title: Light and the City: Breast Cancer Risk Factors Differ Between Urban and Rural Women in Israel.
abstract: Women are exposed to indoor and outdoor artificial light at night (ALAN) in urban and rural environments. Excessive exposure to hazardous ALAN containing short wavelength light may suppress pineal melatonin production and lead to an increased breast cancer (BC) risk. Our objective was to address the differences in BC risks related to light exposure in urban and rural communities. We examined indoor and outdoor light habits of BC patients and controls that had lived in urban and rural areas in a 5-year period, 10 to 15 years before the time of the study. Individual data, night time sleeping habits and individual exposure to ALAN habits were collected using a questionnaire. A total of 252 women (110 BC patients and 142 controls) participated in this study. The sample was divided to subgroups according to dwelling area and disease status. Age matching was completed between all subgroups. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for urban and rural women separately, using binary logistic regression. OR results of urban population (92 BC patients and 72 control) revealed that BC risk increases with daily use of cellphone (OR = 2.13, 95% CI = 1.01-4.49, P < .05) and residence near strong ALAN sources (OR = 1.51, 95% CI = 0.99-2.30, P < .06). Nevertheless, BC risk decreases if a woman was born in Israel (OR = 0.44, 95% CI = 0.21-0.93, P < .03), longer sleep duration (OR = 0.75, 95% CI = 0.53-1.05, P < .1), and reading with bed light illumination before retiring to sleep (OR = 0.77, 95% CI = 0.61-0.96, P < .02). Furthermore, in the rural population (18 BC patients and 66 control) BC risk increases with the number of years past since the last menstruation (OR = 1.12, 95% CI = 1.03-1.22, P < .01). However, BC risk decreases with longer sleep duration (OR = 0.53, 95% CI = 0.24-1.14, P < .1), reading with room light illumination before retiring to sleep (OR = 0.55, 95% CI = 0.29-1.06, P < .07), and sleeping with closed shutters during the night (OR = 0.66, 95% CI = 0.41-1.04, P < .08). These data support the idea that indoor and outdoor nighttime light exposures differ between urban and rural women. Therefore, we suggest that women can influence BC risk and incidence by applying protective personal lighting habits. Further studies with larger sample sizes are needed to strengthen the results.
authors.affiliation: 1 University of Haifa, Mount Carmel, Haifa, Israel.
authors.forename: Atalya
authors.initials: A
authors.lastname: Keshet-Sitton
authors.affiliation: 1 University of Haifa, Mount Carmel, Haifa, Israel.
authors.forename: Keren
authors.initials: K
authors.lastname: Or-Chen
authors.affiliation: 2 Poria Medical Center, Tiberius, Israel.
authors.forename: Sara
authors.initials: S
authors.lastname: Yitzhak
authors.affiliation: 3 Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Ilana
authors.initials: I
authors.lastname: Tzabary
authors.affiliation: 1 University of Haifa, Mount Carmel, Haifa, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Haim
mesh_terms: D001943:Breast Neoplasms / Q000209:etiology*; D002940:Circadian Rhythm / Q000502:physiology; D005260:Female; D006184:Habits; D006801:Humans; D015994:Incidence; D007557:Israel; D008027:Light / Q000009:adverse effects*; D016015:Logistic Models; D008550:Melatonin / Q000378:metabolism; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012890:Sleep / Q000502:physiology; D014505:Urban Population / Q000706:statistics & numerical data*
chemical_list: D008550:Melatonin
keywords: artificial light at night; breast cancer; rural; short wavelength illumination; urban