DOI QR코드

DOI QR Code

Increased breast cancer incidence among nurses in a tertiary university hospital in South Korea

  • Juho Choi (Department of Preventive Medicine, Seoul National University, College of Medicine) ;
  • Dong-Wook Lee (Department of Occupational and Environmental Medicine, Inha University Hospital, Inha University) ;
  • Baek-Yong Choi (Department of Preventive Medicine, Seoul National University, College of Medicine) ;
  • Seung-Woo Ryoo (Department of Preventive Medicine, Seoul National University, College of Medicine) ;
  • Taeshik Kim (Department of Public Health and Community Medicine, Seoul Metropolitan Government–Seoul National University Boramae Medical Center) ;
  • Yun-Chul Hong (Department of Preventive Medicine, Seoul National University, College of Medicine)
  • Received : 2023.07.10
  • Accepted : 2023.11.02
  • Published : 2023.12.31

Abstract

Background: A series of breast cancer cases were recently reported in a tertiary university hospital in South Korea. Nurses are generally exposed to risk factors for breast cancer such as night shift work, antineoplastic agents, and job strain. However, the epidemiological evidence of excess incidence among nurses remains lacking. This study aims to investigate the excess incidence of breast cancer among nurses in a tertiary university hospital and provide epidemiological evidence of occupational risk factors. Methods: A retrospective cohort was developed using personnel records of female workers in the nursing department who worked from January 2011 to June 2021 in a tertiary university hospital in South Korea. Sick leave records were used to identify cases of breast cancer. The standardized incidence ratio of breast cancer among nurses was compared to the general population. Results: A total of 5,509 nurses were followed up for 30,404 person-years, and 26 breast cancer cases were identified. This study revealed a significantly increased breast cancer incidence among all included nurses, with a standardized incidence ratio of 1.65 (95% confidence interval [CI]: 1.08-2.41), compared to the general population. Workers, who handle antineoplastic agents in their representative department and current and/or former department, had significantly elevated breast cancer standardized incidence ratios of 2.73 (95% CI: 1.008-5.94) and 3.39 (95% CI: 1.46-6.68), respectively. Conclusions: This study provides significant evidence of increased breast cancer risk among nursing staff in a hospital setting, particularly those who handle antineoplastic drugs. Measures that reduce exposure to risk factors should be implemented, especially anticancer drugs, to protect healthcare professionals. Further research at a national level that focuses on healthcare workers is necessary to validate breast cancer incidence and its contributing factors.

Keywords

Acknowledgement

This research was supported by Seoul National University Hospital.

