Abstract: In this issue of the Journal, Parent et al. (Am J Epidemiol. 2012;176(9):751-759) report significant associations between night-shift work and risk of cancer at several sites among men. These findings not only address the need for shift-work studies that evaluate cancers other than breast and prostate cancer but also support the increasing concern that the negative effects of shift work may be broadly applicable to risk of many cancers via the direct oncostatic properties of melatonin. Studies of shift work have been limited by a lack of detailed data for determining which aspects of this multifaceted exposure may be associated with increased cancer risk. Additionally, the influence of individual-level characteristics, such as preference for daytime activity versus nighttime activity or chronotype, has not been considered. In moving forward, launching new cohort studies of shift work and cancer risk is the most tenable approach, though it will be limited by the years of follow-up required in order to accrue adequate numbers of cancer cases. Studies incorporating biomarkers of effect are useful for providing immediate information that can aid not only in identifying the underlying mechanisms of the shift-work-cancer association but also in interpreting existing epidemiologic data and informing the design of future epidemiologic studies of cancer risk.

Abstract: Research into health effects of chronodisruption (CD), a relevant disturbance of the circadian organization of physiology, endocrinology, metabolism and behaviour, is evolving at a rapid pace. With regard to malignancies, our synthesis of key experiments indicates that CD can play a causal role for cancer growth and tumor progression in animals. Moreover, our meta-analyses of 30 epidemiological studies evince that flight personnel and shift workers exposed to chronodisruption may have increased breast and prostate cancer risks: summary relative risks (RRs) for investigations of flight personnel and of shift workers suggested a 70 and 40% increase in the risk of breast cancer, respectively, and excess relative risks of prostate cancer in nine studies in flight personnel (40%) and in two studies in male shift workers. There was a remarkable indication of homogeneity of results from the individual studies that contribute to the average statistics. However, in view of doubts about whether the differing assessments of CD can really be regarded as valid reflections of the same causative phenomenon and the lack of control of covariates in the majority of studies, it is premature to conclude that the risk observations reflect a real, rather than spurious, association with CD. The challenge for future epidemiological investigations of the biologically plausible links between chronodisruption and human cancers is to conduct studies which appreciate details of transmeridian travelling, of shift work and of covariates for the development of the diseases.

Abstract: Recent studies of shift-working women have reported that excessive exposure to light at night (LAN) may be a risk factor for breast cancer. However, no studies have yet attempted to examine the co-distribution of LAN and breast cancer incidence on a population level with the goal to assess the coherence of these earlier findings with population trends. Coherence is one of Hill's “criteria” (actually, viewpoints) for an inference of causality. Nighttime satellite images were used to estimate LAN levels in 147 communities in Israel. Multiple regression analysis was performed to investigate the association between LAN and breast cancer incidence rates and, as a test of the specificity of our method, lung cancer incidence rates in women across localities under the prediction of a link with breast cancer but not lung cancer. After adjusting for several variables available on a population level, such as ethnic makeup, birth rate, population density, and local income level, a strong positive association between LAN intensity and breast cancer rate was revealed (p<0.05), and this association strengthened (p<0.01) when only statistically significant factors were filtered out by stepwise regression analysis. Concurrently, no association was found between LAN intensity and lung cancer rate. These results provide coherence of the previously reported case-control and cohort studies with the co-distribution of LAN and breast cancer on a population basis. The analysis yielded an estimated 73% higher breast cancer incidence in the highest LAN exposed communities compared to the lowest LAN exposed communities.