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Increased Breast Cancer Risk among Women Who
Work Predominantly at Night
Johnni Hansen
Irregular working hours, including working at night, have
serious psychological and physiological effects. In a nationwide
population-based case-control study, we investigated the breast
cancer risk among 30- to 54-year-old Danish women who
worked predominantly at night.
Individual employment histo-ries
were reconstructed back to 1964 for each of 7035 women
with breast cancer and their individually matched controls
from the records of a nationwide pension scheme with com-pulsory
membership. Odds ratios, including 5 years of induc-
tion time and adjusted for socio-economic status, age at the
birth of first and last child and number of children, were
estimated by conditional logistic regression analysis.
The odds
ratio for breast cancer among women who worked at night at
least half of a year was 1.5 (95% confidence interval, 1.2 to
1.7), and there was a tendency to increasing odds ratio by
increasing duration of nighttime employment. (Epidemiology
2001;12:74 –77)
Working irregular hours, including night and shift work,
has been acknowledged as an occupational health and
safety problem since a century ago, as it has serious
social, psychological, and physiological effects.1–3 Acute
problems such as drowsiness and accidents have been
studied most intensively 1 ; chronic health problems like
gastrointestinal and coronary heart diseases are also rel-atively
well described, although the mechanisms are not
fully understood.2–6
It has been suggested that women
with irregular working hours are at increased risk for
breast cancer,7 since work that requires the use of arti-ficial
light (in the evening, night, or early morning)
leads to suppression of pineal secretion of melatonin,
which may induce continuous production of estrogen
involved in breast carcinogenesis.8
Irregular work schedules have become increasingly
more common in most industrialized societies: in 1980,
approximately 26% of men and 18% of women in the
United States labor force worked variable shift sched-ules.
2 About 20% of the female Danish workforce works
at night.9
We conducted a case-control study to inves-tigate
whether women in Denmark who work predomi-nantly
at night have an increased risk for breast cancer.
Subjects And Methods
CASES
Altogether 7565 women with confirmed primary
breast cancer, born in the period 1935–59 and 30–54
years of age at the time of diagnosis, were identified in
the files of the Danish Cancer Registry, which contains
information on diagnosis (ICD-7), names, sex, and
unique personal identification number.10
Information on
past employment was reconstructed by record linkage
with the files of the nationwide pension fund, adherence
to which has been compulsory for all wage-earners in
Denmark aged 18–66 years since its establishment in
1964. The fund retains computerized information about
each job held, including the name and 10-digit personal
identification number of the employee, the dates of start
and end of employment and the company name and
unique company number of the employer.11
This information
is kept even after the employees have retired or
died. No employment records existed for 530 of the
breast cancer patients (7%), who were never part of the
workforce (mainly housewives and assisting farmers’
wives), leaving 7035 female breast cancer patients who
had an employment history.
CONTROLS
One control subject per case was drawn at random
from the files of the Central Population Registry, iden-tified
by name, sex, and personal identification number,
and matched to the cases on year of birth and sex.
Controls had to be alive without cancer and to have
been an employee (member of the national pension
fund) before the date of diagnosis of the corresponding
case.
The employment histories of the control subjects
were retrieved from the files of the pension fund in the
From Danish Cancer Society, Institute of Cancer Epidemiology, Strandboule-varden
49, DK-2100 Copenhagen Ř, Denmark.
Address correspondence to: Johnni Hansen, Danish Cancer Society, Institute of
Cancer Epidemiology, Strandboulevarden 49, DK-2100 Copenhagen Ř,
Denmark.
2001 article
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