Total effective xenoestrogen burden in serum samples and risk for breast cancer in a population-based multicase–control study in Spain

Roberto Pastor-Barriuso, Mariana F. Fernández, Gemma Castaño-Vinyals, Denis Whelan, Beatriz Pérez-Gómez, Javier Llorca, Cristina M. Villanueva, Marcela Guevara, José Manuel Molina-Molina, Francisco Artacho-Cordón, Laura Barriuso-Lapresa, Ignasi Tusquets, T. Trinidad, Nuria Aragonés, Nicolás Olea, Manolis Kogevinas, Marina Pollán

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36 Citations (Scopus)


© 2016, Public Health Services, US Dept of Health and Human Services. All rights reserved. Background: Most studies on endocrine-disrupting chemicals and breast cancer have focused on single compounds and have produced inconclusive findings. Objectives: We assessed the combined estrogenic effects of mixtures of xenoestrogens in serum and their relationship to breast cancer risk. Methods: A total of 186 incident pretreatment breast cancer cases and 196 frequency-matched controls were randomly sampled from a large population-based multicase–control study in Spain. The total effective xenoestrogen burden attributable to organohalogenated xenoestrogens (TEXB-α) and endogenous hormones and more polar xenoestrogens (TEXB-β) was determined in serum samples using high-performance liquid chromatography and E-Screen bioassay. Odds ratios for breast cancer comparing tertiles of serum TEXB-α and TEXB-β were estimated using logistic models, and smooth risk trends were obtained using spline models. Results: Cases had higher geometric mean TEXB-α and TEXB-β levels (8.32 and 9.94 Eeq pM/mL, respectively) than controls (2.99 and 5.96 Eeq pM/mL, respectively). The fully adjusted odds ratios for breast cancer (95% confidence intervals) comparing the second and third tertiles of TEXB-α with the first tertile were 1.77 (0.76, 4.10) and 3.45 (1.50, 7.97), respectively, and those for TEXB-β were 2.35 (1.10, 5.03) and 4.01 (1.88, 8.56), respectively. A steady increase in risk was evident across all detected TEXB-α levels and a sigmoidal trend was observed for TEXB-β. Individual xenoestrogens showed weak and opposing associations with breast cancer risk. Conclusions: This is the first study to show a strong positive association between serum total xenoestrogen burden and breast cancer risk, highlighting the importance of evaluating xenoestrogen mixtures, rather than single compounds, when studying hormone-related cancers.
Original languageEnglish
Pages (from-to)1575-1582
JournalEnvironmental Health Perspectives
Issue number10
Publication statusPublished - 1 Oct 2016


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