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Sleep deficiency and breast cancer risk among postmenopausal women in the California teachers study (CTS)

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Abstract

Purpose

There is provocative, yet inconsistent, evidence that sleep deficiency may influence the development of breast cancer. The purpose of this study was to evaluate the risk of breast cancer associated with sleep deficiency among postmenopausal women in the California Teachers Study (CTS).

Methods

We conducted a case–control study of 2,856 invasive breast cancer cases and 38,649 cancer-free controls, nested within the CTS. Self-administered questionnaires were used to ascertain several components of sleep deficiency, including quality, latency, duration, disturbance and use of sleep medications. Additionally, a Global Sleep Index (GSI) was created by summing the individual sleep components and categorizing into quartiles. Multivariable logistic regression analyses were used to estimate odds ratios and 95% confidence intervals (OR, 95% CI).

Results

Increased breast cancer risks were associated with sleep deficiency. With the exception of duration, linear increases in risk were associated with all the other individual components of sleep deficiency (p-trend ≤ 0.002). The OR for the highest GSI quartile vs. lowest was 1.24, 95% CI 1.12–1.38; p-trend < 0.001).

Conclusions

Sleep deficiency may be a risk factor for breast cancer. Additional prospective studies and those aimed at elucidating underlying mechanism are warranted.

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Data availability

All of the data associated with this publication and in the California Teachers Study are available for research use. The California Teachers Study welcomes all such inquiries and encourages individuals to visit https://www.calteachersstudy.org/for-researchers.

References

  1. Centers for Disease Control and Prevention (2011) Unhealthy sleep-related behaviors—12 States, 2009. MMWR Morb Mortal Wkly Rep 60:233–238

    Google Scholar 

  2. Institute of Medicine (2006) Sleep disorders and sleep deprivation: an unmet public health problem. The National Academies Press, Washington, DC

    Google Scholar 

  3. Liu Y, Wheaton AG, Chapman DP, Cunningham TJ, Lu H, Croft JB (2016) Prevalence of healthy sleep duration among adults-United States, 2014. MMWR Morb Mortal Wkly Rep 65:137–141

    PubMed  Google Scholar 

  4. International Agency for Research on Cancer (2010) IARC monographs on the evaluation of carcinogenic risks to humans. Painting, fire-fighting, and shiftwork. International Agency for Research on Cancer, Lyon, pp 563–764

    Google Scholar 

  5. Straif K, Baan R, Grosse Y, Secretan B, El Ghissassi F, Bouvard V, Altieri A, Benbrahim-Tallaa L, Cogliano V, WHO International Agency For Research on Cancer Monograph Working Group (2007) Carcinogenicity of shift-work, painting, and fire-fighting. Lancet Oncol 8:1065–1066

    PubMed  Google Scholar 

  6. Ferrie JE, Kumari M, Salo P, Singh-Manoux A, Kivimaki M (2011) Sleep epidemiology–a rapidly growing field. Int J Epidemiol 40:1431–1437

    PubMed  PubMed Central  Google Scholar 

  7. Blask DE (2009) Melatonin, sleep disturbance and cancer risk. Sleep Med Rev 13:257–264

    PubMed  Google Scholar 

  8. Irwin MR (2014) Why sleep is important for health: a psychoneuroimmunology perspective. Annu Rev Psychol. https://doi.org/10.1146/annurev-psych-010213-115205

    Article  PubMed  PubMed Central  Google Scholar 

  9. Alvarez-Garcia V, Gonzalez A, Martinez-Campa C, Alonso-Gonzalez C, Cos S (2013) Melatonin modulates aromatase activity and expression in endothelial cells. Oncol Rep 29:2058–2064

    CAS  PubMed  Google Scholar 

  10. Cos S, Gonzalez A, Martinez-Campa C, Mediavilla MD, Alonso-Gonzalez C, Sanchez-Barcelo EJ (2008) Melatonin as a selective estrogen enzyme modulator. Curr Cancer Drug Targets 8:691–702

    CAS  PubMed  Google Scholar 

  11. Hill SM, Belancio VP, Dauchy RT, Xiang S, Brimer S, Mao L, Hauch A, Lundberg PW, Summers W, Yuan L, Frasch T, Blask DE (2015) Melatonin: an inhibitor of breast cancer. Endocr Relat Cancer 22:R183–204

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Hill SM, Blask DE, Xiang S, Yuan L, Mao L, Dauchy RT, Dauchy EM, Frasch T, Duplesis T (2011) Melatonin and associated signaling pathways that control normal breast epithelium and breast cancer. J Mammary Gland Biol Neoplasia 16:235–245

    PubMed  Google Scholar 

  13. Chen Y, Tan F, Wei L, Li X, Lyu Z, Feng X, Wen Y, Guo L, He J, Dai M, Li N (2018) Sleep duration and the risk of cancer: a systematic review and meta-analysis including dose-response relationship. BMC Cancer 18:1149

