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            "abstractNote": "A 2007 report by the International Agency for Research on Cancer classified night-shift work as possibly carcinogenic to humans, emphasizing, in particular, its association with breast cancer. Since this report and the publication of the last systematic review on this topic, several new studies have examined this association. Hence, to provide a comprehensive update on this topic, we performed a systematic review and meta-analysis. We searched Medline, Embase, CINAHL, Web of Science (Conference Proceedings), and ProQuest dissertations for studies published before March 1, 2012, along with a manual search of articles that cited or referenced the included studies. Included were observational case-control or cohort studies examining the association between night-shift work and breast carcinogenesis in women, which all ascertained and quantified night-shift work exposure. The search yielded 15 eligible studies for inclusion in the systematic review and meta-analysis. Using random-effects models, the pooled relative risk (RR) and 95 % confidence intervals (CIs) of breast cancer for individuals with ever night-shift work exposure was 1.21 (95 % CI, 1.00-1.47, p = 0.056, I (2) = 76 %), for short-term night-shift workers (<8 years) was 1.13 (95 % CI, 0.97-1.32, p = 0.11, I (2) = 79 %), and for long-term night-shift workers (≥8 years) was 1.04 (95 % CI, 0.92-1.18, p = 0.51, I (2) = 55 %), with substantial between-study heterogeneity observed in all analyses. Subgroup analyses suggested that flight attendants with international or overnight work exposure and nurses working night-shifts long-term were at increased risk of breast cancer, however, these findings were limited by unmeasured confounding. Overall, given substantial heterogeneity observed between studies in this meta-analysis, we conclude there is weak evidence to support previous reports that night-shift work is associated with increased breast cancer risk.",
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            "abstractNote": "Irregular working hours, including working at night, have serious psychological and physiological effects. In a nationwide population-based case-control study, we investigated the breast cancer risk among 30- to 54-year-old Danish women who worked predominantly at night. Individual employment histories were reconstructed back to 1964 for each of 7035 women with breast cancer and their individually matched controls from the records of a nationwide pension scheme with compulsory membership. Odds ratios, including 5 years of induction time and adjusted for socio-economic status, age at the birth of first and last child and number of children, were estimated by conditional logistic regression analysis. The odds ratio for breast cancer among women who worked at night at least half of a year was 1.5 (95% confidence interval, 1.2 to 1.7), and there was a tendency to increasing odds ratio by increasing duration of nighttime employment.",
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            "abstractNote": "OBJECTIVE\n\nPrevious studies have suggested an association between breast cancer and night work. We evaluated the relationship among Norwegian nurses.\n\n\nMETHODS\n\nA case-control study, nested within a cohort of 44,835 nurses educated between 1914 and 1980 was performed, based on a registry of all Norwegian nurses. Four controls were individually matched by year of birth to each of 537 breast cancer cases that occurred during the period 1960-1982. The reconstruction of work history and number of years with night work for each nurse was based on information from the nurse registry, and data from three censuses. We used conditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for total duration of work as a nurse and parity. All statistical tests were two-sided.\n\n\nRESULTS\n\nThe adjusted OR of breast cancer among nurses who worked nights for 30 or more years was 2.21 (CI 1.10-4.45) compared with those who did not work nights after graduation from nursing school (p(trend) = 0.01).\n\n\nCONCLUSION\n\nOur results are in accordance with previous studies that find an association between night work and breast cancer risk among women.",
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            "pages": "39-44",
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            "abstractNote": "Associations between night work and breast cancer risk were investigated in a nested case-control study within a cohort of 49,402 Norwegian nurses. A total of 699 (74%) of the live cases diagnosed in 1990-2007 and 895 (65%) controls, cancer free at the time of sampling, were interviewed about work history and potential risk factors. The odds ratios for risk of breast cancer in relation to different exposure metrics were estimated by multivariate unconditional logistic regression models. No increase of risk was found after long duration of work by nurses working ≥3 night shifts per month. Small, nonsignificantly increased risks were observed for exposure to ≥30 years in hospitals or other institutions (odds ratio (OR) = 1.1), ≥12 years in schedules including night work (OR = 1.3), ≥1,007 night shifts during the lifetime (OR = 1.2), and lifetime average number of ≥4 night shifts per month (OR = 1.2). Nonsignificantly increased risks of breast cancer were observed in nurses who worked ≥5 years with ≥4 (OR = 1.4) and ≥5 (OR = 1.6) consecutive night shifts. Significantly increased risks were seen in nurses who worked ≥5 years with ≥6 consecutive night shifts (OR = 1.8, 95% confidence interval: 1.1, 2.8). The results suggest that risk may be related to number of consecutive night shifts.",
