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EVISA News revisited: Potential link between aluminum salts in deodorants and breast cancer warrants further research

(14.10.2021)


Background:
In 2006, we reported about concerns of some scientists (e.g. P.D. Darbre, 2001), that  underarm antiperspirants may contribute to the risk of breast cancer because they contain aluminum salts with metal ions that mimic the effect of estrogen. Such concerns were fueled by the fact, that the location of breast cancer is often in areas close to the armpit and aluminum is known to have a genotoxic profile, capable of causing both DNA alterations and epigenetic effects. Our headline implied that such hypothesis would warrant further research. We believe that today, 15 years after such speculations, it is time to revisit the case and see whether the research has found an answer.


Studies supporting the hypothesis of aluminum being a risk factor:

A study published in 2003 (K.G. McGrath) addressed the frequency (intensity) of underarm hygiene habits within a cohort of breast cancer survivors with their age of diagnosis. The researcher reported that women who were diagnosed with breast cancer at a younger age said they used antiperspirant and started shaving their underarms earlier and shaved more often than women who were diagnosed when they were older. Unfortunately, the study design did not include a control group of women without breast cancer and has been criticized by experts as not relevant to the safety of these underarm hygiene practices.

A more recent study from Insbruck (Linhart et. al. 2017) investigated the use of underarm cosmetic products (UCP) and the risk for breast cancer (BC).  Self-reported history of UCP use was compared between 209 female BC patients (cases) and 209 healthy controls. The interpretation of the results indicated that frequent use of UCPs may lead to an accumulation of aluminum in breast tissue. More than daily use of UCPs at younger age may increase the risk of BC. Also this study has its limitation, since the usage of cosmetics is reported after a long time just from the memory of the women. Also the women did not report what kind of UCP they used, so a relationship with a component of the UCP such as aluminum cannot be proved.  

Most other studies indicating aluminum being a risk factor for BC are based on in vitro studies: 

Sappino (2012) investigated the question whether aluminum chloride is supporting the growth of breast cancer cells. The results indicated that aluminum chloride results in loss of contact inhibition and anchorage-independent growth.

Mandriota et al. (2016) reported that concentrations of aluminum in the range of those measured in the human breast fully transform cultured mammary epithelial cells, thus
enabling them to form tumors and metastasize in well-established mouse cancer models.

Tenan et al. (2021) found that chronic aluminum absorption by mammalian cells favors chromosome instability, thus promoting carcinogenesis.


Studies finding no relationship between the use of antiperspirants and breast cancer:
A carefully designed epidemiologic study of this issue published in 2002 (Mirick et al.) compared 813 women with breast cancer and 793 women without the disease. The researchers found no link between breast cancer risk and antiperspirant use, deodorant use, or underarm shaving. The researchers admit that the strength of these results may be limited somewhat by the lack of more detailed information on specific patterns of product use and by the self-reported nature of the data.

A subsequent study (Fakri et al., 2006) also found no association between antiperspirant use and breast cancer risk, although it included only 54 women with breast cancer and 50 women without breast cancer.



Comment:
For those waiting for a clear study proving the relationship between the use of aluminum-containing antiperspirants and breast cancer, we can only state that such study was not done during the last 20 years, since the hypothesis has been postulated. If we accept that breast cancer may have many causes, and exposure to aluminum is happening via many pathways, then it becomes clear that an epidemiological study finding a relationship between a single cause (aluminum in antiperspirants) and the progress of breast cancer will be very difficult and has to investigate many confounding factors.

For those accepting the precautional principle, the indications that aluminum seems to be a risk factor for breast cancer, can only result in the wish to reduce exposure to aluminum as much as possible. To avoid aluminum containing antiperspirants/deodorants is a very easy action in view of the available products on the market. 

Michael Sperling



Related studies (newest first)

M.R. Tenan, A. Nicolle, D. Moralli, E. Verbouwe, J.D. Jankowska, M.-A. Durin, C.M. Green, S.J. Mandriota, A.-P. Sappino, Aluminum Enters Mammalian Cells and Destabilizes Chromosome Structure and Number, Int. J. Mol. Sci., 22 (2021) 9515. DOI: 10.3390/ijms22179515

S. Sanajou, G. Sahin, T. Baydar, Aluminium in cosmetics and personal care products, J. Appl. Toxicol., 41/11 (2021) 1704-1718. DOI: 10.1002/jat.4228

S.J. Mandriota, A Case-control Study Adds a New Piece to the Aluminium/Breast Cancer Puzzle, EBioMedicine, 22 (2017) 22-23. DOI: 10.1017/j.ebiom.2017.06.005

C. Linhart, H. Talasz, E.M. Morandi, X. Exlex, H.H. Lindner, S. Taucher, D. Egle, M. Hubalek, N. Concin, H. Ulmer, Use of Underarm Cosmetic Products in Relation to Risk of Breast Cancer: A Case-Control Study, EBioMedicine, 21 (2017) 79-85. DOI: 10.1016/j.ebiom.2017.06.005

S.J. Mandriota, M. Tenan, P. Ferrari, A.-P. Sappino, Aluminium chloride promotes tumorigenesis and metastasis in normal murine mammary gland epithelial cells, Int. J. Cancer, 139/12 (2016) 2781-2790. DOI: 10.1002/ijc.30393

A. Farasani, P.D. Darbre, Effects of aluminium chloride and aluminium chlorohydrate on DNA repair in MCF10A immortalised non-transformed human breast epithelial cells, J. Inorg.- Biochem., 152 (2015) 186.189. DOI: 10.1016/j.jinorgbio.2015.08.003

