Sleep deficiency and breast cancer risk among postmenopausal women in the California teachers study (CTS)

Cancer Causes Control. 2020 Dec;31(12):1115-1128. doi: 10.1007/s10552-020-01349-2. Epub 2020 Sep 26.


Purpose: There is provocative, yet inconsistent, evidence that sleep deficiency may influence the development of breast cancer. The purpose of this study was to evaluate the risk of breast cancer associated with sleep deficiency among postmenopausal women in the California Teachers Study (CTS).

Methods: We conducted a case-control study of 2,856 invasive breast cancer cases and 38,649 cancer-free controls, nested within the CTS. Self-administered questionnaires were used to ascertain several components of sleep deficiency, including quality, latency, duration, disturbance and use of sleep medications. Additionally, a Global Sleep Index (GSI) was created by summing the individual sleep components and categorizing into quartiles. Multivariable logistic regression analyses were used to estimate odds ratios and 95% confidence intervals (OR, 95% CI).

Results: Increased breast cancer risks were associated with sleep deficiency. With the exception of duration, linear increases in risk were associated with all the other individual components of sleep deficiency (p-trend ≤ 0.002). The OR for the highest GSI quartile vs. lowest was 1.24, 95% CI 1.12-1.38; p-trend < 0.001).

Conclusions: Sleep deficiency may be a risk factor for breast cancer. Additional prospective studies and those aimed at elucidating underlying mechanism are warranted.

Keywords: Breast cancer; Case–control; Etiology; Sleep.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / epidemiology*
  • California / epidemiology
  • Case-Control Studies
  • Female
  • Humans
  • Longitudinal Studies
  • Middle Aged
  • Postmenopause*
  • Risk Factors
  • Sleep*
  • Young Adult