Sex Differences in the Association between Night Shift Work and the Risk of Cancers: A Meta-Analysis of 57 Articles

Table 1

Characteristics of studies included in meta-analysis.

Study (year)	Region	Study design	No. of cases	Occupation	Exposure	Adjusted OR (95% CI)	Type of cancer	Adjusted item	Exposure assessment method
Walasa et al. (2018) [40]	Australia	Case-control study	350	NA	Night, never vs. 7.5+ years	0.95 (0.57–1.58)	Colorectal cancer	Age group, education level, socioeconomic status, lifetime cigarette smoking, and alcohol intake 10 years ago	Questionnaire
Talibov et al. (2018) [41]	Europe	Case-control study	131,594	NA	Rotating, never vs. 20+ years	1.033 (0.984–1.084)	Hematological system cancer	Cumulative benzene, formaldehyde, and ionizing radiation	Questionnaire
Tse et al. (2017) [11]	Asia	Case-control study	431	NA	Night, never vs. ever	1.76 (1.07–2.89)	Prostate cancer	Age at interview, marital status, unemployment status, family prostate cancer history, consumption of deep fried food, consumption of pickled vegetable, green tea drinking habits, and cbpai	Interview
Heckman et al. (2017) [44]	North America	Cohort study	4854	Nurses	Rotating, never vs. 10+ years	0.794 (0.711–0.888)	Skin cancer	Years of shift work, hours of sleep, sleep adequacy, sleepy days per week, snoring, restless legs syndrome, family history of melanoma, hours spent in sun, number of severe sunburns, sunburn severity, artificial tanning frequency, annual uv at residence, moles on lower legs, natural hair color in adolescence, marital status, financial status, BMI, physical activity, smoking status, menopausal status, postmenopausal hormones, oral contraceptive use, and healthy eating index	Questionnaire
Papantoniou (2017) [12]	Europe	Case-control study	1626	NA	Night and rotating, never vs. 15+ years	1.28 (1.06–1.56)	Colorectal cancer	Age, centre, educational level, sex, history of colorectal cancer, BMI, smoking, leisure time physical activity, alcohol consumption, total energy intake in grams/day, all red meat consumption, sleep duration, bisphosphonates, and NSAIDs	Questionnaire
Devore et al. (2017) [45]	North America	Cohort study	3014	Nurses	Rotating, never vs. 10+ years	0.96 (0.83, 1.11)	Colorectal adenoma	Age, time period of first lower endoscopy, reason for endoscopy, family history of cancer, height, BMI, physical activity, smoking, alcohol intake, menopausal status, menopausal hormone use, oral contraceptive use, multivitamin use, total calcium intake, vitamin d intake, red meat intake, NSAIDs use, and predicted vitamin D score	Questionnaire
Vistisen et al. (2017) [42]	Europe	Cohort study	1245	NA	Night, never vs. ever	0.90 (0.80–1.01)	Breast cancer	Calendar year, age, age at birth of first child, number of births, family history of breast cancer or ovarian cancer, oral contraception, hormone replacement therapy, other sex hormones, medication related to alcoholism, mammography screening attendance, and highest family educational level	Database
Wegrzyn et al. (2017)^a [10]	North America	Cohort study	5971	Nurses	Rotating, never vs. 30+ years	0.95 (0.77–1.17)	Breast cancer	Age, height, BMI, BMI at age 18, adolescent body size, age at menarche, age at first birth and parity combined, breast feeding, type of menopause and age at menopause, combined menopausal hormone therapy, duration of estrogen alone menopausal hormone therapy, duration of estrogen and progesterone menopausal hormone therapy, first-degree family history of breast cancer, history of benign breast disease, alcohol consumption, physical activity, and current mammography use.	Questionnaire
Wegrzyn et al. (2017)^a [10]	North America	Cohort study	3570	Nurses	Rotating, never vs. 20+ years	2.15 (1.23–3.73)	Breast cancer	Age, height, BMI, BMI at age 18, adolescent body size, age at menarche, age at first birth and parity combined, breast feeding, type of menopause and age at menopause, combined menopausal hormone therapy, duration of estrogen alone menopausal hormone therapy, duration of estrogen and progesterone menopausal hormone therapy, first-degree family history of breast cancer, history of benign breast disease, alcohol consumption, physical activity, and mammography use.	Questionnaire
