Identifying Hot Spots of Breast Cancer Prevalence and their Association with Industrialized Areas in Hermosillo, Sonora, Mexico

Identifying Hot Spots of Breast Cancer Prevalence and their Association with Industrialized Areas in Hermosillo, Sonora, Mexico | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Identifying Hot Spots of Breast Cancer Prevalence and their Association with Industrialized Areas in Hermosillo, Sonora, Mexico Diana Evelyn Villa-Guillen, Jorge Alejandro Villa-Carrillo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4572147/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Breast cancer is a significant public health concern in Sonora, Mexico, which has a history of industrial pollution. Hermosillo, the state capital, exhibits both of these characteristics. Prior studies suggest that living in areas with high levels of pollutants may contribute to a higher incidence of breast cancer, creating what is known as a "hot spot" in that specific region. Purpose This study aims to assess the potential association between living in an industrialized area and the presence of breast cancer hot spots in Hermosillo. Methods The research collected clinical data on breast cancer cases between 2013 and 2023 and pinpointed neighborhoods with a high prevalence of breast cancer using hot spot analysis (ArcGIS software version 10.8.2). The odds ratio was used to compare the likelihood of finding a breast cancer case in industrialized areas versus non-industrialized neighborhoods (R version 4.3.1). Results The study observed a link between industrialized areas and high breast cancer rates (unadjusted OR = 6.94, 95% CI (0.94, 50.8), p-value = 0.05)), particularly in women aged 65 + in 33 industrialized neighborhoods located at Hermosillo's northwest (OR = 2.70, 95% CI (1.27, 5.72), p-value = 0.009). Conclusions In this study cohort, there is a link between industrialized areas and high breast cancer rates in Hermosillo, with hot spots for women aged 65 + living in 33 neighborhoods in the city's northwest. Further extensive studies are needed to confirm these findings in other cities in Sonora, Mexico. breast cancer incidence industrial pollution Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 INTRODUCTION Breast cancer is a pressing global health issue that affects approximately one in every eight women [ 1 ]. In Mexico, it is the leading cause of cancer-related morbidity and mortality [ 2 ]. Recent data from the National Institute of Statistics and Geography (INEGI) highlights that Sonora, along with Mexico City, Colima, Veracruz, Chihuahua, and Morelos, bears one of the highest rates of breast cancer mortality (8.1 per 10,000) [ 2 ]. The etiology of breast cancer is multifactorial, and determining the causes of these high rates requires extensive research [ 3 , 4 ]. Other risk factors that may contribute to this scenario are age, personal and familial history of breast cancer, obesity, and nutrition [ 5 ]. However, potential risk factors, such as exposure to hazardous pollutants in the environment, may increase the risk of developing breast cancer [ 6 ]. Studies suggest that long-term exposure to industrial pollutants like NO 2 , NO x , cadmium, mercury, lithium, and PM 2.5 might increase breast cancer risk [ 7 – 10 ]. Nonetheless, this association remains to be fully understood, as some studies have found little or no correlation between breast cancer and long-term exposure to industrial pollutants [ 11 , 12 ]. It has been suggested that exposure to environmental hazards during biological susceptibility, like puberty or pregnancy, increases the risk of developing breast cancer [ 13 ]. Therefore, an ecological approach is needed to address the relationship between long-term exposure to industrial pollutants and breast cancer. Sonora, which has high industrial and agricultural activities, is an environmental concern that impacts public health [ 14 , 15 ]. Hermosillo, the capital of Sonora, has a history of industrial pollution and holds elevated rates of breast cancer incidence and mortality [ 16 – 19 ]. Prior studies of our research group indicate there is a spatial heterogeneity of breast cancer prevalence within Hermosillo [ 20 ]. Furthermore, a spatial analysis identified regions of interest that suggested a higher prevalence of breast cancer using the neighborhood as the geographical unit of reference [ 20 ]. Preliminary findings suggest that breast cancer prevalence might be related to environmental hazards for a cohort followed up for 5 years [ 20 ]. This study examines breast cancer cases that were diagnosed over a period of 10 years and examines specifically the impact of living near industries that are known to generate hazards using a geospatial approach called "hot spot analysis". The knowledge gained from this research may help in developing public health strategies to prevent and control breast cancer in individuals living in industrialized areas that are more susceptible to this disease. OBJECTIVE This retrospective observational study aims to identify breast cancer hot spots and their association with industrialized areas in Hermosillo, Sonora, Mexico. The study will compare the likelihood of finding breast cancer cases living in an industrialized neighborhood versus a non-industrialized neighborhood. METHODOLOGY Clinical Data Collection . A database for breast cancer cases has been established in Hermosillo by gathering data from both public and private hospitals. Since Mexico does not have a nationwide cancer registry, an online, encrypted, cloud database was created in partnership with various hospitals to address this need. The database includes only female breast cancer cases, whether current, survivors, or deceased, who have been residents of Hermosillo for at least ten years (verified by their address specified at their national ID) and have given their informed consent for data collection and management. The database covers cases from January 2013 to May 2023 at public and private hospitals in Hermosillo. Male breast cancer cases, female non-breast cancer cases, non-informed consent cases, and cases with a residence of less than ten years in Hermosillo are not included. REDCap (Research Electronic Data Capture) was used for data collection and management [ 21 , 22 ]. Data was collected from Hermosillo and de-identified using the Safe Harbor approach before analysis. Since the study aimed to create a census of Hermosillo within ten years, all breast cancer cases from participating institutions were included in the clinical database. This database is not linked to any other electronic databases, so there are no methods for data linkage in this investigation. Variables of Clinical Database Related to Residential Information The database has recorded the neighborhood and zip code of both current and previous residences. In cases where the person has moved out, the analysis considered the oldest residential information available in the hospital's files (neighborhoods equal to or older than 10 years). This was done considering the time for tumors to develop in adulthood [ 23 ]. Variables of Clinical Database Related to Breast Cancer The database contains various information related to breast cancer, such as age at the time of diagnosis, familiar history of breast cancer, personal history of breast cancer, classification of the tumor by SBR (Scarff-Bloom-Richardson) and by TNM, tumor grade, mammography-based breast density (BI-RADS classification), current treatment (chemotherapy, radiotherapy, surgery, breast implants), and current status of the patient (current, survivor, or