Metallic Air Pollutants and Breast Cancer Risk in a Nationwide Cohort Study

Epidemiology. 2019 Jan;30(1):20-28. doi: 10.1097/EDE.0000000000000917.


Background: Toxic metals show evidence of carcinogenic and estrogenic properties. However, little is known about the relationship between airborne metals and breast cancer. We evaluated the risk of breast cancer in relation to exposure to toxic metallic substances in air, individually and combined, in a US-wide cohort.

Methods: Sister Study participants (n = 50,884), breast cancer-free women who had a sister with breast cancer were recruited, from 2003 to 2009. The 2005 Environmental Protection Agency National Air Toxic Assessment's census-tract estimates of metal concentrations in air (antimony, arsenic, cadmium, chromium, cobalt, lead, manganese, mercury, nickel, and selenium) were matched to participants' enrollment residence. We used Cox regression to estimate the association between quintiles of individual metals and breast cancer incidence and weighted quantile sum regression to model the association between the metal mixture and breast cancer.

Results: A total of 2,587 breast cancer cases were diagnosed during follow-up (mean = 7.4 years). In individual chemical analyses comparing the highest to lowest quintiles, postmenopausal breast cancer risk was elevated for mercury (hazard ratio [HR] = 1.3, 95% confidence interval [CI], 1.1, 1.5), cadmium (HR = 1.1, 95% CI, 0.96, 1.3), and lead (HR = 1.1, 95% CI, 0.98, 1.3). The weighted quantile sum index was associated with postmenopausal breast cancer (odds ratio [OR] = 1.1, 95% CI, 1.0, 1.1). Consistent with the individual chemical analysis, the most highly weighted chemicals for predicting postmenopausal breast cancer risk were lead, cadmium, and mercury. Results were attenuated for overall breast cancer.

Conclusions: Higher levels of some airborne metals, specifically mercury, cadmium, and lead, were associated with a higher risk of postmenopausal breast cancer.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Adult
  • Aged
  • Air Pollutants / analysis
  • Air Pollutants / toxicity*
  • Breast Neoplasms / epidemiology*
  • Cadmium / analysis
  • Cadmium / toxicity
  • Cohort Studies
  • Environmental Exposure*
  • Female
  • Humans
  • Lead / toxicity
  • Mercury / analysis
  • Mercury / toxicity
  • Metals, Heavy / analysis
  • Metals, Heavy / toxicity*
  • Middle Aged
  • Retrospective Studies
  • Siblings
  • Surveys and Questionnaires
  • United States / epidemiology


  • Air Pollutants
  • Metals, Heavy
  • Cadmium
  • Lead
  • Mercury