Review
Working against our endogenous circadian clock: Breast cancer and electric lighting in the modern world

https://doi.org/10.1016/j.mrgentox.2009.08.004Get rights and content

Abstract

Breast cancer incidence increases rapidly as societies industrialize. Many changes occur during the industrialization process, one of which is a dramatic alteration in the lighted environment from a sun-based system to an electricity-based system. Increasingly, the natural dark period at night is being seriously eroded for the bulk of humanity. Based on the fact that light during the night can suppress melatonin, and also disrupt the circadian rhythm, it was proposed in 1987 that increasing use of electricity to light the night accounts in part for the rising risk of breast cancer globally. Predictions from the theory include: non-day shift work increases risk, blindness lowers risk, long sleep duration lowers risk, and population level community nighttime light level co-distributes with breast cancer incidence. Thus far, studies of these predictions are consistent in support of the theory. A new avenue of research has been on function of circadian genes and whether these are related to breast cancer risk. In particular, a length variant of Per3 (5-VNTR) has been associated with increased risk in young women, and this same 5-VNTR variant has also been found to predict morning diurnal type and shorter sleep duration compared to the 4-VNTR variant. An important question is how an effect of light-at-night (LAN) exposure on breast cancer risk might be modified by polymorphisms and/or epigenetic alterations in the circadian genes, and conversely whether light-at-night exposure (e.g., shift work) can induce deleterious epigenetic changes in these genes.

Section snippets

Circadian rhythms

The circadian rhythm is an endogenous oscillation of approximately 24 h in physiology and metabolism with characteristic cycles of, among many other attributes, body temperature, hormone secretion, sleep/wake cycle, alertness, and gene expression [1]. ‘Endogenous’ means that the rhythm persists indefinitely in a constant dark environment that also contains no other time cues, and ‘approximately’ means that under constant dark conditions the endogenous rhythm is typically a little longer than 24 h

Light-at-night theory

In the mid-1980s, Stevens [11] proposed that increasing use of electric light-at-night (LAN) might explain part of the increasing incidence of breast cancer in industrial societies and the rapidly increasing risk in the developing world by suppressing melatonin production by the pineal gland; normally, melatonin production is 5–20 times higher at night in the dark than during the day, but this normal elevation at night will be suppressed by exposure to artificial light of sufficient intensity.

Shift work

One of the first and most obvious predictions of this theory was that shift working women would be at higher risk of breast cancer than day-working women [13]. Evidence has advanced to the point where the International Agency for Research on Cancer has concluded that “shift-work that involves circadian disruption is probably carcinogenic to humans (Group 2A)” [14]. This was based on a strong animal model [15], and a limited, but consistent group of epidemiological studies, many of which were of

Circadian genes and cancer epidemiology

As it has become clearer that the core circadian genes directly control the expression of a vast number of other genes, notably genes of cell cycle regulation and apoptosis, other mechanisms by which circadian disruption could increase risk of disease have become apparent [18], [19], [20]. If circadian disruption can cause cancer, then one obvious avenue of investigation is the association of markers of circadian gene function and risk [21], [22]. Specifically, Zhu et al. [23] speculated that

Early life experience and breast cancer

Since the seminal (or ovumal) paper by Trichopoulos [36], there has been growing interest in the possibility that early life experience, even beginning in utero, could affect lifetime risk of breast cancer. Combining this theory with the possibility that circadian disruption from altered lighting might increase risk yields the idea that a woman's light exposure during pregnancy (particularly from non-day shift work) might increase lifetime risk of breast cancer to her daughters, and that the

Discussion

If shift work does cause cancer then the mechanism is crucial to understand for the purposes of intervention and mitigation; shift work is not going to go away as more of world commerce operates on a 24 h basis. Given our advancing understanding of the biology of circadian rhythms and of how light affects the rhythm [40], the scientific and architectural lighting communities will work together to design shift schedules, and the lighting of non-day shift environments that better accommodate

Conflict of interest statement

The author declares that there are no conflicts of interest.

References (40)

  • K.F. Storch et al.

