Table 4.

Overview of epidemiological studies on 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and breast cancer (BC) risk.

Author (Year)	Study Years	Country	Design	Cases/Controls	Exposure Assessment	Results
Warner (2002) [190]	1996–1998	Italy	Prospective	981 participants	Serum (1976–1981)	A 10-fold increase in TCDD plasma concentrations was associated with an increase in BC risk (HR = 2.1; 95% CI: 1.0–4.6)
Warner (2011) [191]	1996–2008	Italy	Prospective	833 participants	Serum (1976–1981)	No association between high TCDD serum concentrations and BC risk (HR = 1.44; 95% CI: 0.89–2.33)
Pesatori (2009) [192]	2006-2009-	Italy	Prospective	2122 participants	Medical records (1992–1996)	Living near the chemical plant during the accident significantly increases BC risk (RR = 2.57; 95% CI: 1.07–6.20)
Revich (2001) [189]	1997–1998	Russia	Prospective	14 participants	Human milk and serum (1997–1998)	BC incidence and mortality are doubled in Chapayevsk compared to the national average
Danjou (2015) [193]	1993–2008	France	Prospective	63,830 participants	Dietary exposure	No significant association between higher dietary dioxin exposure and BC risk (HR = 1.00; 95% CI: 0.96–1.05)
Danjou (2019) [194]	1993–2008	France	Prospective	429/716	Airborne exposure	No significant association between higher estimated airborne dioxin exposure and BC risk (OR = 1.124; 95% CI: 0.693–1.824)
VoPham (2020) [195]	1989–2013	USA	Prospective	112,397 participants	Airborne exposure	Living less than 10 km from a municipal solid waste incinerator significantly increases BC risk (HR = 1.15; 95% CI: 1.03–1.28) The risk increases again by living less than 5 km away (HR = 1.25; 95% CI: 1.04–1.52)
Xu (206) [196]	2015	Multi-centric	Meta-analysis	3 studies	Various	No significant association between higher TCDD exposure and BC risk (RR = 0.99; 95% CI: 0.93–1.06)