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. 2024 Jan:183:108298.
doi: 10.1016/j.envint.2023.108298. Epub 2023 Nov 2.

Use of personal care product mixtures and incident hormone-sensitive cancers in the Sister Study: A U.S.-wide prospective cohort

Che-Jung Chang  1 , Katie M O'Brien  1 , Alexander P Keil  2 , Mandy Goldberg  1 , Kyla W Taylor  3 , Dale P Sandler  1 , Alexandra J White  4
Affiliations

Use of personal care product mixtures and incident hormone-sensitive cancers in the Sister Study: A U.S.-wide prospective cohort

Che-Jung Chang et al. Environ Int. 2024 Jan.

Abstract

Background: Personal care products (PCPs), a source of endocrine-disrupting chemical exposure, may be associated with the risk of hormone-sensitive cancers. Few studies have investigated associations for PCP use with the incidence of hormone-sensitive cancers or considered the joint effect of multiple correlated PCPs. We examined associations between frequently used, or "everyday", PCPs and incident cancers of the breast, ovary, and uterus with a fucus on the joint effect of multiple product exposure.

Methods: Sister Study participants (n=49 899) self-reported frequency of use in the year before enrollment (2003-2009) for 41 PCPs. Using five-level frequency categories based on questionnaire options, hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for the associations between multiple PCP use and incident breast, ovarian, and uterine cancer using quantile-based g-computation with Cox proportional hazards regression as the underlying model. Multiple PCP use was examined using groupings (beauty, hygiene, and skincare products) determined by both a priori knowledge and Spearman correlation coefficients for co-occurring product use. Associations between individual PCPs and the three cancers were also examined using Cox proportional hazards models coupling with Benjamini-Hochberg procedure for multiple comparisons.

Results: Over an average of 11.6 years, 4 226 breast, 277 ovarian, and 403 uterine cancer cases were identified. Positive associations were observed between the hygiene mixture and ovarian cancer (HR=1.35, 95%CI=1.00, 1.83) and the beauty mixture with postmenopausal breast cancer (HR=1.08, 95%CI=1.01, 1.16). Additionally, we observed an inverse association between the skincare mixture and breast cancer (HR=0.91, 95%CI=0.83, 0.99). No significant associations were observed for individual products after corrected for multiple comparison.

Conclusions: Findings from this multi-product, joint-effect approach contribute to the growing body of evidence for associations between PCPs and breast cancer and provides novel information on ovarian and uterine cancer.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1.
Figure 1.
Spearman correlation coefficient matrix for frequency of personal care product use.
Figure 2.
Figure 2.
Spearman correlation coefficients for frequency of personal care product use and covariates. [Note: Race and ethnicity, urbanicity, and HRT were coded as binary covariates for each category.]
Figure 3.
Figure 3.
Adjusted associations between one-frequency category increase in use of personal care products and breast cancer: comparison of effect estimates from single-product models (evaluating products individually) using Cox proportional hazards models and effect estimates from the underlying models of multi-product analyses (evaluating products together) using quantile-based g-computation. HR: hazard ratio; 95%CI: 95% confidence interval. Colors of the forest plots only show the directionality of HRs and did not suggest associations or statistical significance. Models used age as the time scale and adjusted for race and ethnicity (African American/Black, Hispanic/Latina non-Black, non-Hispanic White, other), educational attainment (high school or less, some college, college and above), income (<50,000, 50,000-<100,000, ≥100,000), menopausal status at enrollment (premenopausal, postmenopausal), smoking (never, past or current), alcohol (never or past, current <1 drink, current ≥1 drinks), oral contraceptive use duration (none, <2 years, 2-<10 years, ≥10 years), hormone replacement therapy (none, estrogen alone, estrogen plus progestin), physical activity (metabolic equivalent [MET] hours per week, continuous), BMI (restricted cubic spline, continuous, kg/m2), and product term of BMI (restricted cubic spline, continuous, kg/m2) and menopausal status at enrollment (premenopausal, postmenopausal)
Figure 4.
Figure 4.
Adjusted associations between one-frequency category increase in use of personal care products and ovarian cancer: comparison of effect estimates from single-product models (evaluating products individually) using Cox proportional hazards models and effect estimates from the underlying models of multi-product analyses (evaluating products together) using quantile-based g-computation. HR: hazard ratio; 95%CI: 95% confidence interval. Colors of the forest plots only show the directionality of HRs and did not suggest associations or statistical significance. Models used age as the time scale and adjusted for race and ethnicity (African American/Black, Hispanic/Latina non-Black, non-Hispanic White, other), educational attainment (high school or less, some college, college and above), income (<50,000, 50,000-<100,000, ≥100,000), menopausal status at enrollment (premenopausal, postmenopausal), smoking (never, past or current), alcohol (never or past, current <1 drink, current ≥1 drinks), oral contraceptive use duration (none, <2 years, 2-<10 years, ≥10 years), hormone replacement therapy (none, estrogen alone, estrogen plus progestin), physical activity (metabolic equivalent [MET] hours per week, continuous), BMI (restricted cubic spline, continuous, kg/m2), and product term of BMI (restricted cubic spline, continuous, kg/m2) and menopausal status at enrollment (premenopausal, postmenopausal)
Figure 5.
Figure 5.
Adjusted associations between one-frequency category increase in use of personal care products and uterine cancer: comparison of effect estimates from single-product models (evaluating products individually) using Cox proportional hazards models and effect estimates from the underlying models of multi-product analyses (evaluating products together) using quantile-based g-computation. HR: hazard ratio; 95%CI: 95% confidence interval. Colors of the forest plots only show the directionality of HRs and did not suggest associations or statistical significance. Models used age as the time scale and adjusted for race and ethnicity (African American/Black, Hispanic/Latina non-Black, non-Hispanic White, other), educational attainment (high school or less, some college, college and above), income (<50,000, 50,000-<100,000, ≥100,000), menopausal status at enrollment (premenopausal, postmenopausal), smoking (never, past or current), alcohol (never or past, current <1 drink, current ≥1 drinks), oral contraceptive use duration (none, <2 years, 2-<10 years, ≥10 years), hormone replacement therapy (none, estrogen alone, estrogen plus progestin), physical activity (metabolic equivalent [MET] hours per week, continuous), BMI (restricted cubic spline, continuous, kg/m2), and product term of BMI (restricted cubic spline, continuous, kg/m2) and menopausal status at enrollment (premenopausal, postmenopausal).
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