References

  1. Fenga C. Occupational exposure and risk of breast cancer. Biomed Rep 2016;4(3):282-92.
  2. Vainio H, Bianchini F. Weight Control and Physical Activity. Lyon, France: IARC Press; 2002.
  3. Erren TC, Morfeld P, Gross JV, Wild U, Lewis P. IARC 2019: "Night shift work" is probably carcinogenic: what about disturbed chronobiology in all walks of life? J Occup Med Toxicol 2019;14(1):29.
  4. IARC Monographs Vol 124 group. Carcinogenicity of night shift work. Lancet Oncol 2019;20(8):1058-9.
  5. Wegrzyn LR, Tamimi RM, Rosner BA, Brown SB, Stevens RG, Eliassen AH, et al. Rotating night-shift work and the risk of breast cancer in the nurses' health studies. Am J Epidemiol 2017;186(5):532-40.
  6. Cogliano VJ, Baan R, Straif K, Grosse Y, Lauby-Secretan B, El Ghissassi F, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103(24):1827-39.
  7. Ratner PA, Spinelli JJ, Beking K, Lorenzi M, Chow Y, Teschke K, et al. Cancer incidence and adverse pregnancy outcome in registered nurses potentially exposed to antineoplastic drugs. BMC Nurs 2010;9(1):15.
  8. Falck K, Grohn P, Sorsa M, Vainio H, Heinonen E, Holsti LR. Mutagenicity in urine of nurses handling cytostatic drugs. Lancet 1979;1(8128):1250-1.
  9. Kuper H, Yang L, Theorell T, Weiderpass E. Job strain and risk of breast cancer. Epidemiology 2007;18(6):764-8.
  10. Schernhammer ES, Hankinson SE, Rosner B, Kroenke CH, Willett WC, Colditz GA, et al. Job stress and breast cancer risk: the nurses' health study. Am J Epidemiol 2004;160(11):1079-86.
  11. Kruk J, Aboul-Enein HY. Psychological stress and the risk of breast cancer: a case-control study. Cancer Detect Prev 2004;28(6):399-408.
  12. Rix BA, Lynge E. Cancer incidence in Danish health care workers. Scand J Soc Med 1996;24(2):114-20.
  13. Lee YS, Hsu CC, Weng SF, Lin HJ, Wang JJ, Su SB, et al. Cancer incidence in physicians: a Taiwan National population-based cohort study. Medicine (Baltimore) 2015;94(47):e2079.
  14. Lee DW, Kim H, Lee W, Lee WR, Yoo KB, Choi JH, et al. Cancer incidence in Korean healthcare workers in hospitals. Cancers (Basel) 2023;15(7):2045.
  15. Breslow NE, Day NE. Statistical methods in cancer research. Volume II--The design and analysis of cohort studies. IARC Sci Publ 1987;82(82):1-406.
  16. Sahai H, Khurshid A. Statistics in Epidemiology: Methods, Techniques, and Applications. Boca Raton, FL. USA: CRC Press; 1996.
  17. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. Philadelphia, PA, USA: Lippincott Williams & Wilkins; 2008, 776.
  18. Kamdar BB, Tergas AI, Mateen FJ, Bhayani NH, Oh J. Night-shift work and risk of breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2013;138(1):291-301.
  19. Wang F, Yeung KL, Chan WC, Kwok CC, Leung SL, Wu C, et al. A meta-analysis on dose-response relationship between night shift work and the risk of breast cancer. Ann Oncol 2013;24(11):2724-32.
  20. Korea Institute for Health and Social Affairs. Healthcare Workforce Survey. Sejong, Korea: Korea Institute for Health and Social Affairs; 2022.
  21. Sessink PJ, Bos RP. Drugs hazardous to healthcare workers. Evaluation of methods for monitoring occupational exposure to cytostatic drugs. Drug Saf 1999;20(4):347-59.
  22. Lee SO, Sim ES, Ahn S. Factors affecting periodic screening behaviors for breast cancer among hospital nurses. Korean J Women Health Nurs 2010;16(4):390-8.
  23. Ju HO, Kim JS, Cho YS, Park NH, Eo YS, Cho YR, et al. A survey on cancer screening among nurses at General Hospital in Busan. Korean J Women Health Nurs 2003;9(1):18.
  24. Health Promotion Administration, Ministry of Health and Welfare. 2018 Annual Report of Health Promotion Administration. Taipei City, Taiwan; 2018.
  25. Kang SY, Lee SB, Kim YS, Kim Z, Kim HY, Kim HJ, et al. Breast cancer statistics in Korea, 2018. J Breast Cancer 2021;24(2):123-37.
  26. Shin Y, Kim UJ, Lee HA, Choi EJ, Park HJ, Ahn HS, et al. Health and mortality in Korean healthcare workers. J Korean Med Sci 2022;37(3):e22.
  27. International Agency for Research on Cancer (IARC). IARC Handbooks of Cancer Prevention, Volume 15: Breast Cancer Screening. Lyon, France: IARC; 2016.
  28. International Agency for Research on Cancer (IARC). Some Antiviral and Antineoplastic Drugs, and Other Pharmaceutical Agents. Lyon, France: IARC; 2000.