    Extensive and divergent circadian gene expression in liver and heart

    Nature

    (2002)
  • S. Sahar et al.

    Circadian clock and breast cancer: a molecular link

    Cell Cycle

    (2007)
  • A. Arnold et al.

    Cyclin D1 in breast cancer pathogenesis

    J. Clin. Oncol.

    (2005)
  • K.A. Lamia et al.

    Physiological significance of a peripheral tissue circadian clock

    Proc. Natl. Acad. Sci. U.S.A.

    (2008)
  • R.G. Stevens

    Review and commentary: electric power use and breast cancer: a hypothesis

    Am. J. Epidemiol.

    (1987)
  • R.G. Stevens

    Light-at-night, circadian disruption and breast cancer: assessment of existing evidence

    Int. J. Epidemiol.

    (2009)
  • D.E. Blask et al.

    Melatonin-depleted blood from premenopausal women exposed to light at night stimulates growth of human breast cancer xenografts in nude rats

    Cancer Res.

    (2005)
  • H.A. Kolstad

    Nightshift work and risk of breast cancer and other cancers—a critical review of the epidemiologic evidence

    Scand. J. Work Environ. Health

    (2008)
  • J.B. Burch et al.

    Melatonin, sleep, and shift work adaptation

    J.O.E.M.

    (2005)
  • R.G. Stevens et al.

    Meeting report: the role of environmental lighting and circadian disruption in cancer and other diseases

    Environ. Health Perspec.

    (2007)
  • Cited by (67)

    • Sleep duration and risk of cancer in the Mexican American Mano-a-Mano Cohort

      2019, Sleep Health
      Citation Excerpt :

      Short sleep duration has been associated with increased cancer risk factors related to insulin metabolism, including obesity, metabolic syndrome, and diabetes.4,38 Similarly, the carcinogenic effects of circadian disruption are thought to be mediated through the suppression of melatonin, an endogenous hormone with potentially antiestrogenic properties that is released primarily during nocturnal sleep and would therefore likely exert a defensive effect among long sleepers.37,39–41 Our observation that long sleep duration is associated with increased risk of overall cancer among overweight participants and those with medium or high levels of physical activity can possibly be explained as an effect mediated through proinflammatory immune responses.

    • Chronobiological regulation of psychosocial and physiological outcomes in multiple sclerosis

      2018, Neuroscience and Biobehavioral Reviews
      Citation Excerpt :

      Deletion of BMAL1 in myeloid cells is associated with increased infiltration of myeloid cells and CD4+ T cells into the CNS of acute phase EAE mice. This infiltration was also associated with increased expression of IL-1β in myeloid cells and larger numbers of IFN-γ and IL-17 expressing T cells (Sutton et al., 2017). The efficiency of immunization with respect to lymphoid cells seems to be related to the egress and recruitment of lymphocytes from tissues into secondary lymphoid organs (Druzd et al., 2017).

    • Aging and circadian dysfunction increase alcohol sensitivity and exacerbate mortality in Drosophila melanogaster

      2017, Experimental Gerontology
      Citation Excerpt :

      Aging weakens the circadian system resulting in dampened molecular and neuronal rhythms causing variable and fragmented behavioral rhythms (Banks et al., 2016; Nakamura et al., 2016). Circadian misalignment associated with aging has been implicated in the elevated risk of cancer (Reszka and Przybek, 2016; Smolensky et al., 2016b; Stevens, 2009), obesity (Gibson et al., 2009; Karatsoreos et al., 2011), diabetes (Kawakami et al., 2004; Spiegel et al., 2005), cardiovascular disease (Ha and Park, 2005; Kivimäki et al., 2006) and the onset of myocardial infarction and stroke (Malik et al., 1990; Scheer et al., 2009; Smolensky et al., 2016a; Tofler et al., 1987). Furthermore, circadian dysfunction accelerates cellular aging and mortality with period alterations shortening lifespan in animal models (Krishnan et al., 2012; Park et al., 2012).

    View all citing articles on Scopus
    View full text