The disparity between the rates of breast cancer in industrialized and less-industrialized regions has led to many hypotheses, including the theory that exposure to light-at-night and/or electromagnetic fields (EMF) may suppress melatonin and that reduced melatonin may increase the risk of breast cancer. In this comprehensive review we consider strengths and weaknesses of more than 35 residential and occupational epidemiologic studies that investigated the association between EMF and breast cancer. Although most of the epidemiologic data do not provide strong support for an association between EMF and breast cancer, because of the limited statistical power as well as the possibility of misclassification and bias present in much of the existing data, it is not possible to rule out a relationship between EMF and breast cancer. We make several specific recommendations for future studies carefully designed to test the melatonin-breast cancer and EMF-breast cancer hypotheses. Future study designs should have sufficient statistical power to detect small to moderate associations; include comprehensive exposure assessments that estimate residential and occupational exposures, including shift work; focus on a relevant time period; control for known breast cancer risks; and pay careful attention to menopausal and estrogen receptor status.
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