title: A case-referent study: light at night and breast cancer risk in Georgia.
abstract: BACKGROUND
  Literature has identified detrimental health effects from the indiscriminate use of artificial nighttime light. We examined the co-distribution of light at night (LAN) and breast cancer (BC) incidence in Georgia, with the goal to contribute to the accumulating evidence that exposure to LAN increases risk of BC.
  
  
  METHODS
  Using Georgia Comprehensive Cancer Registry data (2000-2007), we conducted a case-referent study among 34,053 BC cases and 14,458 lung cancer referents. Individuals with lung cancer were used as referents to control for other cancer risk factors that may be associated with elevated LAN, such as air pollution, and since this cancer type was not previously associated with LAN or circadian rhythm disruption. DMSP-OLS Nighttime Light Time Series satellite images (1992-2007) were used to estimate LAN levels; low (0-20 watts per sterradian cm(2)), medium (21-41 watts per sterradian cm(2)), high (>41 watts per sterradian cm(2)). LAN levels were extracted for each year of exposure prior to case/referent diagnosis in ArcGIS.
  
  
  RESULTS
  Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression models controlling for individual-level year of diagnosis, race, age at diagnosis, tumor grade, stage; and population-level determinants including metropolitan statistical area (MSA) status, births per 1,000 women aged 15-50, percentage of female smokers, MSA population mobility, and percentage of population over 16 in the labor force. We found that overall BC incidence was associated with high LAN exposure (OR = 1.12, 95% CI [1.04, 1.20]). When stratified by race, LAN exposure was associated with increased BC risk among whites (OR = 1.13, 95% CI [1.05, 1.22]), but not among blacks (OR = 1.02, 95% CI [0.82, 1.28]).
  
  
  CONCLUSIONS
  Our results suggest positive associations between LAN and BC incidence, especially among whites. The consistency of our findings with previous studies suggests that there could be fundamental biological links between exposure to artificial LAN and increased BC incidence, although additional research using exposure metrics at the individual level is required to confirm or refute these findings.
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA. secbauer@ufl.edu
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Bauer
authors.forename: Sara E
authors.initials: SE
authors.lastname: Wagner
authors.forename: Jim
authors.initials: J
authors.lastname: Burch
authors.forename: Rana
authors.initials: R
authors.lastname: Bayakly
authors.forename: John E
authors.initials: JE
authors.lastname: Vena
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D016022:Case-Control Studies; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008029:Lighting / Q000009:adverse effects*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors