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Occupational exposures and mammographic density in Spanish women
  1. Virginia Lope1,2,
  2. Javier García-Pérez1,2,
  3. Beatriz Pérez-Gómez1,2,
  4. Ana María Pedraza-Flechas1,
  5. Juan Alguacil2,3,
  6. Mª Carmen González-Galarzo4,
  7. Miguel Angel Alba5,
  8. Rudolf van der Haar6,
  9. Rosa Ana Cortés-Barragán7,
  10. Carmen Pedraz-Pingarrón8,
  11. Pilar Moreo9,
  12. Carmen Santamariña10,
  13. María Ederra2,11,
  14. Carmen Vidal12,
  15. Dolores Salas-Trejo13,
  16. Carmen Sánchez-Contador14,
  17. Rafael Llobet15,
  18. Marina Pollán1,2
  1. 1 Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
  2. 2 Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
  3. 3 Centro de Investigación en Salud y Medio Ambiente (CYSMA), Universidad de Huelva, Huelva, Spain
  4. 4 Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain
  5. 5 Área de Higiene Industrial, PREMAP Seguridad y Salud S.L.U, Barcelona, Spain
  6. 6 Departamento I+D+I, MC Mutual, Barcelona, Spain
  7. 7 Escuela Nacional de Medicina del Trabajo, Carlos III Institute of Health, Madrid, Spain
  8. 8 Dirección General de Salud Pública, Junta de Castilla y León, Burgos, Spain
  9. 9 Aragon Breast Cancer Screening Program, Aragon Health Service, Zaragoza, Spain
  10. 10 Servicio de Alertas Epidemiolóxicas, Programa Galego Diagnostico Precoz Cancro de Mama, Unidade Central A Coruña, Conselleria de Sanidade, A Coruña, Spain
  11. 11 Public Health Institute, Navarra Breast Cancer Screening Programme, Pamplona, Spain
  12. 12 Prevention and Control Program, Catalan Institute of Oncology, Barcelona, Spain
  13. 13 Valencia Breast Cancer Screening Program, General Directorate Public Health, Valencia, Spain
  14. 14 Dirección General de Salud Pública, Illes Balears, Spain
  15. 15 Institute of Computer Technology, Universitat Politècnica de València, Valencia, Spain
  1. Correspondence to Dr Virginia Lope, Cancer and Environmental Epidemiology Unit, National Center for Epidemiology Carlos III Institute of Health, 28029 Madrid, Spain; vicarvajal{at}


Objectives The association between occupational exposures and mammographic density (MD), a marker of breast cancer risk, has not been previously explored. Our objective was to investigate the influence of occupational exposure to chemical, physical and microbiological agents on MD in adult women.

Methods This is a population-based cross-sectional study based on 1476 female workers aged 45–65 years from seven Spanish breast cancer screening programmes. Occupational history was surveyed by trained staff. Exposure to occupational agents was assessed using the Spanish job-exposure matrix MatEmESp. Percentage of MD was measured by two radiologists using a semiautomatic computer tool. The association was estimated using mixed log-linear regression models adjusting for age, education, body mass index, menopausal status, parity, smoking, alcohol intake, type of mammography, family history of breast cancer and hormonal therapy use, and including screening centre and professional reader as random effects terms.

Results Although no association was found with most of the agents, women occupationally exposed to perchloroethylene (eβ=1.51; 95% CI 1.04 to 2.19), ionising radiation (eβ=1.23; 95% CI 0.99 to 1.52) and mould spores (eβ=1.44; 95% CI 1.01 to 2.04) tended to have higher MD. The percentage of density increased 12% for every 5 years exposure to perchloroethylene or mould spores, 11% for every 5 years exposure to aliphatic/alicyclic hydrocarbon solvents and 3% for each 5 years exposure to ionising radiation.

Conclusions Exposure to perchloroethylene, ionising radiation, mould spores or aliphatic/alicyclic hydrocarbon solvents in occupational settings could be associated with higher MD. Further studies are needed to clarify the accuracy and the reasons for these findings.

  • breast density
  • occupation
  • breast cancer
  • job-exposure matrix
  • chemical agents

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  • Contributors VL, MP and BP-G designed the DDM studies. CPP, PM, CS, ME, CV, DST and CSC coordinated participant recruitment in their respective provinces and contributed to the data collection. RL was responsible for reading mammograms. JA, MCGG, MAA, RvdH and RACB contributed to the acquisition of occupational exposure data and to analysis and interpretation of results. JGP, AMPF and VL contributed to statistical analyses, interpretation of data, and wrote the initial version of the manuscript. All authors contributed to critical revisions of the draft manuscript and approved the final version.

  • Funding This study was funded by the Spanish Ministry of Economy and Competitiveness - Carlos III Institute of Health (ISCIII) (AESI PI15CIII/00013); the Scientific Foundation of the Spanish Association Against Cancer (Fundación Científica de la Asociación Española Contra el Cáncer (AECC) – EVP-1178/14); the Spanish Public Health Research Fund (FIS PI060386 & PS09/0790); the collaboration agreement between Astra-Zeneca and the ISCIII (EPY1306/06) and a grant from the Spanish Federation of Breast Cancer Patients (FECMA 485 EPY 1170–10).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Spanish Organic Law for the Protection of Personal Data was respected at all times. The DDM-Spain study protocol was evaluated and formally approved by the Bioethics and Animal Welfare Committee at the Carlos III Institute of Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.