Breast Cancer Research and Treatment

, Volume 174, Issue 1, pp 219–225 | Cite as

Sleep duration and risk of breast cancer: The JACC Study

  • Jinhong Cao
  • Ehab S. Eshak
  • Keyang Liu
  • Isao Muraki
  • Renzhe Cui
  • Hiroyasu IsoEmail author
  • Akiko Tamakoshi
  • JACC Study Group



The evidence on beneficial or adverse effects of sleep duration on risk of breast cancer remains controversial and limited, especially in Asia.


A prospective study of 34,350 women aged 40–79 years in whom sleep duration, and menstrual and reproductive histories were determined by a self-administered questionnaire. The follow-up period was from 1988 to 2009, and hazard ratios (HRs) with 95% confidence intervals (CIs) of breast cancer incidence were calculated for shorter sleep duration in reference to sleep duration of ≥ 8 h/day by Cox proportional hazard models.


During 19.2-year median follow-up (236 cases), we found a significant inverse association between sleep duration and risk of breast cancer, especially among postmenopausal women and women with low parity (nulliparous and women with < 3 children); the multivariable HRs (95% CIs) among postmenopausal women who reported 7 h/day and ≤ 6 h/day of sleep in reference to ≥ 8 h/day were 1.49 (0.81–2.76) and 1.98 (1.08–3.70) (P for trend = 0.028), respectively, and the corresponding values among women with low parity were 1.50 (0.96–2.35) and 1.76 (1.01–2.79) (P for trend = 0.018).


Short sleep duration was associated with increased risk of incident breast cancer, especially among postmenopausal women and women with low parity.


Sleep duration Breast cancer Incidence Cohort study Postmenopausal Parity Japan 



The authors thank all staff members involved in this study for their valuable help in conducting the baseline survey and follow-up. Study investigators: Members of the JACC Study Group: Dr. Akiko Tamakoshi (present chairperson of the study group), Hokkaido University Graduate School of Medicine; Dr. Mitsuru Mori, Sapporo Medical University School of Medicine; Dr. Yoshihiro Kaneko, Akita University Graduate School of Medicine; Dr. Ichiro Tsuji, Tohoku University Graduate School of Medicine; Dr. Yosikazu Nakamura, Jichi Medical School; Dr. Hiroyasu Iso, Osaka University School of Medicine; Dr, Kazumasa Yamagishi, Faculty of Medicine, University of Tsukuba; Dr. Haruo Mikami, Chiba Cancer Center; Dr. Michiko Kurosawa, Juntendo University School of Medicine; Dr. Yoshiharu Hoshiyama, Yokohama Soei University; Dr. Naohito Tanabe, University of Niigata Prefecture; Dr. Koji Tamakoshi, Nagoya University Graduate School of Health Science; Dr. Kenji Wakai, Nagoya University Graduate School of Medicine; Dr. Shinkan Tokudome, National Institute of Health and Nutrition; Dr. Koji Suzuki, Fujita Health University School of Health Sciences; Drs. Shuji Hashimoto and Hiroshi Yatsuya, Fujita Health University School of Medicine; Dr. Shogo Kikuchi, Aichi Medical University School of Medicine; Dr. Yasuhiko Wada, Faculty of Nutrition, University of Kochi; Dr. Takashi Kawamura, Kyoto University Health Service; Dr. Yoshiyuki Watanabe, Kyoto Prefectural University of Medicine Graduate School of Medical Science; Dr. Kotaro Ozasa, Radiation Effects Research Foundation; Dr. Kazuya Mikami, Kyoto Prefectural University of Medicine Graduate School of Medical Science; Dr. Chigusa Date, School of Human Science and Environment, University of Hyogo; Dr. Kiyomi Sakata, Iwate Medical University; Dr. Yoichi Kurozawa, Tottori University Faculty of Medicine; Drs. Takesumi Yoshimura and Yoshihisa Fujino, University of Occupational and Environmental Health; Dr. Akira Shibata, Kurume University; Dr. Naoyuki Okamoto, Kanagawa Cancer Center; and Dr. Hideo Shio, Long-Term Care Health Facility Caretown Minamikusatsu, Shiga.


