Post-diagnosis Changes in Polycyclic Aromatic Hydrocarbon Sources of Exposure and Survival Following Breast Cancer

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  • March 20, 2019
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  • Parada, Humberto
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • In 2016, an estimated 246,000 women will be diagnosed with, and 40,000 deaths will be attributed to, breast cancer. Polycyclic Aromatic Hydrocarbons (PAHs), a group of over 100 different chemicals formed during the incomplete combustion of organic substances, may influence survival after breast cancer. This dissertation examined whether the primary sources of PAH exposure, tobacco smoke and intake of grilled/smoked meat, and changes in exposure after diagnosis were associated with mortality after breast cancer. To address the dissertation aims, I utilized resources from the Long Island Breast Cancer Study Project (LIBCSP), a population-based cohort study of 1,508 women who were diagnosed with first primary breast cancer in 1996/1997. Women were interviewed at baseline, shortly after diagnosis, and again five years later and have been followed for 18+ years using the National Death Index. Results of Aim 1A showed that smoking in the year before diagnosis was associated with a 69% increased risk of long-term all-cause mortality, but not breast cancer-specific mortality. Among women who continued smoking after breast cancer, risk of all-cause mortality was elevated by 130%, but this was attenuated by approximately 20% among women who quit smoking after diagnosis. Results of Aim 1B examining environmental tobacco smoke exposure were largely null, a finding that is in agreement with few studies conducted to date examining at-diagnosis ETS exposure. Results of Aim 2 showed that at-diagnosis high intake of total grilled/barbecued and smoked meat was associated with a 23% increased risk of all-cause mortality. At-diagnosis intake of smoked beef/lamb/pork was positively associated with all-cause and breast cancer mortality, while intake of smoked poultry/fish was inversely associated with mortality. Women with continued high post-diagnosis intake of grilled/barbecued and smoked meat had a further elevated risk of all-cause mortality; risk increased from 23% to 31%. Consistent with the associations observed for at-diagnosis intake, risk of breast cancer-specific mortality was inversely associated with high post-diagnosis intake of smoked poultry/fish. The results of this dissertation help strengthen smoking cessation efforts and inform the limited dietary intake guidelines currently available for the more than 3 million women who are survivors of breast cancer.
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  • In Copyright
Advisor
  • Engel, Lawrence
  • Bradshaw, Patrick
  • Gammon, Marilie D.
  • Steck, Susan
  • Conway, Kathleen
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2016
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