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            "title": "Night work and risk of breast cancer",
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                    "creatorType": "author",
                    "firstName": "Eva S",
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                {
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                    "firstName": "Candyce H",
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                    "firstName": "Francine",
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            "abstractNote": "BACKGROUND\n\nMelatonin shows potential oncostatic activity and is acutely suppressed by light exposure. Some evidence suggests an association between night work and breast cancer risk, possibly through the melatonin pathway.\n\n\nMETHODS\n\nIn a cohort of premenopausal nurses, we prospectively studied the relation between rotating night shift work and breast cancer risk. Total number of months during which the nurses worked rotating night shifts was first assessed at baseline in 1989 and periodically updated thereafter. We used Cox proportional hazards models to calculate relative risks (RRs) and 95% confidence intervals (CIs).\n\n\nRESULTS\n\nAmong 115,022 women without cancer at baseline, 1,352 developed invasive breast cancer during 12 years of follow up. Women who reported more than 20 years of rotating night shift work experienced an elevated relative risk of breast cancer compared with women who did not report any rotating night shift work (multivariate RR = 1.79; 95% CI = 1.06-3.01). There was no increase in risk associated with fewer years of rotating night work.\n\n\nCONCLUSION\n\nOur results suggest a modestly elevated risk of breast cancer after longer periods of rotating night work. Additional studies are warranted to rule out small sample size or uncontrolled sources for confounding as alternative explanations.",
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            "title": "Rotating night shifts and risk of breast cancer in women participating in the nurses' health study",
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                    "firstName": "E S",
                    "lastName": "Schernhammer"
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                    "firstName": "F",
                    "lastName": "Laden"
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            "abstractNote": "Melatonin is a ubiquitous molecule and widely distributed in nature, with functional activity occurring in unicellular organisms, plants, fungi and animals. In most vertebrates, including humans, melatonin is synthesized primarily in the pineal gland and is regulated by the environmental light/dark cycle via the suprachiasmatic nucleus. Pinealocytes function as 'neuroendocrine transducers' to secrete melatonin during the dark phase of the light/dark cycle and, consequently, melatonin is often called the 'hormone of darkness'. Melatonin is principally secreted at night and is centrally involved in sleep regulation, as well as in a number of other cyclical bodily activities. Melatonin is exclusively involved in signaling the 'time of day' and 'time of year' (hence considered to help both clock and calendar functions) to all tissues and is thus considered to be the body's chronological pacemaker or 'Zeitgeber'. Synthesis of melatonin also occurs in other areas of the body, including the retina, the gastrointestinal tract, skin, bone marrow and in lymphocytes, from which it may influence other physiological functions through paracrine signaling. Melatonin has also been extracted from the seeds and leaves of a number of plants and its concentration in some of this material is several orders of magnitude higher than its night-time plasma value in humans. Melatonin participates in diverse physiological functions. In addition to its timekeeping functions, melatonin is an effective antioxidant which scavenges free radicals and up-regulates several antioxidant enzymes. It also has a strong antiapoptotic signaling function, an effect which it exerts even during ischemia. Melatonin's cytoprotective properties have practical implications in the treatment of neurodegenerative diseases. Melatonin also has immune-enhancing and oncostatic properties. Its 'chronobiotic' properties have been shown to have value in treating various circadian rhythm sleep disorders, such as jet lag or shift-work sleep disorder. Melatonin acting as an 'internal sleep facilitator' promotes sleep, and melatonin's sleep-facilitating properties have been found to be useful for treating insomnia symptoms in elderly and depressive patients. A recently introduced melatonin analog, agomelatine, is also efficient for the treatment of major depressive disorder and bipolar affective disorder. Melatonin's role as a 'photoperiodic molecule' in seasonal reproduction has been established in photoperiodic species, although its regulatory influence in humans remains under investigation. Taken together, this evidence implicates melatonin in a broad range of effects with a significant regulatory influence over many of the body's physiological functions.",
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