This work was supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT) (Monbusho); Grants-in-Aid for Scientific Research on Priority Areas of Cancer; and Grants-in-Aid for Scientific Research on Priority Areas of Cancer Epidemiology from MEXT (MonbuKagaku-sho) (Nos. 61010076, 62010074, 63010074, 1010068, 2151065, 3151064, 4151063, 5151069, 6279102, 11181101, 17015022, 18014011, 20014026, 20390156, and 26293138); Comprehensive Research on Cardiovascular and Life-Style Related Diseases (H26-Junkankitou [Seisaku]-Ippan-001and H29-Junkankitou [Seishuu]-Ippan-003), JSPS KAKENHI Grant Number JP 16H06277, and Grants-in-Aid for China Scholarship Council (CSC file No. 201608050113).

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in this study were in accordance with the Helsinki declaration and was approved by Osaka and Nagoya Universities research ethics committees.

Informed consent

Informed consent was obtained from all participants included in the study at individual or community leader level.


  1. 1.
    Matsuda A, Matsuda T, Shibata A, Katanoda K, Sobue T, Nishimoto H, Japan Cancer Surveillance Research Group (2013) Cancer incidence and incidence rates in Japan in 2008: A Study of 25 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) Project. Jpn J Clin Oncol 44:388–396CrossRefGoogle Scholar
  2. 2.
    Qian X, Brinton LA, Schairer C, Matthews CE (2015) Sleep duration and breast cancer risk in the Breast Cancer Detection Demonstration Project follow-up cohort. Br J Cancer 112:567–571CrossRefGoogle Scholar
  3. 3.
    Vogtmann E, Levitan EB, Hale L, Shikany JM, Shah NA, Endeshaw Y, Lewis CE, Manson JE, Chlebowski RT (2013) Association between sleep and breast cancer incidence among postmenopausal women in the women’s health initiative. Sleep 36:1437–1444CrossRefGoogle Scholar
  4. 4.
    Girschik J, Heyworth J, Fritschi L (2013) Self-reported Sleep Duration, Sleep Quality, and Breast Cancer Risk in a Population-based Case-Control Study. Am J Epidemiol 177:316–327CrossRefGoogle Scholar
  5. 5.
    Wu AH, Stanczyk FZ, Wang R, Koh WP, Yuan JM, Yu MC (2013) Sleep duration, spot urinary 6-sulfatoxymelatonin levels and risk of breast cancer among Chinese women in Singapore. Int J Cancer 132:891–896CrossRefGoogle Scholar
  6. 6.
    Qin Y, Zhou Y, Zhang X, Wei X, He J (2013) Sleep duration and breast cancer risk: a meta-analysis of observational studies. Int J Cancer 134:1166–1173CrossRefGoogle Scholar
  7. 7.
    Pinheiro SP, Schernhammer ES, Tworoger SS, Michels KB (2006) A prospective study on habitual duration of sleep and incidence of breast cancer in a large cohort of women. Cancer Res 66(10):5521–5525CrossRefGoogle Scholar
  8. 8.
    Verkasalo PK, Lillberg K, Stevens RG, Hublin C, Partinen M, Koskenvuo M, Kaprio J (2005) Sleep duration and breast cancer: a prospective cohort study. Cancer Res 65(20):9595–9601CrossRefGoogle Scholar
  9. 9.
    Wu AH, Wang R, Koh W, Stanczyk Z, Lee H, Yu MC (2008) Sleep duration, melatonin and breast cancer among Chinese women in Singapore. Carcinogenesis 29:1244–1248CrossRefGoogle Scholar
  10. 10.
    Kakizaki M, Kuriyama S, Sone T, Ohmori-Matsuda K, Hozawa A, Nakaya N, Fukudo S, Tsuji I (2008) Sleep duration and the risk of breast cancer: the Ohsaki Cohort Study. Br J Cancer 99:1502–1505CrossRefGoogle Scholar
  11. 11.