Jørgensen et al. (2017) [43]	Europe	Cohort study	945	Nurses	Rotating, night, and rotating, never vs. ever	0.91 (0.77–1.08)	Unclassified cancer	Age, smoking, pack-years, physical activity, BMI, alcohol consumption, diet (vegetables, fruit, and fatty meat consumption), preexisting diseases (hypertension, diabetes, and myocardial infarction), self-reported health, stressful work environment, marital status, female reproductive factors (birth, use of hormone therapy, and oral contraceptives)	Questionnaire
Behrens et al. (2017) [13]	Europe	Cohort study	76	NA	Rotating, never vs. 20+ years	3.08 (1.67–5.69)	Prostate cancer	Age, smoking, family history of prostate cancer, level of school education, and equivalent income	Interview
Akerstedt et al. (2017) [46]	Europe	Cohort study	454	NA	Night, never vs. ever	0.91 (0.74–1.12)	Prostate cancer	Age, education level, tobacco consumption, BMI, having children, coffee consumption, and previous cancer	Interview
Dickerman et al. (2016) [49]	Europe	Cohort study	602	NA	Rotating, never vs. ever	1.0 (0.7–1.2)	Prostate cancer	Age, education, BMI, physical activity, social class, smoking status, alcohol use, snoring, and zygosity	Questionnaire
Papantoniou et al. (2016) [47]	Europe	Case-control study	1708	NA	Night and rotating, never vs. 15+ years	1.21 (0.89–1.65)	Breast cancer	Age, centre, educational level, parity, menopausal status, family history of breast cancer, BMI, smoking status, oral contraceptive use, leisure time physical activity, alcohol consumption, and sleep duration	Interview
Gyarmati et al. (2016) [48]	Europe	Case-control study	374	NA	Night and rotating, never vs. 20+ years	1.1 (0.8–1.6)	Stomach cancer	Age, sex, educational level, centre, BMI, cigarette smoking status, family history, physical activity level, total energy intake, grams of red meat, grams of vegetables, and grams of fruit and alcohol consumption	Interview
Costas et al. (2016) [15]	Europe	Case-control study	321	NA	Night, never vs. 20+ years	1.77 (1.14–2.74)	Chronic lymphocytic leukemia	Region, age, sex, worked on a farm, family history of hematologic malignancies, BMI, tobacco consumption (never, past, and current), sleep problems, and education	Interview
Bai et al. (2016) [16]	Asia	Cohort study	1251	NA	Night, never vs. 20+ years	1.08 (0.90–1.29)	Unclassified cancer	Age, BMI, family history of cancer, alcohol drinking and smoking status, number of children, menopausal status, hormone replacement therapy, and contraception status	Questionnaire
Travis et al. (2016) [14]	Europe	Cohort study	4809	NA	Night, never vs. ever	1.00 (0.92–1.08)	Breast cancer	Socioeconomic status, parity and age at first birth, BMI, alcohol intake, strenuous physical activity, family history of breast cancer, age at menarche, oral contraceptive use, smoking, living with a partner, and hormone therapy	Questionnaire
Gu et al. (2015) [20]	North America	Cohort study	5413	Nurses	Rotating, never vs. 15+ years	1.08 (0.98–1.19)	Unclassified cancer	Age, alcohol consumption, physical exercise, multivitamin use, menopausal status and postmenopausal hormone use, physical exam in the past 2 years, healthy eating score, smoking status, pack-years, BMI, and husband’s education	Questionnaire
Wang P. et al. (2015) [17]	Asia	Case-control study	712	NA	Night, never vs. ever	1.34 (1.05–1.72)	Breast cancer	Age, education, BMI, age at menarche, menopausal status, parity, physical activity, breast feeding, and family history of cancer	Interview
Papantoniou et al. (2015) [18]	Europe	Case-control study	1115	NA	Night and rotating, never vs. 28+ years	1.38 (1.05–1.81)	Prostate cancer	Age, centre, educational level, family history of prostate cancer, physical activity over the past decade, smoking status, past sun exposure, and daily meat consumption	Interview
Li et al. (2015) [51]	Asia	Nested case-control study	1709	Industry	Night, never vs. ever	0.73 (0.66–0.82)	Breast cancer	Age at the beginning of follow-up	Questionnaire
Lin et al. (2015) [50]	Asia	Cohort study	94	NA	Rotating, never vs. ever	1.43 (0.78–2.63)	Biliary tract cancer	Age, BMI, history of cholelithiasis, history of diabetes, cigarette smoking, alcohol drinking, perceived stress, and sleep time	Questionnaire
Kwon et al. (2015) [52]	Asia	Nested case-control study	1451	Industry	Rotating, never vs. 30.6+ years	0.88 (0.69–1.12)	Lung cancer	Adjusted for age, smoking, parity, and endotoxin	Database
Akerstedt et al. (2015) [21]	Europe	Cohort study	463	NA	Night, never vs. 21+ years	1.77 (1.03–3.04)	Breast cancer	Age, education level, tobacco consumption, BMI, having children, coffee consumption, previous cancer, and use of hormones including oral contraceptives	Interview
