Objective To explore the relationship between the urinary levels of five trace elements (cadmium, cobalt, lead, tungsten, and arsenic) and breast cancer, and to expand ideas for the diagnosis and treatment of breast cancer.

Methods Based on the data of the National Health and Nutrition Examination Survey(NHANES) from March 2013 to March 2020, the U.S.A., 110 breast cancer patients were selected as the breast cancer group, and 2 849 participants without cancer were selected as the non-breast cancer group. Meanwhile, the subjects basic information including demographic information, reproductive health status, and the urinary levels of the five trace elements were also collected. The chi-square test was used to compare basic information. The Wilcoxon rank sum test was used to compare the urinary concentrations of trace elements between the two groups. A multivariable logistic regression model was used to analyze the relationship between the urinary levels of the five trace elements and breast cancer. The restricted cubic spline approach was used to explore the dose-response relationship between urinary trace elements and breast cancer.

Results The median (P₂₅, P₇₅) urinary concentrations of cadmium, cobalt, lead, tungsten and arsenic in breast cancer group were 0.35(0.24, 0.61), 0.49(0.32, 0.74), 0.51(0.34, 0.74), 0.08(0.05, 0.14) and 7.90(4.28, 18.58) μg/g creatinine, respectively. The median (P₂₅, P₇₅) urinary concentrations of cadmium, cobalt, lead, tungsten and arsenic in non-breast cancer group were 0.27 (0.15, 0.48), 0.45 (0.29, 0.71), 0.34 (0.21, 0.54), 0.06 (0.04, 0.11), and 7.01 (3.92, 15.15) μg/g creatinine, respectively. Urinary cadmium, lead, and tungsten concentrations in the breast cancer group were significantly higher than those of the non-breast cancer group (P < 0.05). After multi-factor adjustment, urinary cadmium, lead, and tungsten concentrations were associated with breast cancer. Compared with the cadmium Q1 concentration group, the risk of breast cancer in the Q2, Q3 and Q4 groups increased, and the odds ratios (ORs) and 95% confidence intervals (CIs) values were 2.63 (1.17-5.92), 3.49 (1.57-7.79), and 2.87 (1.24-6.66), respectively, with P_trend>0.05. Compared with the Q1 concentration group of lead, the risk of breast cancer in the Q4 group increased, and the OR (95% CI) value was 2.45 (1.22-4.93), with P_trend < 0.05. Compared with the Q1 concentration group of tungsten, the risk of breast cancer in Q3 and Q4 groups increased, and the OR (95% CI) values were 1.90 (1.04-3.47) and 2.03 (1.10-3.75), respectively, with P_trend < 0.05. There were non-linear dose-response relationships between urinary cadmium, lead and tungsten levels and the risk of breast cancer. The risk of breast cancer increased with the increase of urinary cadmium, lead and tungsten concentrations.

Conclusion Exposure to cadmium, lead, and tungsten may be associated with an increased risk of breast cancer in the female population.