Abstract 828: Associations of perfluoroalkyl substances with breast cancer incidence risk and mediation role of mitochondrial DNA copy number: A prospective case-cohort study
Authors: Feng Yue , Guo Huan 
Published: March 2024

Abstract
Background: Perfluorinated carboxylic acids (PFCAs) and perfluorinated sulfonic acids (PFSAs), notable representatives of perfluoroalkyl substances (PFASs), are synthetic persistent chemicals widely accumulated and detected in humans. Short-chain PFASs [PFCAs with carbon number &lt;8 and PFSAs &lt;6, e.g. perfluoroheptanoic acid (PFHpA)] are considered less bioaccumulative and increasingly used in commercial products, yet their health impacts are rarely investigated. Perfluorooctanoic acid (PFOA) has been categorized as a possible human carcinogen (group 2B) and a potential mammary toxicant. However, few population studies explored the prospective associations of PFOA and other common PFASs with breast cancer risk nor the underlying mechanisms.
Methods: Hence, we conducted a case-cohort study within the DongFeng-Tongji Cohort, compromising 226 incident breast cancer cases and a random sub-cohort of 990 individuals. Plasma concentrations of four PFCAs [PFOA, perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and PFHpA] and two PFSAs [perfluorooctane sulfonic acid (PFOS) and perfluorohexane sulfonic acid (PFHxS)], as well as peripheral blood mitochondrial DNA copy number (mtDNAcn) levels, were measured at baseline.
Results: Using Barlow-weighted Cox regression, we found 35% and 20% increased incident risk of breast cancer for each 1-unit ln-transformed increase in PFOA and PFHpA, respectively [HR (95% CI) = 1.35 (1.03, 1.78) and 1.20 (1.02, 1.40)]. Quantile g-computation analysis revealed a 19% increased incident risk of breast cancer along with each simultaneous quartile increase in all ln-transformed PFCA concentrations [HR (95% CI) = 1.19 (1.01, 1.41)], driven mainly by contributions from PFOA (56%), PFNA (24%), and PFHpA (20%). Besides, mtDNAcn was positively associated with PFHpA levels [β (95% CI) =0.027 (0.005, 0.048)], but not with PFOA or PFNA (P&gt;0.05). We also found significantly higher breast cancer risk in participants with the highest mtDNAcn (Q4, ≥1.52) than those with the lowest (Q1, &lt;0.87) [HR (95% CI) =2.92 (1.69, 5.04)], and that mtDNAcn mediated 12.77% of PFHpA-breast cancer association [Indirect effect, HR (95% CI) =1.02 (1.00, 1.04)]. No significant mediation effect of mtDNAcn was observed in associations of PFOA and PFNA with breast cancer (P&gt;0.05).
Conclusions: Our work unveiled the relationship of short-chain PFHpA with increased incident risk of breast cancer for the first time and highlighted the intermediate role of mtDNAcn in this association, providing a research clue for exploring the potential mechanisms of PFAS-induced breast cancer. Moreover, co-exposure to PFASs was observed as a risk factor for breast cancer, shedding light on breast cancer prevention by regulating PFASs as a chemical class.
Citation Format: Yue Feng, Huan Guo. Associations of perfluoroalkyl substances with breast cancer incidence risk and mediation role of mitochondrial DNA copy number: A prospective case-cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 828.