Exposure to outdoor light at night and risk of breast cancer: A systematic review and meta-analysis of observational studies.

Recent epidemiological studies have explored effects of light at night (LAN) exposure on breast cancer, but reported inconsistent findings. We performed a systematic review and meta-analysis of available evidence regarding the association of LAN assessed by satellite data with breast cancer. We conducted a systematic PubMed, Web of Science, and EMBASE database literature search until August 2020. Random-effects meta-analysis was applied to synthesis risk estimates. Heterogeneity was measured using statistics of Cochran's Q, I ² , and Tau ² (τ ² ). We assessed publication bias through funnel plot and Egger's test. Moreover, subgroup analyses according to study design and menopausal status were performed. Risk of bias (RoB) of each included study was assessed using a domain-based RoB assessment tool. The confidence in the body of evidence was appraised using the GRADE approach for level-of-evidence translation. A total of 1157 studies were identified referring to LAN and breast cancer, from which 6 were included for quantitative synthesis. We found a significantly higher odds of breast cancer in the highest versus the lowest category of LAN exposure (OR = 1.11, 95% CI: 1.06, 1.16; I ²  = 0.0%). In the subgroup analyses stratified by menopausal status and study design, significant association was found in postmenopausal women (OR = 1.07, 95% CI = 1.00, 1.13) and cohort studies (OR = 1.11, 95% CI = 1.05, 1.18), while the summary estimates of premenopausal women and case-control studies showed no significance. The level of evidence for the association of LAN exposure and breast cancer risk was graded as "moderate" with "probably low" RoB according to the NTP/OHAT framework. In conclusion, this study suggests a link of LAN exposure with risk of breast cancer. Further high-quality prospective studies, especially performed in low-to middle-income countries with improvement in the area of LAN exposure assessment are needed to advance this field.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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