Annals of Occupational and Environmental Medicine

Original Article

Increased breast cancer incidence among nurses in a tertiary university hospital in South Korea: Juho Choi, Dong-Wook Lee, Baek-Yong Choi, Seung-Woo Ryoo, Taeshik Kim, Yun-Chul Hong; Ann Occup Environ Med 2023;35:e44. Published online November 4, 2023; DOI: https://doi.org/10.35371/aoem.2023.35.e44

Abstract Abstract in Korean PDF PubReader ePub: Background
A series of breast cancer cases were recently reported in a tertiary university hospital in South Korea. Nurses are generally exposed to risk factors for breast cancer such as night shift work, antineoplastic agents, and job strain. However, the epidemiological evidence of excess incidence among nurses remains lacking. This study aims to investigate the excess incidence of breast cancer among nurses in a tertiary university hospital and provide epidemiological evidence of occupational risk factors.
Methods
A retrospective cohort was developed using personnel records of female workers in the nursing department who worked from January 2011 to June 2021 in a tertiary university hospital in South Korea. Sick leave records were used to identify cases of breast cancer. The standardized incidence ratio of breast cancer among nurses was compared to the general population.
Results
A total of 5,509 nurses were followed up for 30,404 person-years, and 26 breast cancer cases were identified. This study revealed a significantly increased breast cancer incidence among all included nurses, with a standardized incidence ratio of 1.65 (95% confidence interval [CI]: 1.08–2.41), compared to the general population. Workers, who handle antineoplastic agents in their representative department and current and/or former department, had significantly elevated breast cancer standardized incidence ratios of 2.73 (95% CI: 1.008–5.94) and 3.39 (95% CI: 1.46–6.68), respectively.
Conclusions
This study provides significant evidence of increased breast cancer risk among nursing staff in a hospital setting, particularly those who handle antineoplastic drugs. Measures that reduce exposure to risk factors should be implemented, especially anticancer drugs, to protect healthcare professionals. Further research at a national level that focuses on healthcare workers is necessary to validate breast cancer incidence and its contributing factors.; 국내 모 대학병원 내 간호노동자에서의 유방암 발병률 증가
목적
최근 서울에 위치한 모 대학병원에서 항암제를 취급하는 근무지 내 간호사 중에서 여러 건의 유방암이 진단되었다. 간호사들에 대한 직업적 위험인자로 야간 근무, 항암제 노출, 직무 스트레스 등이 파악되었다. 그러나 간호사를 포함한 의료종사자들 사이에서 유방암 발병률 증가에 대한 연구 결과는 부족하다. 본 연구는 해당 대학병원의 간호부문 근로자에서의 유방암 발병률을 일반인과 비교하여 확인함으로써, 이들의 직업적 위험요인에 대한 역학적 증거를 제공하고자 하였다.
방법
해당 대학병원의 인사기록을 활용하여 후향적 코호트 연구를 수행하였으며, 2011년 1월부터 2021년 6월까지 간호부문에서 근무한 여성 근로자를 연구대상으로 하였다. 유방암 환자들을 식별하기 위해 병가 기록이 활용되었으며, 대표적인 근무지는 근로자가 가장 오래 근무한 곳을 기준으로 결정되었다. 간호부문 근로자에서의 연령 표준화 유방암 발병률을 산출하여 일반인구와 비교하였다.
결과
본 연구에서는 간호부문 근로자 5,509명을 대상으로 코호트 연구를 수행하였다. 관찰기간은 총 30,404인년이었고, 추적 기간 동안 신규 유방암 환자 26명을 확인하였다. 전체 간호부문 근로자들에서의 일반인구 대비 유방암 표준화발생률(Standardized Incidence ratio, SIR)은 1.65 (95% CI : 1.08-2.41)로 유의한 증가를 보였다. 항암제 취급 부서가 그들의 대표부서이거나 이전에 근무했던 경험이 있는 경우, 각각 2.73배(95% CI :1.00-5.94), 3.39배(95% CI : 1.46-6.68) 높은 유방암 발병위험이 확인되었다.
결론
본 연구는 병원 내 간호부문 종사자, 특히 항암제 취급 종사자에서의 유방암 발병 위험이 일반인구 대비 유의하게 증가함을 확인하였다. 의료종사자들을 직업적 위험요인으로부터 보호하기 위해 항암제 노출 차단, 야간 근무 감소, 개인 맞춤형 건강검진이 도입되어야 할 것이다. 추후 의료종사자를 대상으로 국가 수준의 연구를 통해 이들의 유방암 발병위험과 그 기여요인에 대해 확인해야 할 것이다.

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Case Report

Assessment of risks for breast cancer in a flight attendant exposed to night shift work and cosmic ionizing radiation: a case report: Dong Joon Park, Sungkyun Park, Seong Won Ma, Hoekyeong Seo, Sang Gil Lee, Kyung-Eun Lee; Ann Occup Environ Med 2022;34:e5. Published online March 22, 2022; DOI: https://doi.org/10.35371/aoem.2022.34.e5

Abstract Abstract in Korean PDF Supplementary Material PubReader ePub

Background

Some epidemiological studies have estimated exposure among flight attendants with and without breast cancer. However, it is difficult to find a quantitative evaluation of occupational exposure factors related to cancer development individually in the case of breast cancer in flight attendants. That is, most, if not all, epidemiological studies of breast cancer in flight attendants with quantitative exposure estimates have estimated exposure in the absence of individual flight history data.