    Mcelroy JA, Newcomb PA, Titus- L, Egan KM (2006) Duration of sleep and breast cancer risk in a large population- based case-control study. J Sleep Res 15(3):241–249CrossRefGoogle Scholar
  12. 12.
    Hurley S, Goldberg D, Bernstein L, Reynolds P, Hurley S (2015) Sleep duration and cancer risk in women. Cancer Causes Control 26(7):1037–1045CrossRefGoogle Scholar
  13. 13.
    Brzezinski A (1997) Melatonin in humans. N Engl J Med 336:186–195CrossRefGoogle Scholar
  14. 14.
    Schernhammer ES, Schulmeister K (2004) Melatonin and cancer risk: does light at night compromise physiologic cancer protection by lowering serum melatonin levels? Br J Cancer 90:941–943CrossRefGoogle Scholar
  15. 15.
    Schernhammer ES, Kroenke CH, Dowsett M, Folkerd E, Hankinson SE (2006) Urinary 6-sulfatoxymelatonin levels and their correlations with lifestyle factors and steroid hormone levels. J Pineal Res 40:116–124CrossRefGoogle Scholar
  16. 16.
    Anisimov VN (2003) The role of pineal gland in breast cancer development. Crit Rev Oncol Hematol 46:221–234CrossRefGoogle Scholar
  17. 17.
    Cohen M, Lippman M, Chabner B (1978) Role of the pineal gland in theaetiology and treatment of breast cancer. Lancet 2:814–881CrossRefGoogle Scholar
  18. 18.
    Blask DE, Wilson ST, Zalatan F (1997) Physiological melatonin inhibition of human breast cancer cell growth in vitro: evidence for a glutathione-mediated pathway. Cancer Res 57:1909–1914Google Scholar
  19. 19.
    Cos S, Gonzalez A, Martinez-Campa C, Mediavilla MD, Alonso-Gonzalez C, Sanchez-Barcelo EJ (2006) Estrogen-signaling pathway: a link between breast cancer and melatonin oncostatic actions. Cancer Detect Prev 30(2):118–128CrossRefGoogle Scholar
  20. 20.
    Surakasula A, Nagarjunapu GC, Raghavaiah KV (2014) A comparative study of pre- and post-menopausal breast cancer: Risk factors, presentation, characteristics and management. J Res Pharm Pract 3(1):12–18CrossRefGoogle Scholar
  21. 21.
    Lovejoy JC, Champagne CM, de Jonge L, Xie H, Smith SR (2008) Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes 32(6):949–958CrossRefGoogle Scholar
  22. 22.
    Cleary MP, Grossmann ME (2009) Obesity and breast cancer: the estrogen connection. Endocrinology 150(6):2537–2542CrossRefGoogle Scholar
  23. 23.
    Molis TM, Spriggs LL, Hill SM (1994) Modulation of estrogen receptor mRNA expression by melatonin in MCF-7 human breast cancer cells. Mol Endocrinol 8:1681–1690Google Scholar
  24. 24.
    Xiao Q, Signorello LB, Brinton LA, Cohen SS, Blot WJ, Matthews CE (2016) Sleep duration and breast cancer risk among black and white women. Sleep Med 20:25–29CrossRefGoogle Scholar
  25. 25.
    Lambe M, Hsieh CC, Chan HW, Ekbom A, Trichopoulos D, Adami HO (1996) Parity, age at first and last birth, and risk of breast cancer: a population-based study in Sweden. Breast Cancer Res Treat 38(3):305–311CrossRefGoogle Scholar
  26. 26.
    Palmer JR, Boggs DA, Wise LA, Ambrosone CB, Adams-Campbell LL, Rosenberg L (2011) Parity and lactation in relation to estrogen receptor negative breast cancer in African American women. Cancer Epidemiol Biomark Prev 20:1883–1891CrossRefGoogle Scholar
  27. 27.
    Ambrosone CB, Zirpoli G, Ruszczyk M, Shankar J, Hong CC, McIlwain D, Roberts M, Yao S, McCann SE, Ciupak G, Hwang H, Khoury T, Jandorf L, Bovbjerg DH, Pawlish K, Bandera E (2014) Parity and breastfeeding among African-American Women: differential effects on breast cancer risk by estrogen receptor status in the Women’s Circle of Health Study. Cancer Causes Control 25(2):259–265CrossRefGoogle Scholar