    PubMed  PubMed Central  Google Scholar 

  14. Erren TC, Morfeld P, Foster RG, Reiter RJ, Gross JV, Westermann IK (2016) Sleep and cancer: synthesis of experimental data and meta-analyses of cancer incidence among some 1,500,000 study individuals in 13 countries. Chronobiol Int 33:325–350

    CAS  PubMed  Google Scholar 

  15. Lu C, Sun H, Huang J, Yin S, Hou W, Zhang J, Wang Y, Xu Y, Xu H (2017) Long-term sleep duration as a risk factor for breast cancer: evidence from a systematic review and dose-response meta-analysis. Biomed Res Int 2017:4845059

    PubMed  PubMed Central  Google Scholar 

  16. Lu Y, Tian N, Yin J, Shi Y, Huang Z (2013) Association between sleep duration and cancer risk: a meta-analysis of prospective cohort studies. PLoS ONE 8:e74723

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Qin Y, Zhou Y, Zhang X, Wei X, He J (2014) Sleep duration and breast cancer risk: a meta-analysis of observational studies. Int J Cancer 134:1166–1173

    CAS  PubMed  Google Scholar 

  18. Samuelsson LB, Bovbjerg DH, Roecklein KA, Hall MH (2018) Sleep and circadian disruption and incident breast cancer risk: an evidence-based and theoretical review. Neurosci Biobehav Rev 84:35–48

    PubMed  Google Scholar 

  19. National Institutes of Health (2011) 2011 National Institutes of Health Sleep Disorders Research Plan. Available at: https://www.nhlbi.nih.gov/health-topics/all-publications-and-resources/2011-national-institutes-health-sleep-disorders. Accessed on 2019

  20. Brenner R, Kivity S, Peker M, Reinhorn D, Keinan-Boker L, Silverman B, Liphsitz I, Kolitz T, Levy C, Shlomi D, Pillar G, Peled N (2019) Increased risk for cancer in young patients with severe obstructive sleep apnea. Respiration 97:15–23

    PubMed  Google Scholar 

  21. Choi JH, Lee JY, Han KD, Lim YC, Cho JH (2019) Association between obstructive sleep apnoea and breast cancer: the Korean National Health Insurance Service Data 2007–2014. Sci Rep 9:19044

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Fang HF, Miao NF, Chen CD, Sithole T, Chung MH (2015) Risk of cancer in patients with insomnia, parasomnia, and obstructive sleep apnea: a nationwide nested case–control study. J Cancer 6:1140–1147

    PubMed  PubMed Central  Google Scholar 

  23. Gozal D, Ham SA, Mokhlesi B (2016) Sleep apnea and cancer: analysis of a nationwide population sample. Sleep 39:1493–1500

    PubMed  PubMed Central  Google Scholar 

  24. Sillah A, Watson NF, Gozal D, Phipps AI (2019) Obstructive sleep apnea severity and subsequent risk for cancer incidence. Prev Med Rep 15:100886

    PubMed  PubMed Central  Google Scholar 

  25. Kakizaki M, Kuriyama S, Sone T, Ohmori-Matsuda K, Hozawa A, Nakaya N, Fukudo S, Tsuji I (2008) Sleep duration and the risk of breast cancer: the Ohsaki Cohort Study. Br J Cancer 99:1502–1505

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Khawaja A, Rao S, Li L, Thompson CL (2013) Sleep duration and breast cancer phenotype. J Cancer Epidemiol 2013:467927

    PubMed  PubMed Central  Google Scholar 

  27. Verkasalo PK, Lillberg K, Stevens RG, Hublin C, Partinen M, Koskenvuo M, Kaprio J (2005) Sleep duration and breast cancer: a prospective cohort study. Cancer Res 65:9595–9600

    CAS  PubMed  Google Scholar 

  28. McElroy JA, Newcomb PA, Titus-Ernstoff L, Trentham-Dietz A, Hampton JM, Egan KM (2006) Duration of sleep and breast cancer risk in a large population-based case-control study. J Sleep Res 15:241–249

    PubMed  Google Scholar 

  29. Pinheiro SP, Schernhammer ES, Tworoger SS, Michels KB (2006) A prospective study on habitual duration of sleep and incidence of breast cancer in a large cohort of women. Cancer Res 66:5521–5525

    CAS  PubMed  Google Scholar 

  30. Vogtmann E, Levitan EB, Hale L, Shikany JM, Shah NA, Endeshaw Y, Lewis CE, Manson JE, Chlebowski RT (2013) Association between sleep and breast cancer incidence among postmenopausal women in the Women’s Health Initiative. Sleep 36:1437–1444

