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Long-term sleep habits and the risk of breast cancer among Chinese women

a case–control study

Yang, Wanshuia,b,*; Shi, Yingfangc,*; Ke, Xiumeib; Sun, Hainab; Guo, Jianchaob; Wang, Xinb

European Journal of Cancer Prevention: July 2019 - Volume 28 - Issue 4 - p 323–329
doi: 10.1097/CEJ.0000000000000458
Research Papers: Breast Cancer

Previous observational studies have inconsistently suggested that poor sleep is a novel risk factor for breast cancer (BC). However, these studies mainly focused on sleep duration; other sleep domains were rarely reported. The aim of this study was to evaluate the association of a broad range of sleep domains with the risk of BC incidence. We used a community-based 1 : 1 individual matched case–control design that included 401 female patients with incident BC and 401 age-matched and area-matched female controls in Jiujiang, China. Long-term sleep habits were assessed comprehensively using a validated 17-item Sleep Factors Questionnaire. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression. Light exposure at night (highest vs. lowest level, aOR=1.19, 95% CI: 1.06–2.68), habitual timing of sleep (after 12 a.m. midnight vs. before 22 p.m., aOR=1.12, 95% CI: 1.03–2.62), night/shift work (yes vs. no, aOR=1.38, 95% CI: 1.04–2.71), and frequency of night-time wakings (>2 per night vs. never, aOR=1.21, 95% CI: 1.10–2.96) were associated with an increased risk of BC after mutually adjusting for other sleep parameters. These positive associations remained irrespective of menopausal status and tumor estrogen receptor status. There was no association between sleep duration, sleep quality, sleep medication use, insomnia frequency, daytime nap, and the risk of BC. Our results indicate that sleep problems including light exposure at night, night/shift work, late sleeping, and frequent night waking could increase the risk of BC development, independent of other sleep factors.

aDepartment of Nutrition, School of Public Health, Anhui Medical University, Hefei

bDepartment of Social Science and Public Health, School of Basic Medical Science, Jiujiang University

cDepartment of Breast Surgery, First people’s Hospital of Jiujiang, Jiujiang, People’s Republic of China

*Wanshui Yang and Yingfang Shi contributed equally to the writing of this article.

Correspondence to Wanshui Yang, MD, PhD, Department of Nutrition, School of Public Health, Anhui Medical University, 81 Mei Shan Road, Hefei 230032, People’s Republic of China Tel/fax: +86 792 857 7050; e-mail:

Received December 29, 2017

Accepted February 20, 2018

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