deceased). However, the database includes only those cases of breast cancer that were diagnosed on or after January 1, 2013, and no information regarding cases predating this date is available in the hospitals’ records. A total of 1844 cases of breast cancer were gathered from both public and private hospitals. Out of these cases, 450 were excluded from the analysis as they were residents of cities other than Hermosillo. The remaining 1394 cases met the inclusion criteria, which required that they were diagnosed between January 1st, 2013, and May 31st, 2023 and that the individuals had been living in the same neighborhood for at least 10 years. Other Variables of Clinical Database . The following information was collected: the highest level of education attained (none, elementary school, junior high school, high school, technical career, university, not specified), religion (atheist, Catholic, Christian, Mormon, Jehovah Witness, other, not specified), occupation (housewife, employee, teacher, engineer, accountant, business owner, retired, other, not specified), alcohol consumption (non-consumer, former consumer, social consumer ( 7 drinks per week), not specified), tobacco consumption (none, former consumer, passive smoker, current smoker, not specified), weekly consumption of red meat (none, 1–2 times, 3–4 times, 5 + times, not specified), BMI, exercise habits (yes, no, not specified), number of live births, age at menarche, menopausal status (premenopausal, perimenopausal, menopause, postmenopausal, not specified), use of hormonal contraception (yes, no, not specified), use of hormonal replacement therapy (yes, no, not specified), elements of metabolic syndrome as defined by the NCEP ATP III criteria [ 24 ], prior chronic illnesses other than cancer, prior cancers other than breast cancer, and red blood type. Race and ethnicity were not collected for this population, as Hermosillo is composed solely of Hispanics, considered to be a homogeneous population. Industrialized Areas. The 2020 INEGI Census provided coordinates (longitude, latitude) for active industries that produce hazardous biological and chemical residues. These industries include welding shops, auto repair shops, automotive paint shops, paint distributors and manufacturers, agrochemical distributors and manufacturers, hardware stores, dental clinics, laboratories, and hospitals. ArcGIS version 10.8.2 was used to plot the coordinates of these industries on a map and group them according to neighborhoods. A neighborhood was classified as industrialized if it had six or more active industries, and not industrialized if a neighborhood had five or fewer active industries. This classification was based on a prior regression analysis, where the proportion of breast cancer cases per neighborhood was the response variable, and the number of industries was the explanatory variable based on a sample of 914 cases, as seen in Table 1 . Moreover, the criteria for industrialized areas were confirmed with the final sample ( see Suppl. Table 1 and Suppl. Figure 1 ). Table 1 Number of active industries in 2019 and the breast cancer cases per 100,000 females (18 years old or older) per neighborhood. Data related to industries was obtained from the INEGI Census 2010. Data related to breast cancer cases was obtained from public and private hospitals in Hermosillo, Sonora, Mexico, from 2013 to 2019 [ 20 ]. Number of Industries Breast cancer cases per 100,000 females per neighborhood 0 437 1 364 2 441 3 512 4 309 5 442 6 398 7 798 8 903 11 541 14 645 21 1,203 29 665 Hot Spots of Breast Cancer Prevalence. This study aimed to identify the neighborhoods where breast cancer is more prevalent (hot spots). The number of cases reported from 2013 to 2023 and the number of females in each neighborhood who are 18 years old or older (INEGI Census 2020) were considered to estimate the prevalence of breast cancer per neighborhood. The prevalence was calculated based on 100,000 females and projected onto a digital map using the neighborhood as the geographical unit. It's important to note that the study didn't collect any private addresses of the patients, and thus, it complies with national (DOF 05-07-2010) and international regulations for the protection and privacy of human subjects (HIPAA Privacy Rule) [ 25 , 26 ]. Neighborhoods were managed according to the INEGI identification numbers (CVEASEN). The hot spot and outlier analyses were used to identify neighborhoods with high breast cancer prevalence using ArcGIS version 10.8.2. This statistical approach enables to discriminate clusters of high values (regions of high incidences of breast cancer) from low values (regions of low incidences of breast cancer) and spatial outliers, which differs from the Anselin Local Moran’s I used for the preliminary analysis of this population in a prior work [ 20 ]. Assessment of breast cancer prevalence and industrialized areas. To investigate the potential link between breast cancer prevalence and industrialized areas, this study analyzed and compared the neighborhoods with high incidence of breast cancer and industrialized regions with those that have low incidence of breast cancer in non-industrialized areas. The neighborhood was considered the unit of analysis and R v. 4.3.1 was used for statistical analysis. Key Assumptions. All neighborhoods (units of analysis) have different sizes and represent different quantities of persons (which is the case in this type of study). We assume that results apply to an aggregation of these units. Ethics Statement. This study was IRB-approved on behalf of the Health Secretariat of Sonora State, IMSS UMF No. 37, Hospital San José Hermosillo, ISSSTE Hospital Fernando C. Ocaranza, CIMA, Clínica del Noroeste, Hospital General del Estado de Sonora “Dr. Ernesto Ramos Bours”, and Centro Estatal de Oncología “Dr. Ernesto Rivera Claisse”. Informed written consent for research and publication was obtained before data collection from the patient or her closest relative in the case of deceased patients. RESULTS Breast Cancer Cases from 2013 to 2023 Between 2013 and 2019, a total of 914 cases of breast cancer were diagnosed in both public and private hospitals in Hermosillo, Sonora, Mexico, according to a study by Villa-Guillen et al. [ 20 ]. An updated database now shows that between 2013 and 2023, there were a total of 1,394 cases of breast cancer diagnosed, representing a 52% increase within five years. The study collected data from public and private hospitals, and the database created is the first breast cancer census for this city in the past ten years. This information was used to construct a digital map, which depicted the neighborhoods in Hermosillo that had reported cases of breast cancer between 2013 and 2023. Out of a total of 756 neighborhoods, 290 (38.36%) had at least one case of breast cancer, while the remaining 466 (61.64%) did not have any reports of breast cancer. The neighborhoods containing at least one case are depicted in Fig. 1 . The greatest numbers (25 cases or more) are concentrated in seven neighborhoods. Of those, five are in Hermosillo’s downtown. Those are 57 cases for Balderrama (CVEASEN 2603000010022), 43 cases for Olivares (CVEASEN 2603000010138), 42 cases for San Benito (CVEASEN 2603000010196), 42 cases for Centro (CVEASEN 2603000010043), and 33 cases for Jesús García (CVEASEN 2603000010096). Moreover, there is one neighborhood in the west with 38 cases (Sahuaro, CVEASEN 2603000010191), and one neighborhood in the south with 40 cases (Palo Verde, CVEASEN 2603000010142). This is to be expected, as those neighborhoods have the