    PubMed  PubMed Central  Google Scholar 

  31. Girschik J, Heyworth J, Fritschi L (2013) Self-reported sleep duration, sleep quality, and breast cancer risk in a population-based case-control study. Am J Epidemiol 177:316–327

    PubMed  Google Scholar 

  32. Hurley S, Goldberg D, Bernstein L, Reynolds P (2015) Sleep duration and cancer risk in women. Cancer Causes Control 26:1037–1045

    PubMed  PubMed Central  Google Scholar 

  33. Wu AH, Stanczyk FZ, Wang R, Koh WP, Yuan JM, Yu MC (2013) Sleep duration, spot urinary 6-sulfatoxymelatonin levels and risk of breast cancer among Chinese women in Singapore. Int J Cancer 132:891–896

    CAS  PubMed  Google Scholar 

  34. White AJ, Weinberg CR, Park YM, D’Aloisio AA, Vogtmann E, Nichols HB, Sandler DP (2017) Sleep characteristics, light at night and breast cancer risk in a prospective cohort. Int J Cancer 141:2204–2214

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Bernstein L, Allen M, Anton-Culver H, Deapen D, Horn-Ross PL, Peel D, Pinder R, Reynolds P, Sullivan-Halley J, West D, Wright W, Ziogas A, Ross RK (2002) High breast cancer incidence rates among California teachers: results from the California Teachers Study (United States). Cancer Causes Control 13:625–635

    PubMed  Google Scholar 

  36. California Cancer Registry. Available at: https://www.ccrcal.org/abouttheccr.html

  37. Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F (2002) Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 53:737–740

    PubMed  Google Scholar 

  38. Beck SL, Schwartz AL, Towsley G, Dudley W, Barsevick A (2004) Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients. J Pain Symptom Manag 27:140–148

    Google Scholar 

  39. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    CAS  PubMed  Google Scholar 

  40. Adan A, Almirall H (1991) Horne and Ostberg morningness eveningness questionnaire—a reduced scale. Personality Individ Differ 12:241–253

    Google Scholar 

  41. Chelminski I, Petros TV, Plaud JJ, Ferraro R (2000) Psychometric properties of the reduced Horne and Ostberg questionniare. Personality Individ Differ 29:469–478

    Google Scholar 

  42. Duffy JF, Rimmer DW, Czeisler CA (2001) Association of intrinsic circadian period with morningness-eveningness, usual wake time, and circadian phase. Behav Neurosci 115:895–899

    CAS  PubMed  Google Scholar 

  43. Horne JA, Ostberg O (1976) A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int J Chronobiol 4:97–110

    CAS  PubMed  Google Scholar 

  44. Hurley S, Goldberg D, Von Behren J, Clague DeHart J, Wang S, Reynolds P (2019) Chronotype and postmenopausal breast cancer risk among women in the California Teachers Study. Chronobiol Int 36:1504–1514

    PubMed  Google Scholar 

  45. Centers for Disease Control and Prevention (2017) Data and Statistics: Short Sleep Duration Among US Adults. Available at: https://www.cdc.gov/sleep/data_statistics.html. Accessed 2019

  46. Gu F, Xiao Q, Chu LW, Yu K, Matthews CE, Hsing AW, Caporaso NE (2016) Sleep duration and cancer in the NIH-AARP diet and health study cohort. PLoS ONE 11:e0161561

    PubMed  PubMed Central  Google Scholar 

  47. Qian X, Brinton LA, Schairer C, Matthews CE (2015) Sleep duration and breast cancer risk in the Breast Cancer Detection Demonstration Project follow-up cohort. Br J Cancer 112:567–571

    CAS  PubMed  Google Scholar 

  48. Shen J, Chrisman M, Wu X, Chow WH, Zhao H (2019) Sleep duration and risk of cancer in the Mexican American Mano-a-Mano Cohort. Sleep Health 5:78–83

    PubMed  Google Scholar 

  49. Wu AH, Wang R, Koh WP, Stanczyk FZ, Lee HP, Yu MC (2008) Sleep duration, melatonin and breast cancer among Chinese women in Singapore. Carcinogenesis 29:1244–1248

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Xiao Q, Signorello LB, Brinton LA, Cohen SS, Blot WJ, Matthews CE (2016) Sleep duration and breast cancer risk among black and white women. Sleep Med 20:25–29

    PubMed  Google Scholar 

  51. Haus EL, Smolensky MH (2013) Shift work and cancer risk: potential mechanistic roles of circadian disruption, light at night, and sleep deprivation. Sleep Med Rev 17:273–284

    PubMed  Google Scholar 

  52. Hunter CM, Figueiro MG (2017) Measuring light at night and melatonin levels in shift workers: a review of the literature. Biol Res Nurs 19:365–374

    CAS  PubMed  PubMed Central  Google Scholar 

  53. Ball LJ, Palesh O, Kriegsfeld LJ (2016) The pathophysiologic role of disrupted circadian and neuroendocrine rhythms in breast carcinogenesis. Endocr Rev 37:450–466

    CAS  PubMed  PubMed Central  Google Scholar 

  54. Erren TC (2013) Shift work and cancer research: can chronotype predict susceptibility in night-shift and rotating-shift workers? Occup Environ Med 70:283–284

    PubMed  Google Scholar 

  55. Erren TC, Morfeld P (2013) Shift work and cancer research: a thought experiment into a potential chronobiological fallacy of past and perspectives for future epidemiological studies. Neuro Endocrinol Lett 34:282–286

    PubMed  Google Scholar 

  56. Erren TC, Morfeld P, Stork J, Knauth P, von Mulmann MJ, Breitstadt R, Muller U, Emmerich M, Piekarski C (2009) Shift work, chronodisruption and cancer?–The IARC 2007 challenge for research and prevention and 10 theses from the Cologne Colloquium 2008. Scand J Work Environ Health 35:74–79

    PubMed  Google Scholar 

  57. Hansen J, Lassen CF (2012) Nested case-control study of night shift work and breast cancer risk among women in the Danish military. Occup Environ Med 69:551–556

    PubMed  Google Scholar 

  58. Saksvik IB, Bjorvatn B, Hetland H, Sandal GM, Pallesen S (2011) Individual differences in tolerance to shift work—a systematic review. Sleep Med Rev 15:221–235

    PubMed  Google Scholar 

  59. Lauderdale DS, Knutson KL, Yan LL, Liu K, Rathouz PJ (2008) Self-reported and measured sleep duration: how similar are they? Epidemiology 19:838–845

    PubMed  PubMed Central  Google Scholar 

  60. Signal TL, Gale J, Gander PH (2005) Sleep measurement in flight crew: comparing actigraphic and subjective estimates to polysomnography. Aviat Space Environ Med 76:1058–1063

    PubMed  Google Scholar 

  61. Girschik J, Fritschi L, Heyworth J, Waters F (2012) Validation of self-reported sleep against actigraphy. J Epidemiol 22:462–468

    PubMed  PubMed Central  Google Scholar 

  62. Van Den Berg JF, Van Rooij FJ, Vos H, Tulen JH, Hofman A, Miedema HM, Neven AK, Tiemeier H (2008) Disagreement between subjective and actigraphic measures of sleep duration in a population-based study of elderly persons. J Sleep Res 17:295–302

    Google Scholar 

  63. Li J, Vitiello MV, Gooneratne NS (2018) Sleep in normal aging. Sleep Med Clin 13:1–11

    PubMed  Google Scholar 

  64. Figueiro MG, Hamner R, Bierman A, Rea MS (2013) Comparisons of three practical field devices used to measure personal light exposures and activity levels. Light Res Technol 45:421–434

    CAS  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank the California Teachers Study Steering Committee that is responsible for the formation and maintenance of the Study within which this research was conducted. A full list of California Teachers Study team members is available at https://www.calteachersstudy.org/team. We also express our appreciation to all the participants in the California Teachers Study and to the phlebotomists, the researchers, analysts and staff who have contributed to the success of this research, including Nadia Chung, Christine Duffy, Kristen Savage, Emma Spielfogel, and Jane Sullivan-Halley.

Funding

The California Teachers Study and the research reported in this publication were supported by the National Cancer Institute of the National Institutes of Health under award number U01-CA199277; P30-CA033572; P30-CA023100; UM1-CA164917; R01-CA077398; and R01 CA207020. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. The collection of cancer incidence data used in the California Teachers Study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s National Program of Cancer Registries, under cooperative agreement 5NU58DP006344; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute. The opinions, findings, and conclusions expressed herein are those of the author(s) and do not necessarily reflect the official views of the State of California, Department of Public Health, the National Cancer Institute, the National Institutes of Health, the Centers for Disease Control and Prevention or their Contractors and Subcontractors, or the Regents of the University of California, or any of its programs.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, University of California San Francisco, Berkeley, CA, USA

    S. Hurley, D. Goldberg, J. Von Behren & P. Reynolds

  2. School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA

    J. Clague DeHart

  3. Division of Health Analytics, Department of Computational and Quantitative Medicine, City of Hope Comprehensive Cancer Center, Beckman Research Institute, Duarte, CA, USA

    S. Wang

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  1. S. Hurley
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  2. D. Goldberg
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  3. J. Von Behren
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  4. J. Clague DeHart
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  6. P. Reynolds
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Correspondence to S. Hurley.

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Hurley, S., Goldberg, D., Von Behren, J. et al. Sleep deficiency and breast cancer risk among postmenopausal women in the California teachers study (CTS). Cancer Causes Control 31, 1115–1128 (2020). https://doi.org/10.1007/s10552-020-01349-2

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