{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T09:28:57Z","timestamp":1782206937516,"version":"3.54.5"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"4","funder":[{"name":"Intramural Research Program"},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Ethylene oxide (EtO) is a carcinogenic gas used in chemical production and to sterilize medical equipment that has been linked to risk of breast and lymphohematopoietic cancers in a small number of occupational studies. We investigated the relationship between environmental EtO exposure and risk of these cancers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using the US Environmental Protection Agency\u2019s Toxics Release Inventory, we estimated historical exposures for National Institutes of Health\u2013AARP Diet and Health Study participants enrolled in 1995-1996. We constructed 2 metrics at 3, 5, and 10\u2009km: 1) distance between residences and EtO-emitting facilities, weighted by the proportion of time the home was downwind of each facility, and 2) distance-weighted, wind direction\u2013adjusted average airborne emissions index (AEI=\u2211[lbs EtO\/km2]). We estimated risk (hazard ratio [HR], 95% confidence interval [CI]) of incident breast cancer (in situ and invasive) among postmenopausal women (n\u2009=\u2009173\u200a670) overall and by tumor estrogen receptor status and non-Hodgkin lymphoma in the full cohort (n\u2009=\u2009451\u200a945).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We observed an increased risk of breast cancer associated with EtO-emitting facilities within 10\u2009km (HR[\u226410vs&amp;gt;10]\u2009=\u20091.05, 95% CI\u2009=\u20091.00 to 1.10) that appeared stronger for in situ (HR[\u226410vs&amp;gt;10]\u2009=\u20091.13, 95% CI\u2009=\u20091.00 to 1.27) than invasive (HR[\u226410vs&amp;gt;10]\u2009=\u20091.03, 95% CI\u2009=\u20090.97 to 1.09) disease. Risk of breast cancer in situ was also increased in the top AEI quartiles, and associations weakened with larger distances (HR[Q4vs0]\u2009=\u20091.60, 95% CI\u2009=\u20090.98 to 2.61; HR[Q4vs0]\u2009=\u20091.28, 95% CI\u2009=\u20090.92 to 1.79; HR[Q4vs0]\u2009=\u20091.25, 95% CI\u2009=\u20091.02 to 1.53 at 3, 5, and 10\u2009km, respectively). No differences in breast cancer risk were observed by estrogen receptor status. We found no clear pattern of increased non-Hodgkin lymphoma risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A novel potential association between EtO emissions and risk of in situ, but not invasive, breast cancer warrants additional evaluation.<\/jats:p><\/jats:sec>","DOI":"10.1093\/jnci\/djad004","type":"journal-article","created":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T17:43:09Z","timestamp":1673545389000},"page":"405-412","source":"Crossref","is-referenced-by-count":49,"title":["Ethylene oxide emissions and incident breast cancer and non-Hodgkin lymphoma in a US cohort"],"prefix":"10.1093","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1294-1679","authenticated-orcid":false,"given":"Rena R","family":"Jones","sequence":"first","affiliation":[{"name":"Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health , Rockville, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared A","family":"Fisher","sequence":"additional","affiliation":[{"name":"Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health , Rockville, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle N","family":"Medgyesi","sequence":"additional","affiliation":[{"name":"Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health , Rockville, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian D","family":"Buller","sequence":"additional","affiliation":[{"name":"Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health , Rockville, MD, USA"},{"name":"Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health , Rockville, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda M","family":"Liao","sequence":"additional","affiliation":[{"name":"Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health , Rockville, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gretchen","family":"Gierach","sequence":"additional","affiliation":[{"name":"Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health , Rockville, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary H","family":"Ward","sequence":"additional","affiliation":[{"name":"Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health , Rockville, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra T","family":"Silverman","sequence":"additional","affiliation":[{"name":"Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health , Rockville, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,1,12]]},"reference":[{"key":"2023041108155863300_","author":"US Environmental Protection Agency"},{"key":"2023041108155863300_","author":"Liteplo"},{"key":"2023041108155863300_","volume-title":"IARC Monographs on the Evaluation of Carcinogenic Risks to Humans","author":"International Agency for Research on Cancer"},{"key":"2023041108155863300_","author":"Agency for Toxic Substances and Disease Registry"},{"issue":"5","key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1080\/15376516.2017.1414343","article-title":"Carcinogenicity of ethylene oxide: key findings and scientific issues","volume":"28","author":"Jinot","year":"2018","journal-title":"Toxicol Mech Methods"},{"issue":"10","key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1093\/oxfordjournals.aje.a116782","article-title":"Exposure-response analysis of cancer mortality in a cohort of workers exposed to ethylene oxide","volume":"138","author":"Stayner","year":"1993","journal-title":"Am J Epidemiol"},{"issue":"6","key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1023\/A:1024891529592","article-title":"Ethylene oxide and breast cancer incidence in a cohort study of 7576 women (United States)","volume":"14","author":"Steenland","year":"2003","journal-title":"Cancer Causes Control"},{"issue":"1","key":"2023041108155863300_","first-page":"2","article-title":"Mortality analyses in a cohort of 18 235 ethylene oxide exposed workers: follow up extended from 1987 to 1998","volume":"61","author":"Steenland","year":"2004","journal-title":"Occup Environ Med"},{"issue":"1","key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s12940-018-0372-3","article-title":"Exposure to hazardous air pollutants and risk of incident breast cancer in the Nurses\u2019 Health Study II","volume":"17","author":"Hart","year":"2018","journal-title":"Environ Health"},{"issue":"10","key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"606","DOI":"10.14423\/SMJ.0000000000000545","article-title":"Relations between residential proximity to EPA-designated toxic release sites and diffuse large B-cell lymphoma incidence","volume":"109","author":"Bulka","year":"2016","journal-title":"South Med J"},{"key":"2023041108155863300_","author":"US Environmental Protection Agency"},{"issue":"22","key":"2023041108155863300_","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17228646","article-title":"Levels of ethylene oxide biomarker in an exposed residential community","volume":"17","author":"Szwiec","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"12","key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1093\/aje\/154.12.1119","article-title":"Design and serendipity in establishing a large cohort with wide dietary intake distributions: the National Institutes of Health-American Association of Retired Persons Diet and Health Study","volume":"154","author":"Schatzkin","year":"2001","journal-title":"Am J Epidemiol"},{"key":"2023041108155863300_","volume-title":"International Classification of Diseases for Oncology (ICD-O)","author":"World Health Organization","edition":"3rd ed"},{"key":"2023041108155863300_"},{"key":"2023041108155863300_","author":"US Environmental Protection Agency"},{"issue":"1","key":"2023041108155863300_","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17010042","article-title":"Ethylene oxide exposure attribution and emissions quantification based on ambient air measurements near a sterilization facility","volume":"17","author":"Olaguer","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"110986","DOI":"10.1016\/j.envres.2021.110986","article-title":"Evaluation of a commercial database to estimate residence histories in the Los Angeles Ultrafines Study","volume":"197","author":"Medgyesi","year":"2021","journal-title":"Environ Res"},{"issue":"2","key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1158\/1055-9965.EPI-12-1050","article-title":"A comparison of the polytomous logistic regression and joint cox proportional hazards models for evaluating multiple disease subtypes in prospective cohort studies","volume":"22","author":"Xue","year":"2013","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"2023041108155863300_","first-page":"767","volume-title":"Cancer Epidemiology & Prevention","author":"Cerhan","year":"2018","edition":"4th ed"},{"key":"2023041108155863300_","first-page":"861","volume-title":"Cancer Epidemiology & Prevention","author":"Brinton","year":"2018","edition":"4th ed."},{"issue":"11","key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"e15538","DOI":"10.1371\/journal.pone.0015538","article-title":"Neighborhood socioeconomic deprivation and mortality: NIH-AARP Diet and Health Study","volume":"5","author":"Major","year":"2010","journal-title":"PLoS One"},{"key":"2023041108155863300_","volume-title":"IARC Monographs on the Evaluation of Carcinogenic Risks to Humans","author":"International Agency for Research on Cancer"},{"issue":"20","key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1056\/NEJM199105163242004","article-title":"Mortality among workers exposed to ethylene oxide","volume":"324","author":"Steenland","year":"1991","journal-title":"N Engl J Med"},{"issue":"12","key":"2023041108155863300_","first-page":"860","article-title":"Workers exposed to ethylene oxide: a follow up study","volume":"46","author":"Gardner","year":"1989","journal-title":"Br J Ind Med"},{"issue":"4","key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1136\/oem.2003.008268","article-title":"Mortality of workers exposed to ethylene oxide: extended follow up of a British cohort","volume":"61","author":"Coggon","year":"2004","journal-title":"Occup Environ Med"},{"key":"2023041108155863300_","volume-title":"Small Business Guide for Ethylene Oxide","author":"Occupational Safety and Health Administration (OSHA)","year":"2009"},{"issue":"5","key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/j.molonc.2013.07.005","article-title":"Progression from ductal carcinoma in situ to invasive breast cancer: revisited","volume":"7","author":"Cowell","year":"2013","journal-title":"Mol Oncol"},{"issue":"12","key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1093\/aje\/kwx206","article-title":"Epidemiologic risk factors for in situ and invasive breast cancers among postmenopausal women in the National Institutes of Health-AARP Diet and Health Study","volume":"186","author":"Mullooly","year":"2017","journal-title":"Am J Epidemiol"},{"key":"2023041108155863300_","first-page":"31","article-title":"Health and racial disparity in breast cancer","author":"Yedjou","journal-title":"Breast Cancer Metastasis and Drug Resistance. Advances in Experimental Medicine and Biology"},{"key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.envres.2016.07.011","article-title":"Human exposure to endocrine disrupting compounds: their role in reproductive systems, metabolic syndrome and breast cancer. A review","volume":"151","author":"Giulivo","year":"2016","journal-title":"Environ Res"},{"key":"2023041108155863300_","doi-asserted-by":"crossref","first-page":"105113","DOI":"10.1016\/j.yrtph.2021.105113","article-title":"Ethylene oxide derived glycol ethers: a review of the alkyl glycol ethers potential to cause endocrine disruption","volume":"129","author":"Kelsey","year":"2022","journal-title":"Regul Toxicol Pharmacol"},{"key":"2023041108155863300_","author":"US Environmental Protection Agency"},{"key":"2023041108155863300_","author":"US Environmental Protection Agency"}],"container-title":["JNCI: Journal of the National Cancer Institute"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jnci\/advance-article-pdf\/doi\/10.1093\/jnci\/djad004\/49166212\/djad004.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jnci\/article-pdf\/115\/4\/405\/49808390\/djad004.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jnci\/article-pdf\/115\/4\/405\/49808390\/djad004.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T13:24:44Z","timestamp":1701696284000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jnci\/article\/115\/4\/405\/6986131"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,12]]},"references-count":34,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,1,12]]},"published-print":{"date-parts":[[2023,4,11]]}},"URL":"https:\/\/doi.org\/10.1093\/jnci\/djad004","relation":{},"ISSN":["0027-8874","1460-2105"],"issn-type":[{"value":"0027-8874","type":"print"},{"value":"1460-2105","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,4,1]]},"published":{"date-parts":[[2023,1,12]]}}}