highest numbers of females of 18 years old or older per 100,000 inhabitants (Balderrama with 4,467; Olivares with 4,364; San Benito with 3,200; Centro with 1,745; Jesús García with 3,488; Sahuaro with 4,843; and Palo Verde with 4,858 females) ( see Fig. 1 ). Industrialized Areas To further evaluate the potential association between breast cancer prevalence and industrialized areas, a digital map was constructed for targeting neighborhoods with at least six active, hazard-generator industries. According to the INEGI Census 2020, 3,697 industries met the criteria for hazard-generators. To represent industrialized areas visually, the data was projected onto a map using ArcGIS v. 10.8.2 and converted to UTM 12 N. The resulting map revealed that out of 756 neighborhoods located in Hermosillo, 95 (12.57%) were industrialized areas (pale blue for 6 to 83 active industries, and navy blue for 84 or more industries), while the remaining 661 (87.43%) were categorized as non-industrialized locations (white color). Those are depicted in Fig. 2 . Industrialized Areas and Breast Cancer Cases per Neighborhood A digital map was utilized to highlight industrialized areas in the neighborhoods with ( see Fig. 3 a) and without breast cancer cases ( see Fig. 3 b) during ten years of follow-up. Non-industrialized areas are depicted in white color. It is noticeable that highly industrialized neighborhoods in Hermosillo’s downtown match with those reporting the highest numbers of breast cancer cases ( see Fig. 1 and Fig. 3 a). To compare industrialized areas with locations without breast cancer cases, a digital map was created for cancer-free neighborhoods. A total of 472 neighborhoods had no reports of breast cancer during the ten years of observance. Interestingly, most of those neighborhoods are considered non-industrialized areas (98.94%), with only five of them categorized as industrialized (1.06%) ( see Fig. 3 b). Hot Spots of Breast Cancer Prevalence A hot spot analysis (ArcGIS v. 10.8.2) was conducted to identify neighborhoods of interest that may have high rates of breast cancer among the female population aged 18 or older. The analysis revealed that there were four neighborhoods of interest with a high prevalence of breast cancer (p-value < 0.0005). The neighborhoods found with this approach might represent areas of interest, as there could be a potential relationship (trend) between high breast cancer prevalence in industrialized areas ( see Fig. 4 ). All four neighborhoods of interest for breast cancer prevalence were in a cluster (Las Lomas, CVEASEN 2603000010686; Urbi Villa del Rey II Sección Etapa I, CVEASEN 2603000010638; El Jito, CVEASEN 2603000010097; Urbi Villa del Rey III, CVEASEN 2603000010635), particularly in the southeast of Hermosillo (Fig. 4 ). Of those, the highest prevalence of breast cancer (7,826 per 100,000 females) was found in a neighborhood of interest (Las Lomas, CVEASEN 2603000010686), which is also an industrialized area with seven active industries. For this reason, further analysis was conducted to evaluate the potential association between those neighborhoods of interest and industrialized areas. Association between Hot Spots of Breast Cancer Prevalence and Industrialized Areas 290 neighborhoods had at least one breast cancer case. Results show a hot spot comprising four neighborhoods, which are regions of interest ( see Fig. 4 ). Those may present a trend for an association between breast cancer prevalence and industrialized areas. In this hot spot, two neighborhoods (Las Lomas, CVEASEN 2603000010686; and El Jito, CVEASEN 2603000010097) are targeted as industrialized areas according to the criteria previously mentioned (0.69%), while the remaining two neighborhoods of this cluster (Urbi Villa del Rey II Sección Etapa I, CVEASEN 2603000010638; and Urbi Villa del Rey III, CVEASEN 2603000010635), were considered as not industrialized locations (0.69%). In contrast, 36 locations were industrialized areas but not areas of interest for breast cancer prevalence (12.41%), and 250 neighborhoods were non-industrialized areas but had no registries of breast cancer cases (86.21%). According to the odds ratio, there is a trend between hot spots of breast cancer prevalence and industrialized areas (OR = 6.94, 95% CI (0.94, 50.8), p-value = 0.05) ( see Fig. 5 ). The inference procedure requires at least 5 elements in each cell. Therefore, the result OR = 6.94 (0.94, 50.8) could be taken as a trend. That means two expressions: a) There is a greater probability that a neighborhood is not industrialized if it is not a hot spot, and b) there is a greater probability that a neighborhood is industrialized if it is a hot spot for breast cancer prevalence. Breast Cancer Prevalence by Age Group A global trend was obtained for breast cancer prevalence and industrialized areas. To further explore this trend, the sample was analyzed in terms of age groups, which consider age as a breast cancer risk factor. The age groups were divided as follows: 18–59 years old were in the first age group, 60–64 years old in the second, and ages 65 years or older made up the third group. Categorization of age groups was performed based on demographics reported by neighborhood according to the INEGI Census 2020. The OR for the three age groups was calculated. For the first age group, Fig. 6 shows one neighborhood of interest located on the southeast side of the city (Parque Industrial, CVEASEN 2603000010145, see Supp. Table 2a ). For the second age group, Fig. 7 shows three neighborhoods of interest (Villa del Real, CVEASEN 2603000010439; Arándanos Residencial; CVEASEN 2603000010512; Mini Parque Industrial, CVEASEN 2603000010563, see Supp. Table 2b ) located on the northwest side of the city. The association between breast cancer prevalence and industrialized areas was confirmed only for the third age group ( see Fig. 8 ), where the hot spot comprises 33 neighborhoods of interest (see Supp. Table 2c ) located on the northwest side of the city. Which group has the greater risk? An analysis was conducted to evaluate the potential association between hot spots of breast cancer prevalence and industrialized areas by age group. The aim was to determine whether age played a role as a confounding variable. The results showed that for the age group of 18 to 59, there was no significant link between the two (OR = 1.69, 95% CI (0.07, 41.74), p-value = 0.75, refer to Fig. 9 ). Similarly, for the age group of 60 to 64, the association was not statistically significant either (OR = 2.56, 95% CI (0.23, 28.46), p-value = 0.44, refer to Fig. 10 ). However, for the age group of 65+, the study found a statistically significant association between breast cancer hot spots and living in industrialized neighborhoods (OR = 2.7, 95% CI (1.27, 5.72), p-value = 0.009), refer to Fig. 11 ). That means, there is a greater probability that the neighborhood is a breast cancer hot spot for the elderly group (ages 65 or older) if it is industrialized. DISCUSSION The purpose of this study was to investigate whether there is a connection between living in an industrial area and the prevalence of breast cancer after a decade of follow-up. The analysis shows that there is an association for women aged 65 or older. The risk of developing breast cancer is higher in neighborhoods that have at least six active industries that generate hazardous pollutants. However, for other age groups, this association was not statistically significant. The study identified a global hot spot for breast cancer, which includes four neighborhoods of interest. After adjusting for age, the hot spot was found to consist of 33 neighborhoods located in the northwest area of Hermosillo. Hot spots of breast cancer prevalence in Hermosillo Spatial heterogeneity of breast cancer prevalence exists in Hermosillo, as indicated by hot spot analysis. The study identified four neighborhoods of interest in the southeast and a hot spot in the northwest, which comprises 33 neighborhoods clustered together. After age adjustment, it was found that the prevalence is higher for the elderly group in the northwest region. The study collected breast cancer cases reported from both public and private sectors for 10 years and observed a considerable increase of 52% compared to cases reported from 2013–2019 [ 20 ]. This increase in breast cancer cases and sustained heterogeneity in their geographical distribution highlights the need to target vulnerable populations in Hermosillo city. The study also revealed the location of a hot spot for an elderly group, which is relevant for breast cancer prevention and control. Other studies support the spatial heterogeneity of breast cancer within Mexico. One such research, conducted by Castrezana-Campos, mapped the incidences of breast cancer per counties across the nation [ 27 ]. The study revealed that 120 counties had higher incidence rates compared to the norm, with Hermosillo as one of those regions of interest. Another study that supports our research is that of Soto-Perez-de-Celis, which showed that breast cancer mortality rates also exhibit spatial heterogeneity within a 10-year timeframe (2001 to 2011), with higher rates detected in the Center-North (APC 1.7%, p < 0.05) and Southwest (APC 2.7%, p < 0.05) regions of Mexico [ 28 ]. It is necessary to further explore other risk factors, such as long-term exposure to hazardous pollutants, to elucidate their implications on morbidity and mortality rates for breast cancer. Breast Cancer Prevalence and Industrialized Areas The present study has found a trend between breast cancer rates and living in industrialized areas. The study shows that women living in industrialized regions are almost seven times more likely to develop breast cancer. The unadjusted odds ratio is 6.94 with a 95% confidence interval of 0.94 to 50.8 and a p-value of 0.05. This trend is particularly pronounced for women aged 65 or older. The adjusted odds ratio confirms that there is an association between a hot spot for breast cancer prevalence and living in an industrialized area (OR = 2.7, 95% CI (1.27–5.72), p-value = 0.009). The findings suggest that the risk of developing breast cancer is higher in areas with at least six industries that produce hazardous materials. These results are consistent with a previous study by Castrezana-Campos, which identified the city of Hermosillo as one of the 120 counties where industrial pollution was linked to breast cancer incidence [ 27 ]. However, the previous study did not include important factors such as age and length of time living in the same location. Therefore, this study's findings provide valuable information for future research in this area about which age groups could be included in future research. The present study provides evidence supporting a link between breast cancer and residential exposure to hazardous pollutants derived from industrial activities. A case-control study conducted in Spain found an association between breast cancer risk and residential proximity (between 1 to 3 km) to specific industrial installations (OR = 1.30, 95% CI (1.00, 1.69)) [ 29 ]. This association was particularly strong for organic chemical industries (OR = 2.12, 95% CI (1.20, 3.76)), food and beverages (OR = 1.87, 95% CI (1.26, 2.78)), ceramics (OR = 4.71, 95% CI (1.62, 13.66)), surface treatment with organic solvents (OR = 2.00, 95% CI (1.23, 3.24)), surface treatment of plastics and metals (OR = 1.51, 95% CI (1.06, 2.14)), pesticides (OR = 2.09 95% CI (1.14, 3.82)), and dichlorometane (OR = 2.09, 95% CI (1.28, 3.40)) [ 29 ]. Exposure to hazardous air pollutants was related to higher breast cancer for women residing in urban areas [ 30 , 31 ]. Long-term exposure to particulate matter (PM 2.5 or smaller) was related to hormonal-responsive breast cancers in non-Hispanic whites living in the US (HR = 1.10, 95% CI (1.04, 1.17)) [ 7 ]. On the same lines, the Sisters Study found associations between PM 2.5 and breast cancer risk [ 9 ]. A meta-analysis found that exposure to a 10 µg/m3 increase in nitrogen dioxide (NO 2 ), a marker for traffic pollution, is related to a 3% increased risk for breast cancer [ 10 ]. Another research work within the Sisters Study indicated no association between postmenopausal breast cancer and long-term exposure (from 2003 to 2009) to mercury (HR = 1.3, 95% CI (0.96, 1.3)), cadmium (HR = 1.1, 95% CI (0.96, 1.3)), and lead (HR = 1.1, 95% CI (0.98, 1.3)) [ 32 ]. A cohort study conducted in California found no meaningful links between invasive breast cancers with long-term exposure to hazardous air pollutants during a follow-up of 1989 to 2011 [ 11 ]. Finally, a review found a higher risk for breast cancer with nitrogen dioxide (NO 2 ) and nitrogen oxide (NOx) levels, but little evidence regarding exposure to particulate matter, except nickel and vanadium [ 12 ]. One possible explanation for the discrepancy among studies is that most studies only focus on breast cancer cases detected in adulthood, without considering the potential risk factors during periods of biological susceptibility, such as pregnancy and puberty [ 13 ]. Additionally, different sources of hazardous air pollutants can result in varying levels of exposure and produce diverse effects. All the above reasons highlight the need to evaluate these sources in diverse populations to fully understand their health impact [ 33 ]. Strengths and Limitations The study has shown that there is a variation in breast cancer risk depending on the location, with industrial areas having a higher risk. This finding could lead to the implementation of measures to prevent and control breast cancer in elderly women (ages 65+). One of the strengths of the study is that it only included cases with a verifiable ID address and at least ten years of residence in the same neighborhood, which allowed for the assessment of residential exposure to industrial areas. However, it is important to consider some limitations of the study to evaluate the results accurately. One of the limitations is the potential influence of a family history of breast cancer in the study group. Additionally, it is necessary to consider the impact of occupational exposure to hazards that patients may have had, particularly during puberty and pregnancy. Further research is needed to confirm the effects of long-term residential exposure to hazardous air pollutants, including studies analyzing particulate matter and heavy metals in urban dust. Efforts are currently underway to address these issues. CONCLUSIONS It has been observed that there is a strong link between living in industrial areas and higher rates of breast cancer in certain areas, referred to as "hot spots". In Hermosillo's northwest, a hot spot was identified, which comprises 33 neighborhoods, confirming the correlation between breast cancer prevalence and industrial areas among elderly women aged 65 and over. This research work examines breast cancer cases in Hermosillo over a period of 10 years, and confirms the spatial differences observed in a previous study conducted over a period of 5 years. It is important to focus on vulnerable populations who are exposed to hazards in their residential areas and to develop effective ecological practices to prevent such exposure. Additionally, stronger screening programs should be implemented for early breast cancer diagnosis. Further research on a larger scale is necessary in other cities in Sonora, Mexico, to validate these findings. Declarations The first author was the recipient of the Consortium Arizona – Mexico (CAZMEX) Funding in 2018 for Postdoctoral Stays. Resources for the present work were derived from this funding. Competing Interests The authors and collaborators of this work have no relevant financial or non-financial interests to disclose. Author Contribution D.E. Villa-Guillen conceived of the presented idea, conducted and developed the geospatial analysis, coordinated the collaborations and data collection, and wrote the manuscript with support from J.A. Villa-Carrillo.J.A. Villa-Carrillo contributed to developing the presented idea, conducted the statistical analysis, and wrote the manuscript with support from D.E. Villa-Guillen. Acknowledgement We are very grateful to all the institutions that collaborated in this work: Health Secretariat of Sonora State, IMSS UMF No. 37, Hospital San José Hermosillo, ISSSTE Hospital Fernando C. Ocaranza, CIMA, Clínica del Noroeste, Hospital General del Estado de Sonora “Dr. Ernesto Ramos Bours”, Centro Estatal de Oncología “Dr. Ernesto Rivera Claisse”, and INEGI. Special thanks to Dr. Mata-Valenzuela, Dr. Tecuanhuey-Tláhuel, Dr. Ávila-Monteverde, Dr. Fierros-Greenhouse, Dr. Gonzalez-Zepeda, Dr. Corral-Villegas, Dr. Aguilar-Gutierrez, Dr. Rojas-Camarena, Dr. Durazo-Cons, Dr. Luque-Morales, Dr. Aguilar-Peraza, and Dr. Cordon-Guillen for their collaboration through their institutions. Thanks to the students Andres Galvez-Arevalo, Kenneth Garcia-Castellon, Yoahanna Guzman-Hernandez, Karla Ortega-Landa, Fatima Pelayo-Rodriguez, Jose Silva-Romero, and Rogelio Ureña-Acosta for their support with data collection and in acquiring informed consent from the patients analyzed in this work. Data Availability The datasets generated during the present work are not publicly available due to compliance with the protection of the clinical data of the patients according to the national regulations of Mexico for research in health institutions [NORMA Oficial Mexicana NOM-024-SSA3-2012, Ley Federal de Protección de Datos Personales en Posesión de los Particulares]. Partial datasets with IRB approval from the hospitals involved in this research are available from the corresponding author upon reasonable request. References Kashyap D et al (2022) Global Increase in Breast Cancer Incidence: Risk Factors and Preventive Measures. Biomed Res Int 2022: 9605439. 10.1155/2022/9605439 INEGI. (2023), February 4 Statistics for the World's Cancer Day (February 4th): National Data [Press release]. https://www.inegi.org.mx/contenidos/saladeprensa/aproposito/2023/EAP_Cancer.pdf Barnard ME et al (2015) Established breast cancer risk factors and risk of intrinsic tumor subtypes. 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Environ Prog Sustainable Energy 41:e13796 Meza-Figueroa et al (2009) The impact of unconfined mine tailings in residential areas from a mining town in a semi-arid environment: Nacozari, Sonora, Mexico. Chemosphere 77(1):140–147 Moreno-Rodríguez et al (2015) Historical trends and sources of TSP in a Sonoran desert city: Can North America Monsoon enhance dust emissions? Atmospheric Environment 110(2015): 111–121 Meza-Figueroa et al (2007) Heavy metal distribution in dust from elementary schools in Hermosillo. Sonora México Atmos Environ 41:276–288 Calderón-García et al (2021) Metals, Nanoparticles, Particulate Matter, and Cognitive Decline. Front Neurol 12:794071 Santos-Romo et al (2014) Microbiological identification of atmospheric particles in Hermosillo, Sonora, Mexico. J Environ 5(5):376–386 Villa-Guillen DE et al (2020) Breast Cancer Period Prevalence in a Hazard-Exposed Cohort at Hermosillo, Sonora, Mexico: A Report from 2013–2019. OAJBS 3(3):762–774. 10.38125/OAJBS.000242 Harris PA et al (2009) Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf 42(2):377–381 Harris PA et al (2019) The REDCap consortium: Building an international community of software partners. J Biomed Inform. 95 (2019): 103208. 10.1016/j.jbi.2019.103208 Brender JD et al (2011) Residential proximity to environmental hazards and adverse health outcomes. AJPH 10:S37–S52 Huang PL (2009) A comprehensive definition for metabolic syndrome. Dis Model Mech 2(5–6):231–237 Cámara de Diputados del H. Congreso de La Unión (2017), January 26 Ley General De Protección De Datos Personales En Posesión De Sujetos Obligados. https://www.diputados.gob.mx/LeyesBiblio/pdf/LGPDPPSO.pdf U.S. Department of Health and Human Services (2021) June 9). Health Information Privacy. https://www.hhs.gov/hipaa/index.html Castrezana-Campos M (2017) The geography of Mexico breast cancer. Investigaciones Geográficas UNAM Soto-Perez-de-Celis E et al (2016) National and regional breast cancer incidence and mortality trends in Mexico 2001–2011: Analysis of a population-based database. Cancer Epidemiol 41:24–33 García-Pérez J et al (2018) Risk of breast cancer and residential proximity to industrial installations: New findings from a multicase-control study (MCC-Spain). Environ Pollut 237:559–568 Garcia E et al (2015) Hazardous air pollutants and breast cancer risk in California teachers: a cohort study. Environ Health 14:14 Liu R et al (2015) Residential exposure to estrogen disrupting hazardous air pollutants and breast cancer risk: the California teachers’ study. Epidemiology 26(3):365–373 White AJ, O’Brien KM et al (2019) Metallic Air Pollutants and Breast Cancer Risk in a Nationwide Cohort Study. Epidemiology 30(1):20–28. 10.1097/EDE.0000000000000917 White AJ (2021) Invited Perspective: Air Pollution and Breast Cancer Risk: Current State of the Evidence and Next Steps. Environ Health Perspect 129(5):051302. 10.1289/EHP9466 Diario Oficial de la Federación (2012) November 30). NORMA Oficial Mexicana NOM-024-SSA3-2012, Sistemas de información de registro electrónico para la salud. Intercambio de información en salud. https://dof.gob.mx/nota_detalle.php?codigo=5280847&fecha=30/11/2012#gsc.tab=0 Cámara de Diputados del H. Congreso De La Unión (2010), July 5 Ley Federal de Protección de Datos Personales en Posesión de los Particulares. https://www.diputados.gob.mx/LeyesBiblio/pdf/LFPDPPP.pdf Additional Declarations No competing interests reported. Supplementary Files SupplementalMaterialVillaGuillenetal2024.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4572147","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318965100,"identity":"981aaba1-df37-4c16-b87f-02b868762ea3","order_by":0,"name":"Diana Evelyn Villa-Guillen","email":"data:image/png;base64,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","orcid":"","institution":"Hospital General del Estado de Sonora. Hermosillo","correspondingAuthor":true,"prefix":"","firstName":"Diana","middleName":"Evelyn","lastName":"Villa-Guillen","suffix":""},{"id":318965101,"identity":"a09a9978-ff28-4d8c-9b34-2410cc42a054","order_by":1,"name":"Jorge Alejandro Villa-Carrillo","email":"","orcid":"","institution":"Health Secretariat of Sonora. Hermosillo","correspondingAuthor":false,"prefix":"","firstName":"Jorge","middleName":"Alejandro","lastName":"Villa-Carrillo","suffix":""}],"badges":[],"createdAt":"2024-06-12 19:08:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4572147/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4572147/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59872565,"identity":"3684d094-b1f6-4e7f-8b86-2bdc9ed7672d","added_by":"auto","created_at":"2024-07-08 17:13:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2801630,"visible":true,"origin":"","legend":"\u003cp\u003eNeighborhoods with breast cancer cases diagnosed from January 1\u003csup\u003est\u003c/sup\u003e, 2013, to May 31\u003csup\u003est\u003c/sup\u003e, 2023, in Hermosillo, Sonora, Mexico. The number of breast cancer cases is depicted per neighborhood. The highest numbers are in seven neighborhoods. Five of them are in Hermosillo’s downtown (Balderrama, 57 cases); Olivares, 43 cases; San Benito, 42 cases; Centro, 42 cases; Jesús García, 33 cases), while there is one neighborhood on the west side (Sahuaro, 38 cases) and another one at the south (Palo Verde, 40 cases).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4572147/v1/68cb2ad688d46532206ae6f7.png"},{"id":59873357,"identity":"75ef7224-025e-499e-8091-185beb404285","added_by":"auto","created_at":"2024-07-08 17:21:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2677084,"visible":true,"origin":"","legend":"\u003cp\u003eIndustrialized areas in Hermosillo, Sonora, Mexico, considering a minimum of six active, hazard-generator industries per neighborhood. Neighborhoods are labeled according to the number of hazard-generator industries reported in the area. Data regarding the number and the type of industries was obtained through the INEGI Census 2020.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4572147/v1/d23c643f337f206c67a1a011.png"},{"id":59872568,"identity":"d3388c4c-fcd4-4ce1-80bb-1627f81db3b7","added_by":"auto","created_at":"2024-07-08 17:13:40","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":2635895,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 3a. \u003c/strong\u003eNeighborhoods reporting breast cancer cases by the number of industries in Hermosillo, Sonora, Mexico, from the period of 2013 to 2023. Industrialized areas are those neighborhoods containing a minimum of 6 active, hazard-generator industries (pale blue for 6 to 11 industries, navy blue for 112 industries or more).\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4572147/v1/5a92e1e834437280bfa1c5fe.png"},{"id":59872569,"identity":"cb66c3b0-134c-4268-896d-c98f1b986392","added_by":"auto","created_at":"2024-07-08 17:13:40","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":2747093,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 3b. \u003c/strong\u003eNeighborhoods without reports of breast cancer cases in Hermosillo, Sonora, Mexico, during the years of 2013 to 2023. Neighborhoods containing five or fewer industries are considered non-industrialized. Neighborhoods are labeled according to the number of active, hazard-generator industries as reported by the INEGI Census 2020.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-4572147/v1/03af2ef938426e880025b247.png"},{"id":59872570,"identity":"66f9189e-c5d7-4c53-83ab-0574cd0ae61c","added_by":"auto","created_at":"2024-07-08 17:13:40","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1750190,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 4. \u003c/strong\u003eNeighborhoods of interest (highlighted in red) of breast cancer prevalence during the period of 2013 to 2023, in Hermosillo. The cluster depicts four neighborhoods of interest (Las Lomas, CVEASEN 2603000010686; Urbi Villa del Rey II Sección Etapa I, CVEASEN 2603000010638; El Jito, CVEASEN 2603000010097; Urbi Villa del Rey III, CVEASEN 2603000010635), which represent a potential trend between breast cancer prevalence and industrialized areas.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-4572147/v1/555a551ccdc61509a8000227.png"},{"id":59872571,"identity":"e49908f6-b285-4ef9-8a06-61e4e18014f3","added_by":"auto","created_at":"2024-07-08 17:13:40","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":222755,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 5. \u003c/strong\u003eOdds ratio for hot spots of breast cancer prevalence and industrialized neighborhoods. There is a trend for four neighborhoods related to industrialized areas (OR = 6.94, 95% CI (0.94, 50.8), p-value = 0.05) which makes them areas of interest.\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-4572147/v1/5be26b613601cdeaf1d6dafc.png"},{"id":59872574,"identity":"1215aca9-a309-413d-8037-f8b5f9e20452","added_by":"auto","created_at":"2024-07-08 17:13:40","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":1292622,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 6.\u003c/strong\u003e Neighborhoods of interest (highlighted in red color) for breast cancer prevalence of the age group no. 1 (18 to 59 years old). The number of industries is labeled per neighborhood.\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-4572147/v1/89ba31c0226b47e954eb20dd.png"},{"id":59872575,"identity":"84be4b78-2186-43fc-a473-a16eb40d5b9c","added_by":"auto","created_at":"2024-07-08 17:13:40","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":2606069,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 7.\u003c/strong\u003e Neighborhoods of interest (highlighted in red color) for breast cancer prevalence of the age group no. 2 (60 to 64 years old). Active industries are labeled per neighborhood.\u003c/p\u003e","description":"","filename":"floatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-4572147/v1/fb0890fffd97fde64c2c6c56.png"},{"id":59873360,"identity":"358a0614-6f53-4919-b20f-5e0d935d5ac2","added_by":"auto","created_at":"2024-07-08 17:21:41","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":1102100,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 8.\u003c/strong\u003e Confirmed hot spot for breast cancer prevalence (highlighted in red), specifically for the elderly group (65 years old or older). The hot spot comprises 33 neighborhoods, where there is an association between breast cancer prevalence and industrialized areas. Those locations report active welding shops, auto repair shops, and automotive paint shops, among others. The number of industries is indicated per neighborhood.\u003c/p\u003e","description":"","filename":"floatimage9.png","url":"https://assets-eu.researchsquare.com/files/rs-4572147/v1/99678f1a8dc112b5906bcd5c.png"},{"id":59872573,"identity":"675a161b-9590-4d8a-9558-680b8c7bf2ae","added_by":"auto","created_at":"2024-07-08 17:13:40","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":223489,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 9. \u003c/strong\u003eOdds ratio of breast cancer prevalence (18 to 59 years old) and industrialized neighborhoods. There is no association between industrialized areas and breast cancer prevalence for this age group. OR = 1.69, 95% CI (0.07, 41.74), p-value = 0.75.\u003c/p\u003e","description":"","filename":"floatimage10.png","url":"https://assets-eu.researchsquare.com/files/rs-4572147/v1/27687fd17b361db5a6acd2de.png"},{"id":59872577,"identity":"5fb2d433-ede5-475a-8b17-58dbddba9b7b","added_by":"auto","created_at":"2024-07-08 17:13:40","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":231930,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 10. \u003c/strong\u003eOdds ratio of breast cancer prevalence (60 to 64 years old) and industrialized neighborhoods. On the same lines, for this age group, there is no relationship between living in an industrialized area with breast cancer. OR = .56, 95% CI (0.23, 28.46), p-value = 0.44.