Case presentation

A 41-year-old woman visited the hospital due to a left breast mass after a regular check-up. Breast cancer was suspected on ultrasonography. Following core biopsy, she underwent various imaging modalities. She was diagnosed invasive ductal carcinoma of no special type (estrogen receptor positive in 90%, progesterone receptor positive in 3%, human epidermal growth factor receptor 2/neu equivocal) with histologic grade 3 and nuclear grade 3 in the left breast. Neoadjuvant chemotherapy was administered to reduce the tumor size before surgery. However, due to serious chemotherapy side effects, the patient opted for alternative and integrative therapies. She joined the airline in January, 1996. Out of all flights, international flights and night flights accounted for 94.9% and 26.2, respectively. Night flights were conducted at least four times per month. Moreover, based on the virtual computer program CARI-6M, the estimated dose of cosmic radiation exposure was 78.81 mSv. There were no other personal triggers or family history of breast cancer.

Conclusions

This case report shows that the potentially causal relationship between occupational harmful factors and the incidence of breast cancer may become more pronounced when night shift workers who work continuously are exposed to cosmic ionizing radiation. Therefore, close attention and efforts are needed to adjust night shift work schedules and regulate cosmic ionizing radiation exposure.

국제항공 승무원에서 발생한 유방암 사례와 업무관련성 평가
배경
유방암은 여성에게 가장 흔하게 진단되는 암으로, 전리방사선과 야간교대근무와 같은 직업환경적 위험을 포함한 다양한 요인에 의해 영향을 받는다. 항공승무원은 우주 전리 방사사선과 야간교대근무 환경에 노출되는 대표적인 직업군으로 일반인구집단 대비 유방암의 발병 위험이 높다고 몇몇 역학연구에서는 보고되고 있다. 그러나 항공승무원의 유방암 사례에서 암 발병과 관련된 직업적 노출요인에 대하여 정량적으로 평가한 사례는 찾기 어렵다. 본 연구에서는 질환발병의 업무관련성을 인정받은 항공승무원 종사자의 유방암 사례에서 질환 발병과 관련된 직업적 요인들의 노출 수준을 정량적인 평가하였다.
증례
41세의 여성 환자는 항공승무원 재직 중 정기건강검진에서 우연히 발견된 좌측 유방종괴를 주소로 병원에 내원하였다. 초음파 검사 및 조직생검 등의 검사결과 유방의 침습암종(조직 및 핵분화도 3기), 을 진단 받았다. 환자는 유방 보존술을 위한 선행화학요법 시행 중에 부작용이 발생하여 수술적 치료를 시행하지 못하고 보존적 치료를 유지중이다. 환자는 1996년 1월 항공사에 입사하여, 20년 2개월간 항공승무원으로 종사하였다. 총 비행기 탑승 이력 중 94.9%는 국제선에 탑승하였고 총 비행시간의 26.2%는 야간 비행으로 한 달에 네 번 이상 야간 비행업무를 수행하였다. 컴퓨터 시뮬레이션 프로그램인 CARI-6M을 이용하여 추정한 근로자의 우주 방사선 누적노출 추정량은 78.81 mSv였다. 유방암에 대한 개인적 유발 요인 및 가족력은 없었다. 역학조사평가위원회는 이 여성 승무원에서 발생한 유방암은 20년 2개월 간의 야간교대근무와 78.81 mSv의 우주 방사선 노출을 근거로 업무관련성이 상당하다고 평가하였다.
고찰
이번 사례는 항공 승무원 집단에서의 높은 유방암 발병률은 야간교대근무와 함께 기체 탑승 중 우주 전리방사선의 복합적 노출에 의해 기인될 수 있음을 보여준다. 항공 승무원 집단에서의 야간교대근무와 우주 전리방사선 복합노출에 따른 건강영향을 최소화하기 위해서는 더많은 노출평가 사례 및 집단 역학조사를 통한 비행일정 관리기준의 근거마련이 필요하다.

Citations

Citations to this article as recorded by

Influence of occupational factors on the development of gynecologic pathology in flight attendants in civil aviation
Nailya I. Nasyrova, Artem Y. Yurovskiy, Aleksei V. Overko, Lyudmila A. Ozolinya
V.F.Snegirev Archives of Obstetrics and Gynecology.2024; 11(2): 137. CrossRef

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Research Article

The relationship between night work and breast cancer: Hye-Eun Lee, Jongin Lee, Tae-Won Jang, In-Ah Kim, Jungsun Park, Jaechul Song; Ann Occup Environ Med 2018;30:11. Published online February 6, 2018; DOI: https://doi.org/10.1186/s40557-018-0221-4

Abstract PDF PubReader ePub

Background

Since the International Agency for Research on Cancer classified shift work that involves circadian disruption as “probably carcinogenic to humans,” there has been growing concern on the relationship between night work and breast cancer. In Korea, about 10–15% of workers are engaged in night-shift work, and breast cancer is one of the most common cancers in women. The purpose of this study was to review epidemiologic evidence on the relationship between night work and breast cancer.

Methods

We reviewed 21 original articles and 5 meta analyses on relationship between nightwork and breast cancer, and investigated the compensation criteria of Denmark.

Results

The association between breast cancer and night work has been reported by numerous epidemiologic studies, including cohort studies, case-control studies, and meta-analysis. However, a dose-response relationship has not clearly emerged among workers exposed to less than 20 years of night work.

Conclusion

Although there are some limitations to the epidemiological studies so far, further consideration of breast cancer cases in patients with high exposure to night work is needed to assess breast cancer as a work-related disease.

Citations

Citations to this article as recorded by

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