Hammer et al. (2015) [19]	Europe	Cohort study	337	Industry	Rotating, never vs. ever	0.93 (0.73–1.18)	Prostate cancer	Age and professional status	Database
Gapstur et al. (2014) [55]	North America	Cohort study	4974	NA	Rotating, night, and evening, never vs. ever	1.08 (0.95–1.22)	Prostate cancer	Age, race, education, BMI, smoking status, family history of prostate cancer, and painful/frequent urination	Questionnaire
Koppes et al. (2014) [54]	Australia	Cohort study	2531	NA	Night, never vs. ever	0.87 (0.72–1.05)	Breast cancer	Night work, age, origin, children in household, education, occupation, job tenure (years), and contractual working hours	Interview
Carter et al. (2014) [23]	North America	Cohort study	1289	NA	Rotating, night, and evening, never vs. ever	1.27 (1.03–1.56)	Ovarian cancer	Oral contraceptive use, age at menarche and menopause, tubal ligation, parity, postmenopausal estrogen use, race, family history of cancers, exercise, BMI, and height	Questionnaire
Yong et al. (2014) [53]	Europe	Cohort study	10,873	Industry	Rotating, never vs. ever	1.04 (0.89–1.21)	Unclassified cancer	Age, job level, cigarette smoking, and employment duration in categories	Questionnaire
Datta et al. (2014) [56]	Asia	Case-control study	50	Industry	Night, never vs. ever	1.51 (0.27–8.52)	Breast cancer	None	Interview
Truong et al. (2014) [22]	Europe	Case-control study	1126	NA	Night, never vs. ever	1.32 (1.02–1.72)	Breast cancer	Age, study area, parity, age at first full-term pregnancy, age at menarche, family history of breast cancer, current use of hormonal replacement therapy, BMI, tobacco, and alcohol	Interview
Knutsson et al. (2013) [26]	Europe	Cohort study	94	NA	Night, never vs. ever	2.02 (1.03–3.95)	Breast cancer	Height, weight, waist, hip circumference, educational level, number of children, smoking, menopausal status, oral contraceptive use, hormones other than contraceptives, alcohol intake, educational level, BMI, and waist–hip ratio	Questionnaire
Rabstein et al. (2013) [57]	Europe	Case-control study	857	NA	Night, never vs. ever	1.01 (0.68–1.5)	Breast cancer	Age, adjusted for family history of breast cancer, hormone replacement use, and number of mammograms	Interview
Fritschi et al. (2013) [59]	Australia	Case-control study	1205	NA	Night, never vs. 20+ years	1.02 (0.71–1.45)	Breast cancer	Light at night, phase shift and sleep disruption, poor diet, lack of physical activity and little time outdoors, and age	Questionnaire
Schernhammer et al. (2013) [24]	North America	Cohort study	1455	Nurses	Rotating, never vs. 15+ years	1.28 (1.07–1.53)	Lung cancer	Age, smoking status, age at start of smoking, cigarettes smoked per day among current smoker, time since quitting among past smokers, fruit intake, vegetable intake, BMI, and environmental smoking exposures	Questionnaire
Menegaux et al. (2013) [25]	Europe	Case-control study	1232	NA	Night, never vs. 4.5+ years	1.40 (1.01–1.92)	Breast cancer	Age, study area, parity, age at first full-term pregnancy, age at menarche, family history of breast cancer, current hormonal replacement therapy, BMI, tobacco, and alcohol	Interview
Grundy et al. (2013) [27]	North America	Case-control study	1134	NA	Mixed, never vs. 30+ years	2.21 (1.14–4.31)	Breast cancer	Age and centre	Questionnaire
Bhatti et al. (2013) [60]	North America	Case-control study	1490	NA	Night, never vs. 7+ years	1.02 (0.74–1.42)	Ovarian cancer	Age at reference, county, reference year, duration of oral contraceptive use, number of full-term pregnancies, and BMI	Interview
Lin et al. (2013) [58]	Asia	Cohort study	127	Industry	Rotating, never vs. ever	0.83 (0.43–1.60)	Pancreatic cancer	Age, BMI, history of diabetes, alcohol drinking, cigarette smoking, perceived stress, and sleep time	Questionnaire
Hansen and Stevens (2012) [30]	Europe	Nested case-control study	267	Nurses	Night and evening, never vs. 20+ years	2.1 (1.3–3.2)	Breast cancer	Adjusted for age, weight regularity, use of hormone replacement therapy, age at menarche, menstrual regularity, menopausal status, age at birth of first child, breast cancer in mother or sister, and total duration of lactation	Interview
Hansen and Lassen (2012) [31]	Europe	Nested case-control study	132	Industry	Evening, never vs. 15+ years	2.1 (1.0–4.5)	Breast cancer	Adjusted for age, hormone replacement therapy, number of childbirths, age at menarche, years of education, occasional sunbathing frequency, and tobacco smoking status	Questionnaire