\u003c/p\u003e","description":"","filename":"floatimage11.png","url":"https://assets-eu.researchsquare.com/files/rs-4572147/v1/5a26edbdfb1144a30d4f8de8.png"},{"id":59873358,"identity":"cfd67f44-b6b0-4035-82c7-6ba2acd74f89","added_by":"auto","created_at":"2024-07-08 17:21:40","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":239358,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 11. \u003c/strong\u003eOdds ratio of breast cancer prevalence (65+ years old) and industrialized neighborhoods. The hot spot of 33 neighborhoods confirms an association between breast cancer and industrialized areas for the elderly group. OR = 2.7, 95% CI (1.27, 5.72), p-value = 0.009.\u003c/p\u003e","description":"","filename":"floatimage12.png","url":"https://assets-eu.researchsquare.com/files/rs-4572147/v1/e67b44cada7a0db007e65c16.png"},{"id":61780451,"identity":"7b7fbf7e-261d-48e6-8a0b-25683dcf84e9","added_by":"auto","created_at":"2024-08-05 13:31:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":30174988,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4572147/v1/4601aaf8-e0f2-489f-80c2-5297fa0de684.pdf"},{"id":59872566,"identity":"18fde839-3df7-440a-9049-5791b6aa1fa1","added_by":"auto","created_at":"2024-07-08 17:13:40","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":139250,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalMaterialVillaGuillenetal2024.docx","url":"https://assets-eu.researchsquare.com/files/rs-4572147/v1/0d700e56f4c4ffd7a9e64429.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Identifying Hot Spots of Breast Cancer Prevalence and their Association with Industrialized Areas in Hermosillo, Sonora, Mexico","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eBreast cancer is a pressing global health issue that affects approximately one in every eight women [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In Mexico, it is the leading cause of cancer-related morbidity and mortality [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Recent data from the National Institute of Statistics and Geography (INEGI) highlights that Sonora, along with Mexico City, Colima, Veracruz, Chihuahua, and Morelos, bears one of the highest rates of breast cancer mortality (8.1 per 10,000) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe etiology of breast cancer is multifactorial, and determining the causes of these high rates requires extensive research [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Other risk factors that may contribute to this scenario are age, personal and familial history of breast cancer, obesity, and nutrition [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, potential risk factors, such as exposure to hazardous pollutants in the environment, may increase the risk of developing breast cancer [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies suggest that long-term exposure to industrial pollutants like NO\u003csub\u003e2\u003c/sub\u003e, NO\u003csub\u003ex\u003c/sub\u003e, cadmium, mercury, lithium, and PM\u003csub\u003e2.5\u003c/sub\u003e might increase breast cancer risk [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Nonetheless, this association remains to be fully understood, as some studies have found little or no correlation between breast cancer and long-term exposure to industrial pollutants [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It has been suggested that exposure to environmental hazards during biological susceptibility, like puberty or pregnancy, increases the risk of developing breast cancer [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Therefore, an ecological approach is needed to address the relationship between long-term exposure to industrial pollutants and breast cancer.\u003c/p\u003e \u003cp\u003eSonora, which has high industrial and agricultural activities, is an environmental concern that impacts public health [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Hermosillo, the capital of Sonora, has a history of industrial pollution and holds elevated rates of breast cancer incidence and mortality [\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Prior studies of our research group indicate there is a spatial heterogeneity of breast cancer prevalence within Hermosillo [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Furthermore, a spatial analysis identified regions of interest that suggested a higher prevalence of breast cancer using the neighborhood as the geographical unit of reference [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Preliminary findings suggest that breast cancer prevalence might be related to environmental hazards for a cohort followed up for 5 years [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study examines breast cancer cases that were diagnosed over a period of 10 years and examines specifically the impact of living near industries that are known to generate hazards using a geospatial approach called \"hot spot analysis\". The knowledge gained from this research may help in developing public health strategies to prevent and control breast cancer in individuals living in industrialized areas that are more susceptible to this disease.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eOBJECTIVE\u003c/strong\u003e \u003cp\u003eThis retrospective observational study aims to identify breast cancer hot spots and their association with industrialized areas in Hermosillo, Sonora, Mexico. The study will compare the likelihood of finding breast cancer cases living in an industrialized neighborhood versus a non-industrialized neighborhood.\u003c/p\u003e \u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003e \u003cb\u003eClinical Data Collection\u003c/b\u003e. A database for breast cancer cases has been established in Hermosillo by gathering data from both public and private hospitals. Since Mexico does not have a nationwide cancer registry, an online, encrypted, cloud database was created in partnership with various hospitals to address this need. The database includes only female breast cancer cases, whether current, survivors, or deceased, who have been residents of Hermosillo for at least ten years (verified by their address specified at their national ID) and have given their informed consent for data collection and management. The database covers cases from January 2013 to May 2023 at public and private hospitals in Hermosillo. Male breast cancer cases, female non-breast cancer cases, non-informed consent cases, and cases with a residence of less than ten years in Hermosillo are not included. REDCap (Research Electronic Data Capture) was used for data collection and management [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Data was collected from Hermosillo and de-identified using the Safe Harbor approach before analysis. Since the study aimed to create a census of Hermosillo within ten years, all breast cancer cases from participating institutions were included in the clinical database. This database is not linked to any other electronic databases, so there are no methods for data linkage in this investigation.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eVariables of Clinical Database Related to Residential Information\u003c/strong\u003e \u003cp\u003eThe database has recorded the neighborhood and zip code of both current and previous residences. In cases where the person has moved out, the analysis considered the oldest residential information available in the hospital's files (neighborhoods equal to or older than 10 years). This was done considering the time for tumors to develop in adulthood [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eVariables of Clinical Database Related to Breast Cancer\u003c/strong\u003e \u003cp\u003eThe database contains various information related to breast cancer, such as age at the time of diagnosis, familiar history of breast cancer, personal history of breast cancer, classification of the tumor by SBR (Scarff-Bloom-Richardson) and by TNM, tumor grade, mammography-based breast density (BI-RADS classification), current treatment (chemotherapy, radiotherapy, surgery, breast implants), and current status of the patient (current, survivor, or deceased). However, the database includes only those cases of breast cancer that were diagnosed on or after January 1, 2013, and no information regarding cases predating this date is available in the hospitals\u0026rsquo; records.