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Air Pollution and Risk of Uterine Leiomyomata

Mahalingaiah, Shruthia; Hart, Jaime E.b,c; Laden, Francineb,c,d; Terry, Kathryn L.d,e,f; Boynton-Jarrett, Renéeg; Aschengrau, Annh; Missmer, Stacey A.b,d,f

doi: 10.1097/EDE.0000000000000126
Air Pollution

Background: Air pollution, particularly from vehicle exhaust, has been shown to influence hormonal activity. However, it is unknown whether air pollution exposure is associated with the occurrence of uterine leiomyomata, a hormonally sensitive tumor of the uterus.

Methods: For 85,251 women 25–42 years of age at enrollment in the Nurses’ Health Study II, we examined proximity to major roadways and outdoor levels of particulate matter less than 10 microns (PM10) or 2.5 microns (PM2.5) or between 10 and 2.5 microns (PM10–2.5) in diameter for all residential addresses from September 1989 to May 2007. To be eligible for this analysis, a woman had to be alive and respond to questionnaires, premenopausal with an intact uterus, and without diagnoses of cancer or prevalent uterine leiomyomata. Incidence of ultrasound- or hysterectomy-confirmed uterine leiomyomata and covariates were reported on biennial questionnaires sent through May 2007. Multivariable time-varying Cox proportional hazard models were used to estimate the relationship between distance to road or PM exposures and uterine leiomyomata risk.

Results: During 837,573 person-years of follow-up, there were 7760 incident cases of uterine leiomyomata. Living close to a major road and exposures to PM10 or PM10–2.5 were not associated with an increased risk of uterine leiomyomata. However, each 10 μg/m3 increase in 2-year average, 4-year average, or cumulative average PM2.5 was associated with an adjusted hazard ratio of 1.08 (95% confidence interval = 1.00–1.17), 1.09 (0.99–1.19), and 1.11 (1.03–1.19), respectively.

Conclusions: Chronic exposure to PM2.5 may be associated with a modest increased risk of uterine leiomyomata.

From the aDepartment of Obstetrics and Gynecology, Boston Medical Center and Boston University, Boston, MA; bChanning Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; cExposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA; dDepartment of Epidemiology, Harvard School of Public Health, Boston, MA; eObstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA; fDepartment of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; gDivision of General Pediatrics, Boston University School of Medicine, Boston, MA; and hDepartment of Epidemiology, Boston University School of Public Health, Boston, MA.

Submitted 15 May 2013; accepted 14 January 2014; posted 8 May 2014.

S.M. and J.E.H. contributed equally to the manuscript.

The authors report no conflicts of interest.

Supported by grant 5K12HD043444-10 and R01HD57210 from the National Institute of Child Health and Human Development, R01CA50385 from the National Cancer Institute, 5R01ES017017 from the National Institute for Environmental Health Sciences, an infrastructure grant from the National Cancer Institute: UM1CA176726, a research grant from the Boston University Department of Obstetrics and Gynecology, and the Massachusetts Institute of Technology Center for Environmental Health Sciences Translational Pilot Project Program.

Correspondence: Shruthi Mahalingaiah, Department of Obstetrics and Gynecology, Boston Medical Center/Boston University, 85 East Concord St. 6th Floor, Boston, MA 02118. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc