Breast Cancer Risks in California Nail Salon Workers

Institution: Cancer Prevention Institute of California
Investigator(s): Peggy  Reynolds , Ph.D. - Linda  Okahara ,  -
Award Cycle: 2007 (Cycle 13) Grant #: 13BB-3400 Award: $348,319
Award Type: CRC Full Research Award
Research Priorities
Prevention & Risk Reduction>Risk reduction and identification

This is a collaboration with: 13BB-3401 -

Initial Award Abstract (2007)
Concerns about the chemical composition of cosmetics have recently garnered considerable attention. Nail salon workers, in particular, have been the focus of health concerns because they routinely handle nail care products containing organic solvents, some of which can cause cancer or affect a woman’s endocrine system. The nail salon industry is one of the country’s fastest growing professions; California has over 300,000 nail salon workers. Additionally, over 80% of California’s nail salon workforce is comprised of Vietnamese immigrant women. Surprisingly, despite the size of the workforce, the chronic exposure to cancer-related chemicals and the high proportion of underserved immigrant workers, no human health studies have been conducted to date for this workforce. Understanding breast cancer risks in this worker population will allow us to explore the potential risk relationship between cosmetic compounds and breast cancer.

Asian Health Services (AHS), a community health center serving the Asian indigent population, and the Northern California Cancer Center (NCCC), a non-profit organization dedicated to cancer research, partnered in a CBCRP-funded pilot study of Vietnamese nail salon workers. Findings from our focus groups and surveys of over 200 nail salon workers suggest that many workers are concerned about the chemicals they work with and are experiencing health problems commonly associated with high levels of exposure to solvents (e.g. headaches, rashes and respiratory problems), underscoring the need for a more in-depth investigation of breast cancer risk in this workforce.

To begin to elucidate the relationship between cosmetic compounds and breast cancer, we will address two questions:
1) Do nail salon workers have higher breast cancer rates than the general population, or the Vietnamese population, in California? Higher rates among workers would indicate a potential link between breast cancer risk and their work-related exposures.
2) Do Vietnamese nail salon workers have workplace exposures to organic solvents that exceed health-based standards? Measured levels of exposures that are higher than the recommended levels by regulatory agencies would inform future health interventions, health policy and future research focusing on this workforce.

To address the first question, we will link the California cosmetology licensee file to the California Cancer Registry file to estimate breast cancer rates in this workforce compared to the general population. Since all nail salon workers are required to be licensed by the state, we will be able to examine the breast cancer experience for the entire California workforce. Similarly, we will compare rates between Vietnamese nail salon workers and the California Vietnamese population; this restricted analysis will allow us take into account other factors (e.g., homeland exposures) that may influence breast cancer risk in this subpopulation.

To address the second question, we will recruit 80 Vietnamese nail salon workers in the greater San Francisco Bay Area to wear a small personal air-monitoring device on their shirt collars during their work shifts, in order to will measure levels of benzene and toluene, two solvents associated with cancer, in addition to total hydrocarbons, which reflect a mix of solvents. Each worker will contribute 2–3 measurements, which will also allow us to examine variability in exposures to individual workers as well as differences in exposure levels between salons and workers.

Our project has three innovative elements: First, we will use complex record-linkage strategies to link between the licensee file and the cancer registry to estimate breast cancer rates. Second, since no race/ethnicity information is collected on the licensee file, we will develop and test a new list-assisted surname and first name methodology to identify workers of Vietnamese descent for restricted Vietnamese analyses. Third, we will use a non-invasive and cost-effective method to measure individual exposure to solvents for a sample of workers. Together these strategies will bring us closer to an assessment of occupational risks for this workforce.


Final Report (2011)

Concerns about the chemical composition of cosmetics have drawn considerable public attention. Nail salon workers, a majority of whom are Vietnamese immigrant women, have been the focus of health concerns because they routinely handle nail care products containing harmful compounds, some of which can cause cancer or affect a woman’s endocrine system. The Cancer Prevention Institute of California (CPIC) partnered with Asian Health Services (AHS) to begin to elucidate the relationship between ingredients in cosmetic compounds and breast cancer. This community-research project has two main components: 1) a record linkage component in which we linked the cosmetology licensee file to the California Cancer Registry file to assess breast cancer rates in California-licensed nail salon workers, and 2) an exposure assessment component in which Vietnamese nail salon workers in the San Francisco Bay Area wore a personal air monitor device to measure exposures to select solvents (i.e., toluene, ethyl acetate, isopropyl acetate) during their workshift.

For the record linkage component of the study, our findings have not suggested an excess of breast cancer incidence in California nail salon workers relative to the general female population in California. These findings have been published in the American Journal of Epidemiology (2010). Similarly, when restricted to Vietnamese nail salon workers, we also did not find evidence of excess breast cancer incidence relative to the general Vietnamese female population. However, because the workforce is still fairly young and the length of follow up is relatively short, there is still a need to continue to follow-up this worker cohort.

For the air monitoring component, we found that measured levels of toluene, methyl methacrylate and total volatile organic compounds were higher than recommended guidelines to prevent health symptoms like headaches, irritations, and breathing problems, which were frequently reported in this workforce. Our findings were published in the American Journal of Public Health (2011) and have garnered considerable media attention, including from the Vietnamese ethnic media. Vietnamese nail salon workers/owners and their family members have contacted the investigators to express their deep appreciation for this important research. Furthermore, results have also helped to inform public policy, including the recent re-introduction of the Federal Safe Cosmetic Act of 2011 to ban toxic compounds; require pre-market safety testing of product manufacturers; and provide greater regulatory authority to the FDA to oversee cosmetic manufacturers.

The relationship between CPIC and AHS has continued to strengthen over the course of both the pilot and full CRC projects. The two partners have also secured multiple NIH grants based on this work (e.g., an ARRA Challenge grant and a pilot intervention) and continue to work together to promote worker health and safety.