A. Pineau, B. Fauconneau, André-Pascal Sappino, Roger Deloncle, Olivier Guillard, If exposure to aluminiumin antiperspirants presents health risks, its content should be reduced, J. Trace Elem. Med. Biol., 28/2 (2014) 147-150. DOI: 10.1016/j.jtemb.2013.12.002

C.C. Willhite, N.A. Karyakina, R.A. Yokel, N. Yenugadhati, T.M. Wisniewski, I.M.F. Arnold, F. Momoli, D. Krewski1, Systematic review of potential health risks posed by pharmaceutical, occupational and consumer exposures to metallic and nanoscale aluminum, aluminum oxides, aluminum hydroxide and its soluble salts, Crit Rev Toxicol, 2014; 44(S4): 1–80. DOI: 10.3109/10408444.2014.934439

E. House, A. Polwart, P. Darbre, L. Barrd, G. Metaxas, C. Exley, The aluminium content of breast tissue taken from women with breast cancer, J. Trace Elem. Med. Biol., 27 (2013) 257–266. DOI: 10.1016/j.jtemb.2013.05.002

R.M. Rodrigues-Peres, S. Cadore, S. Febraio, J.K. Heinrich, K. Piton Serra, S.F.M. Derchain, J. Vassallo, L.O. Sarian, Aluminum concentrations in central and peripheral areas of malignant breast lesions do not differ from those in normal breast tissues, BMC Cancer, 13 (2013) 104. DOI: 10.1186/1471-2407-13-104

P.D. Darbre, A. Bakir, E. Iskakova, Effect of aluminium on migratory and invasive properties of MCF-7 human breast cancer cells in culture, J. Inorg. Biochem., 128 (2013) 245-249. DOI: 10.1016/j.jinorgbio.2013.07.004

P.D. Darbre, F. Mannello, C. Exley, Aluminium and breast cancer: Sources of exposure, tissue measurements and mechanisms of toxicological actions on breast biology, J. Inorg. Biochem., 128 (2013) 257–261. DOI: 10.1016/j.jinorgbio.2013.07.005

A.P. Sappino, R. Buser, L. Lesne, S. Gimelli, F. Béna, D. Belin, S.J. Mandriota, Aluminium chloride promotes anchorage-independent growth in human mammray epithelial cells, J. Appl. Toxicol. 32/34 (2012) 233-243. DOI: 10.1002/jat.1793

A. Pineau, O. Guillard, B. Fauconneau, F. Favreau, M.-H. Marty, A. Gaudin, C.M. Vincent, A. Marrauld, J.-P. Marty, In vitro study of percutaneous absorption of aluminum from antiperspirants through human skin in the Franz™ diffusion cell, J. Inorg. Biochem., 110 (2012) 21–26. DOI: 10.1016/j.jinorgbio.2012.02.013.

P.D. Darbre, D. Pugazhendhi, F. Mannello, Aluminium and human breast diseases, J. Inorg. Biochem., 105 (2011) 1484–1488. DOI: 10.1016/j.jinorgbio.2011.07.017

F. Mannello, G.A. Tonti, V. Medda, P. Simone, P.D. Darbre, Analysis of aluminium content and iron homeostasis in nipple aspirate fluids from healthy women and breast cancer-affected patients,  J. Appl. Toxicol., 31 (2011) 262–269. DOI: 10.1002/jat.1641

F. Mannello, G.A. Tontia, P.D. Darbre, Concentration of aluminium in breast cyst fluids collected from women affected by gross cystic breast disease, J. Appl. Toxicol., 29 (2009) 1–6. DOI: 10.1002/jat.1384

M. Namer, E. Luporsi, J. Gligorov, F. Lokiec, M. Spielmann, The use of deodorants/ antiperspirants does not constitute a risk factor for breast cancer, Bull Cancer, 95/9 (2008)871-880. DOI : 10.1684/bdc.2008.0679

C. Exley, L.M. Charles, L. Barr, C.  Martin, A. Polwart, P.D. Darbre,  Aluminium in human breast tissue, J. Inorg. Biochem., 101/9 (2007) 1344-1346. DOI: 10.1016/j.jinorgbio.2007.06.005

P.D. Darbre, Metalloestrogens: an emerging class of inorganic xenoestrogens with potential to add to the oestrogenic burden of the human breast, J. Appl. Toxicol., 26/3 (2006) 191-197. DOI: 10.1002/jat.1135

S. Fakri, A. Al-Azzawi, N. Al-Tawil, Antiperspirant use as a risk factor for breast cancer in Iraq. Eastern Mediterranean Health J., 12/3–4 (2006) 478–482.

P.D. Darbre, Aluminium, antiperspirants and breast cancer, J. Inorg. Biochem., 99/9 (2005) 1912-1919. DOIi: 10.1016/j.jinorgbio.2005.06.001

P.D. Darbre, Underarm cosmetics and breast cancer, J. Appl. Toxicol., 23/2 (2003) 89-95. DOI: 10.1002/jat.899

K.G. McGrath, An earlier age of breast cancer diagnosis related to more frequent use of antiperspirants/deodorants and underarm shaving, Eur. J. Cancer Prevent., 12 (2003) 479–485. DOI: 10.1097/00008469-200312000-00006

D.K. Mirick, S. Davis, D.B. Thomas, Antiperspirant Use and the Risk of Breast Cancer, J. Natl. Cancer Inst., 94/20 (2002) 1578-1580. DOI: 10.1093/jnci/94.20.1578

P.D. Darbre, Underarm cosmetics are a cause of breast cancer, Eur. J. Cancer Prevent., 10 (2001) 389-393. DOI: 10.1097/00008469-200110000-00002









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