Contents lists available at ScienceDirect Environment International journal homepage: www.elsevier.com/locate/envint Bisphenol A and other environmental risk factors for prostate cancer in Hong Kong Lap Ah. Tse a,⁎ , Priscilla Ming Yi Lee a , Wing Ming Ho b , Augustine Tsan Lam c , Man Kei Lee c , Simon Siu Man Ng d , Yonghua He e , Ka-sing Leung f , Jennifer C. Hartle g , Howard Hu h , Haidong Kan i , Feng Wang a , Chi Fai Ng j a Division of Occupational and Environmental Health, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China b Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, China c Family Medicine Training Centre, Prince of Wales Hospital, Hong Kong, China d Department of Surgery, Prince of Wales Hospital, Hong Kong, China e Guilin Medical College, Guangxi Province, China f Department of Applied Biology and Chemical Technology, Hong Kong Polytechnic University, Hong Kong, China g Department of Health Science and Recreation, San Jose State University, USA h Dalla Lana School of Public Health a Faculty of the University of Toronto, Canada i School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China j SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China ARTICLE INFO Keywords: Prostate cancer Environmental exposures Bisphenol A Epidemiology ABSTRACT Background: Environmental exposures are contributing factors to prostate cancer etiology, but these remain unclear. We aimed to document the associations between environmental risk factors and prostate cancer in Chinese, with special reference to bisphenol A (BPA). Methods: We recruited 431 newly diagnosed prostate cancer cases and 402 age-matched controls from Prince of Wales Hospital in Hong Kong. We obtained each participant's clinical data and epidemiological information on chronic BPA exposure and other environmental risk factors (e.g., dietary habits, occupation and shift work) using a standard questionnaire. A new assessment tool of environmental BPA exposure was developed and replicated. Multiple logistic regression analysis was performed to examine odds ratio (OR) and 95% confidence interval (95% CI) for the association of prostate cancer with a novel cumulative BPA exposure index (CBPAI) and other environmental risk factors. Results: Weekly consumption of deep fried food (OR = 1.85, 95% CI: 1.15–2.95) and pickled vegetable (OR = 1.87, 95% CI: 1.07–3.28) was significantly associated with excessive prostate cancer risk. Prostate cancer was positively associated with nightshift work (OR = 1.76, 95% CI: 1.07–2.89) and it was negatively associated with green tea drinking (OR = 0.56, 95% CI: 0.34–0.91). There was a positive exposure-response relationship between CBPAI and prostate cancer, with the greatest and significant risk in the high versus reference category (OR = 1.57, 95% CI: 1.01–2.44). Conclusions: Frequent consumption of deep fried food and pickled vegetable, non-habitual green tea drinking and nightshift work are the contributing risk factors to prostate cancer in Hong Kong Chinese. More importantly, this study provides the first epidemiological evidence on carcinogenicity of BPA on the human prostate. 1. Introduction Prostate cancer is the leading cancer incidence in Hong Kong and many other countries (Hsing and Chokkalingam, 2006; Registry, 2016; Sim and Cheng, 2005). Only advancing age, race, and family history of prostate cancer are the established risk factors (Hsing and Chokkalingam, 2006), but these known risk factors cannot explain the accelerating age-standardized incidence rate of prostate cancer in Hong http://dx.doi.org/10.1016/j.envint.2017.06.012 Received 21 April 2017; Received in revised form 8 June 2017; Accepted 9 June 2017 ⁎ Correspondence author at: JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, 4/F School of Public Health and Primary Care, Sha Tin, N.T., Hong Kong, China. E-mail address: shelly@cuhk.edu.hk (L.A. Tse). Abbreviations: BPA, bisphenol A; CBPAI, cumulative BPA exposure index; ICC, interclass correlation coefficient; OR, odds ratio; 95% CI, 95% confidence interval Environment International 107 (2017) 1–7 0160-4120/ © 2017 Published by Elsevier Ltd. MARK