Parent et al. (2012) [28]	North America	Case-control study	3137	NA	Night, never vs. 10+ years	2.016 (1.246–3.261)	Unclassified cancer	None	Interview
Natti et al. (2012) [29]	Europe	Cohort study	99	NA	Night, never vs. ever	2.148 (1.178–3.917)	Unclassified cancer	Age, longstanding illness (among men), and smoking status	Interview
Kubo et al. (2011) [32]	Asia	Cohort study	17	Industry	Rotating, never vs. ever	1.79 (0.57–5.68)	Prostate cancer	Age, BMI, alcohol intake, smoking, exercise, and marital status	Database
Lie et al. (2011) [62]	Europe	Nested case-control study	699	Nurses	Night, never vs. 12+ years	1.3 (0.9–1.8)	Breast cancer	Age, period of diagnosis, parity, family history of breast cancer in mother or sister, and frequency of alcohol consumption at time of diagnosis	Interview
Poole et al. (2011) [61]	North America	Cohort study	718	Nurses	Rotating, never vs. 20+ years	0.8 (0.51–1.23)	Ovarian cancer	Age, duration of oral contraceptive use, parity, BMI, smoking status, tubal ligation history, menopausal status, family history of ovarian cancer (yes/no), and duration of breastfeeding	Questionnaire
Pesch et al. (2010) [64]	Europe	Case-control study	753	NA	Night, never vs. 20+ years	2.48 (0.62–9.99)	Breast cancer	Age in 5-year groups, adjusted for family history of breast cancer, hormone replacement use, and number of mammograms	Interview
Pronk et al. (2010) [63]	Asia	Cohort study	349	NA	Mixed, never vs. 17+ years	0.8 (0.5–1.2)	Breast cancer	Age, education, family history of breast cancer, number of pregnancies, age at first birth, and physical activity	Interview
Lahti et al. (2008) [33]	Europe	Cohort study	6307	NA	Rotating, never vs. ever	1.07 (1.01–1.13)	Non-Hodgkin lymphoma	Age, social class, and cohort period	Database
Viswanathan et al. (2007) [34]	North America	Cohort study	515	Nurses	Rotating, never vs. 20+ years	1.47 (1.03–2.10)	Endometrial cancer	Age, age at menarche, age at menopause, parity, BMI, oral contraceptive use, use and duration of postmenopausal hormones, hypertension, diabetes, and smoking	Questionnaire
Lie et al. (2006) [36]	Europe	Nested case-control study	537	Nurses	Rotating, never vs. 30+ years	2.21 (1.10–4.45)	Breast cancer	Total employment time as a nurse and parity	Database
O’Leary et al. (2006) [65]	North America	Case-control study	487	NA	Mixed, never vs. ever	1.04 (0.79–1.38)	Breast cancer	Age at reference date, parity, family history, education, and history of benign breast disease	Interview
Schernhammer et al. (2006) [35]	North America	Cohort study	1352	Nurses	Rotating, never vs. 20+ years	1.79 (1.06–3.01)	Breast cancer	Age, age at menarche, menopausal status, age at menopause, age at first birth, BMI, current alcohol consumption, oral contraceptive use, postmenopausal hormone use, smoking status, benign breast disease, family history of breast cancer, and physical activity	Questionnaire
Kubo et al. (2006) [37]	Asia	Cohort study	31	Industry	Rotating, never vs. ever	3.0 (1.2–7.7)	Prostate cancer	Age, study area, family history of prostate cancer, BMI, smoking, alcohol drinking, job type, physical activity at work, workplace, perceived stress, educational level, and marriage status	Questionnaire
Schernhammer et al. (2003) [38]	North America	Cohort study	602	Nurses	Rotating, never vs. 15+ years	1.35 (1.03–1.77)	Colorectal cancer	Age in years, smoking, BMI, physical activity in quintiles, regular aspirin use, colorectal cancer in parent or sibling, screening endoscopy during the study period, consumption of beef, pork, or lamb as a main dish, alcohol consumption status, total caloric intake in quintiles, use of postmenopausal hormones, menopausal status, and height in seven categories	Questionnaire
Davis et al. (2001) [66]	North America	Case-control study	767	NA	Mixed, never vs. 3+ years	1.6 (0.8–3.2)	Breast cancer	Parity, family history of breast cancer (mother or sister), oral contraceptive use (ever), and recent (<5 years) discontinued use of hormone replacement therapy	Interview
Hansen (2001) [39]	Europe	Case-control study	6281	NA	Night, never vs. 0.6+ years	1.5 (1.3–1.7)	Breast cancer	Age, social class, age at birth of first child, age at birth of last child, and number of children	Interview

Abbreviations: BMI: body mass index; NSAIDs: nonsteroidal anti-inflammatory drugs; NA: not available. ^aThis study included two prospective cohorts (NHS and NHS2).