  28. 28.
    Signal TL, Gander PH, Sangalli MR, Travier N, Firestone RT, Tuohy JF (2007) Sleep duration and quality in healthy nulliparous and multiparous women across pregnancy and post-partum.Aust N. Z J Obstet Gynaecol 47(1):16–22Google Scholar
  29. 29.
    Tamakoshi A, Ozasa K, Fujino Y, Suzuki K, Sakata K, Mori M, Kikuchi S, Iso H, The JACC Study Group (2013) Cohort profile of the Japan Collaborative Cohort Study. J Epidemiol 23:227–232CrossRefGoogle Scholar
  30. 30.
    Reiter RJ (1980) The pineal and its hormones in the control of reproduction in mammals. Endocr Rev 1:109–131CrossRefGoogle Scholar
  31. 31.
    Leon-Blanco MM, Guerrero JM, Reiter RJ, Calvo JR, Pozo D (2003) Melatonin inhibits telomerase activity in the MCF-7 tumor cell line both in vivo and in vitro. J Pineal Res 35(3):204–211CrossRefGoogle Scholar
  32. 32.
    Allegra M, Reiter RJ, Tan DX, Gentile C, Tesoriere L, Livrea MA (2003) The chemistry of melatonin’s interaction with reactive species. J Pineal Res 34:1–10CrossRefGoogle Scholar
  33. 33.
    Longcope C, Speizer FE (1995) Reproductive factors and family history of breast cancer in relation to plasma estrogen and prolactin levels in postmenopausal women in the Nurses’ Health Study (United States). Cancer Causes Control 6:217–224CrossRefGoogle Scholar
  34. 34.
    Kwa HG, Cleton F, Bulbrook RD, Wang DY, Hayward JL (1981) Plasma prolactin levels and breast cancer: relation to parity, weight and height, and age at first birth. Int J Cancer 28:31–34CrossRefGoogle Scholar
  35. 35.
    Bernstein L, Pike MC, Ross RK, Judd HL, Brown JB, Henderson BE (1985) Estrogen and sex hormone-binding globulin levels in nulliparous and parous women. J Natl Cancer Inst 74:741–745Google Scholar
  36. 36.
    Tamakoshi K, Yatsuya H, Wakai K, Suzuki S, Nishio K, Lin Y, Niwa Y, Kondo T, Yamamoto A, Tokudome S, Toyoshima H, Tamakoshi A, JACC Study Group (2005) Impact of menstrual and reproductive factors on breast cancer risk in Japan: results of the JACC study. Cancer Sci 96(1):57–62CrossRefGoogle Scholar
  37. 37.
    Ukawa S, Tamakoshi A, Mori M, Ikehara S, Shirakawa T, Yatsuya H, Iso H, JACC study group (2018) Association between average daily television viewing time and the incidence of ovarian cancer: findings from the Japan Collaborative Cohort Study. Cancer Causes Control 29(2):213–219CrossRefGoogle Scholar
  38. 38.
    Fang HF, Miao NF, Chen CD, Sithole T, Chung MH (2015) Risk of cancer in patients with insomnia, parasomnia, and obstructive sleep apnea: a nationwide nested case-control study. J Cancer 6(11):1140–1147CrossRefGoogle Scholar
  39. 39.
    Lockley SW, Skene DJ, Arendt J (1999) Comparison between subjective and actigraphic measurement of sleep and sleep rhythms. J Sleep Res 8:175–183CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Public Health, Department of Social MedicineOsaka University Graduate School of MedicineOsakaJapan
  2. 2.Department of Public Health, Community and Preventive Medicine, Faculty of MedicineMinia UniversityMiniaEgypt
  3. 3.Department of Public Health, Faculty of MedicineHokkaido UniversitySapporoJapan

Personalised recommendations