- Short communication
- Open Access
Underarm antiperspirants/deodorants and breast cancer
© BioMed Central Ltd 2009
- Published: 13 December 2009
- Breast Cancer
- Cosmetic Product
- Human Breast Tissue
- Outer Quadrant
- Breast Cyst
Clinical studies dating back decades report a disproportionately high number of female breast cancers originating in the upper outer quadrant of the breast , and although this is attributed to a greater amount of epithelial tissue in that region, it is also the area to which underarm cosmetic products are applied [2, 3]. Early studies reported 31% of cancers in the upper outer quadrant , but later studies in the 1990s report up to 61% [2, 3]. The annually recorded quadrant incidence of breast cancer in Britain documents a rise in England and Wales from 47.9% in the upper outer quadrant in 1979 to 53.3% in 2000, and in Scotland a rise from 38.3% in the upper outer quadrant in 1980 to 54.7% in 2001 . Any increase in the disproportionality of breast cancer in the upper outer quadrant would be inconsistent with an explanation relating to the greater amount of target epithelial tissue in that region but does parallel the increasing use of cosmetics in the underarm area [2–5].
Many component cosmetic chemicals with oestrogenic properties have been measured as present in human breast tissue or human milk [5, 12], and direct confirmation of the ability of these chemicals (parabens, phthalates, sunscreens) to be absorbed from topical application in cosmetic cream into the human body has also been published [13–16]. Furthermore, the ability of cosmetic chemicals to be absorbed at sufficient concentrations to exert physiological effects is exemplified by the Mortician's Mystery published in the New England Journal of Medicine in 1988 . This case report demonstrates that long-term topical exposure of hands to embalming creams can result in endocrine disruption to the whole human body, and in particular can affect breast tissue in males .
More recent studies report endocrine disruption in women at both young and old age following inappropriate exposure to oestrogenic chemicals in personal care products - including premature breast development and menstruation in a 36-month girl following exposure to hair lotion containing oestrogenic products used by her mother , and, at the other extreme of age, abnormal genital bleeding and breast cancer in a 93-year old lady after long-term use of an ethynyloestradiol-containing body care cream . The administration of hormone replacement therapy by skin patches relies on the ability of the hormones to be absorbed from the patch through the skin, but the effects of daily application over the long term of multiple cosmetic products containing oestrogenic chemicals warrants equal consideration .
Clinical studies in 2004 reported increased levels of genomic instability in outer regions of the breast in histologically normal tissue , which was suggested to result from exposure to genotoxic chemicals in that region . Instability of the genome is an important contributor to genetic changes that drive carcinogenic processes, and in accordance with the cancer field theory could provide a milieu where genetically altered cells would be more susceptible to the development of cancer [5, 24, 25].
The active antiperspirant agents are aluminium salts - and aluminium has a known genotoxic profile [26, 27], and aluminium chlorhydrate has been shown active in the Comet assay . Use of these salts in cosmetics relies on the inability of the antiperspirant complexes to be absorbed . Dermal absorption of aluminium from topically applied antiperspirant aluminium chlorhydrate, however, has been demonstrated through intact human skin of the underarm , and aluminium was measured in human breast tissue at greater levels in outer quadrants than in inner quadrants . Clinical consequences arising from absorbed antiperspirant salts were described in a case study in 2004 reporting adverse bone pain and fatigue associated with toxic blood levels of aluminium, both of which disappeared after discontinuing antiperspirant use .
Although cancer assumes the highest profile, it represents only about 5% of clinical abnormalities of the human breast, with breast cysts and fibroadenomas being the most common benign breast abnormalities . The reason for such a high incidence of benign breast conditions is unknown, but it is notable that the most common site of occurrence of these benign conditions is also the upper outer quadrant of the breast [1–3, 5].
On the basis that antiperspirant formulations are designed to block underarm sweat ducts  and breast cysts arise from blocked breast ducts in the adjacent region of the body , it is plausible that breast cysts might also arise from antiperspirant use if sufficient chemicals are absorbed over long periods of usage [3, 5]. The recent study reporting raised aluminium levels in human breast cyst fluids, most notably from type 1 cysts, compared with serum or milk  provides evidence warranting further research into a link between aluminium-based antiperspirant use and breast cyst development.
Although cosmetic products were used even as long ago as 3500 BC in Ancient Egypt, the mass marketing of recent decades has resulted in unprecedented quantities being now used on the human body and in unprecedented exposure of people across the whole global population. The proposed link between breast cancer and the application of cosmetic chemicals with oestrogenic and/or genotoxic properties provides an evidence-based hypothesis capable of further testing. Although individual chemicals will have been tested by current safety guidelines, the effects of long-term usage of mixtures of these chemicals over an entire lifetime by people of all ages across the whole world warrants retrospective investigation. If use of underarm cosmetics is a factor in the development of breast cancer, then options for prevention could at last become a reality through individual decisions to cease usage or through alterations to product formulations.
This article has been published as part of Breast Cancer Research Volume 11 Suppl 3 2009: Controversies in Breast Cancer 2009. The full contents of the supplement are available online at http://breast-cancer-research.com/content/11/S3.
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