Abstract
BACKGROUND: It is unknown whether carcinogenic and endocrine disrupting polychlorinated biphenyls (PCBs) influence mortality following breast cancer. We examined plasma levels of 17 PCB congeners in association with mortality among women with breast cancer. METHODS: Participants included 456 white and 292 black women in North Carolina who were diagnosed with primary invasive breast cancer from 1993 to 1996, and who had PCB and lipid measurements from blood samples obtained an average of 4.1 months after diagnosis. Over a median follow-up of 20.6 years, there were 392 deaths (210 from breast cancer). We used Cox regression to estimate covariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and breast cancer-specific 5-year mortality, and 20-year mortality (conditional on 5-year survival) in association with tertiles and continuous ln-transformed lipid-adjusted PCB levels. RESULTS: The highest (vs. lowest) tertiles of PCB74, PCB99, and PCB118 were associated with 5-year breast cancer-specific mortality HRs of 1.46 (95%CI = 0.86-2.47), 1.57 (95%CI = 0.90-2.73), and 1.86 (95%CI = 1.07-3.23), respectively. Additionally, one-ln unit increases in PCB74, PCB99, PCB118, and total PCBs were each associated with 33-40% increases in 5-year breast cancer-specific mortality rates. The PCBs were not, however, associated with longer-term breast cancer-specific mortality. For all-cause mortality, one-ln unit increases in PCB118, PCB146, PCB153, PCB182, PCB187, and total PCBs were associated with 20-37% increases in 20-year all-cause mortality rates among women who survived at least 5 years. CONCLUSION: PCBs may increase the risk of short-term breast cancer-specific mortality and long-term all-cause mortality among women with breast cancer.