg/m) ≥25 vs <20 at age 18). Among postmenopausal women currently using hormone therapy, only those with the greatest body size had increased breast cancer risk (HR = 1.36, 95% CI 1.13-1.64 for height ≥67 inches and adult BMI ≥25 vs height <67). Among postmenopausal women not currently using hormone therapy, the relationship between body size and risk was complex, with the largest effects of adiposity among short women. Among short women, those with gluteal adiposity (HR = 2.70, 95% CI 1.77-4.10) and those who continued to gain weight throughout adulthood (HR = 2.57, 95% CI 1.60-4.12) were at greatest risk, whereas those who had been overweight/obese since adolescence were not at increased risk (HR = 1.33, 95% CI 0.84-2.10). Height was associated with a small increased risk, with borderline statistical significance.

Conclusions: Considering absolute body mass in adolescence and at two points in adulthood, dynamic changes in adiposity over time, and body fat distribution, we identified obesity phenotypes associated with ER+ breast cancer risk. Our approach more clearly identifies specific risk groups than do analyses that evaluate similar measures separately. These findings may aid in improving risk prediction models and developing targeted interventions, and may clarify inconsistent findings across studies.
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http://dx.doi.org/10.1186/s13058-016-0790-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5178085PMC
December 2016

Body size over the life-course and the risk of endometrial cancer: the California Teachers Study.

Cancer Causes Control 2016 Dec 1;27(12):1419-1428. Epub 2016 Nov 1.

Cancer Prevention Institute of California, Berkeley, CA, USA.

Purpose: Obesity is a public health epidemic and a major risk factor for endometrial cancer. Here, we identify key aspects of body size which jointly, over the life-course (since adolescence), are associated with endometrial cancer risk.

Methods: Among 88,142 participants in the California Teachers Study, 887 were diagnosed with invasive type 1 endometrial cancer between 1997-1998 and 2012. Multivariable Cox proportional hazards models provided estimates of hazard rate ratios (HR) and 95% confidence intervals (CI) for endometrial cancer associated with life-course body size phenotypes, which incorporated validated measures.

Results: Among women currently using hormone therapy, endometrial cancer risk was only associated with height (HR 1.78, 95% CI 1.32-2.40 for ≥67 vs. <67 inches). Among women not using hormone therapy, tall women who were overweight/obese in adolescence (HR 4.33, 95% CI 2.51-7.46) or who became overweight/obese as adults (HR 4.74, 95% CI 2.70-8.32) were at greatest risk.

Conclusions: Considering absolute body mass, changes in adiposity over time, and body fat distribution together, instead of each measure alone, we identified lifetime obesity phenotypes associated with endometrial cancer risk. These results more clearly define specific risk groups, and may explain inconsistent findings across studies, improve risk prediction models, and aid in developing targeted interventions for endometrial cancer.
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http://dx.doi.org/10.1007/s10552-016-0820-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5134925PMC
December 2016

Temporal Trends of Insecticide Concentrations in Carpet Dust in California from 2001 to 2006.

Environ Sci Technol 2016 07 24;50(14):7761-9. Epub 2016 Jun 24.

Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute , Bethesda, Maryland 20892, United States.

Active ingredients in residential and agricultural insecticides have changed over time, due in part to regulatory restrictions. Few studies have evaluated how changes in active ingredients have impacted insecticide levels measured in homes. We measured concentrations of insecticides in one carpet-dust sample from each of 434 homes in California from 2001 to 2006. Analytes included four insecticides sold for indoor home use during our study period (carbaryl, cypermethrin, permethrin, and propoxur) and four that are no longer sold for indoor use including dichlorodiphenyltrichloroethylene (DDT, removed from the market in 1972), chlordane (1988), chlorpyrifos (2001), and diazinon (2004). We considered other potential determinants of concentrations of insecticides in carpet dust, such as home and garden use, occupational exposure, and nearby agricultural applications. We calculated the percentage change in the concentration of each insecticide per year, adjusting for significant determinants. In adjusted models, concentrations of insecticides in carpet dust decreased for three of four insecticides no longer sold for residential use: chlordane (-15% per year), chlorpyrifos (-31%), diazinon (-48%), and propoxur (-34%), which is currently sold for residential use but with increased restrictions since 1997. Concentrations of other insecticides sold for indoor use (carbaryl, cypermethrin, and permethrin) and DDT did not change over time in our study population.
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http://dx.doi.org/10.1021/acs.est.6b00252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404968PMC
July 2016

Association between Serum Polybrominated Diphenyl Ether Levels and Residential Proximity to Solid-Waste Facilities.

Environ Sci Technol 2016 Apr 10;50(7):3945-53. Epub 2016 Mar 10.

Cancer Prevention Institute of California , Berkeley, California 94704, United States.

As consumer products treated with polybrominated diphenyl ethers (PBDEs) reach the end of their life cycle, they often are discarded into solid-waste facilities, offering a potential reservoir for exposure. The likelihood of exposures to PBDEs by residents living near those sites rarely has been explored. This study collected blood samples from 923 female participants in the California Teachers Study in 2011-2013 and examined the association between participants' residential proximity to solid-waste facilities with potential release of PBDEs and serum levels of three congeners (BDE-47, BDE-100, and BDE-153). General linear regression analysis was used to examine the association, adjusting for age, race, body-mass index, neighborhood socioeconomic status, and urban residency. Compared to participants living >10 km from any selected site, those living within 2 km had 45% higher BDE-47 (95% CI: 5-100%) and BDE-100 (95% CI: 0-109%) levels, and those living between 2 and 10 km had 35% higher BDE-47 (95% CI: 0-82%) and 29% higher BDE-100 (95% CI: -9 to 82%) levels. No associations were found for BDE-153. Living close to some solid waste sites may be related to higher serum BDE-47 and BDE-100 levels. Studies with comprehensive exposure assessments are needed to confirm these initial observations.
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http://dx.doi.org/10.1021/acs.est.5b04715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102683PMC
April 2016