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eA total of 1844 cases of breast cancer were gathered from both public and private hospitals. Out of these cases, 450 were excluded from the analysis as they were residents of cities other than Hermosillo. The remaining 1394 cases met the inclusion criteria, which required that they were diagnosed between January 1st, 2013, and May 31st, 2023 and that the individuals had been living in the same neighborhood for at least 10 years.\u003c/p\u003e \u003cp\u003e \u003cem\u003eOther Variables of Clinical Database\u003c/em\u003e. The following information was collected: the highest level of education attained (none, elementary school, junior high school, high school, technical career, university, not specified), religion (atheist, Catholic, Christian, Mormon, Jehovah Witness, other, not specified), occupation (housewife, employee, teacher, engineer, accountant, business owner, retired, other, not specified), alcohol consumption (non-consumer, former consumer, social consumer (\u0026lt;\u0026thinsp;7 drinks per week), alcoholism (\u0026gt;\u0026thinsp;7 drinks per week), not specified), tobacco consumption (none, former consumer, passive smoker, current smoker, not specified), weekly consumption of red meat (none, 1\u0026ndash;2 times, 3\u0026ndash;4 times, 5\u0026thinsp;+\u0026thinsp;times, not specified), BMI, exercise habits (yes, no, not specified), number of live births, age at menarche, menopausal status (premenopausal, perimenopausal, menopause, postmenopausal, not specified), use of hormonal contraception (yes, no, not specified), use of hormonal replacement therapy (yes, no, not specified), elements of metabolic syndrome as defined by the NCEP ATP III criteria [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], prior chronic illnesses other than cancer, prior cancers other than breast cancer, and red blood type. Race and ethnicity were not collected for this population, as Hermosillo is composed solely of Hispanics, considered to be a homogeneous population.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIndustrialized Areas.\u003c/b\u003e The 2020 INEGI Census provided coordinates (longitude, latitude) for active industries that produce hazardous biological and chemical residues. These industries include welding shops, auto repair shops, automotive paint shops, paint distributors and manufacturers, agrochemical distributors and manufacturers, hardware stores, dental clinics, laboratories, and hospitals. ArcGIS version 10.8.2 was used to plot the coordinates of these industries on a map and group them according to neighborhoods. A neighborhood was classified as industrialized if it had six or more active industries, and not industrialized if a neighborhood had five or fewer active industries. This classification was based on a prior regression analysis, where the proportion of breast cancer cases per neighborhood was the response variable, and the number of industries was the explanatory variable based on a sample of 914 cases, as seen in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Moreover, the criteria for industrialized areas were confirmed with the final sample (\u003cem\u003esee Suppl. Table\u0026nbsp;1 and Suppl. Figure\u0026nbsp;1\u003c/em\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNumber of active industries in 2019 and the breast cancer cases per 100,000 females (18 years old or older) per neighborhood. Data related to industries was obtained from the INEGI Census 2010. Data related to breast cancer cases was obtained from public and private hospitals in Hermosillo, Sonora, Mexico, from 2013 to 2019 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Industries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreast cancer cases per 100,000 females per neighborhood\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e437\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e364\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e441\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e512\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e309\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e442\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e398\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e798\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e903\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e541\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e645\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,203\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e665\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eHot Spots of Breast Cancer Prevalence.\u003c/b\u003e This study aimed to identify the neighborhoods where breast cancer is more prevalent (hot spots). The number of cases reported from 2013 to 2023 and the number of females in each neighborhood who are 18 years old or older (INEGI Census 2020) were considered to estimate the prevalence of breast cancer per neighborhood. The prevalence was calculated based on 100,000 females and projected onto a digital map using the neighborhood as the geographical unit. It's important to note that the study didn't collect any private addresses of the patients, and thus, it complies with national (DOF 05-07-2010) and international regulations for the protection and privacy of human subjects (HIPAA Privacy Rule) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Neighborhoods were managed according to the INEGI identification numbers (CVEASEN). The hot spot and outlier analyses were used to identify neighborhoods with high breast cancer prevalence using ArcGIS version 10.8.2. This statistical approach enables to discriminate clusters of high values (regions of high incidences of breast cancer) from low values (regions of low incidences of breast cancer) and spatial outliers, which differs from the Anselin Local Moran\u0026rsquo;s I used for the preliminary analysis of this population in a prior work [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eAssessment of breast cancer prevalence and industrialized areas.\u003c/b\u003e To investigate the potential link between breast cancer prevalence and industrialized areas, this study analyzed and compared the neighborhoods with high incidence of breast cancer and industrialized regions with those that have low incidence of breast cancer in non-industrialized areas. The neighborhood was considered the unit of analysis and R v. 4.3.1 was used for statistical analysis.\u003c/p\u003e \u003cp\u003e \u003cb\u003eKey Assumptions.\u003c/b\u003e All neighborhoods (units of analysis) have different sizes and represent different quantities of persons (which is the case in this type of study). We assume that results apply to an aggregation of these units.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEthics Statement.\u003c/b\u003e This study was IRB-approved on behalf of the Health Secretariat of Sonora State, IMSS UMF No. 37, Hospital San Jos\u0026eacute; Hermosillo, ISSSTE Hospital Fernando C. Ocaranza, CIMA, Cl\u0026iacute;nica del Noroeste, Hospital General del Estado de Sonora \u0026ldquo;Dr. Ernesto Ramos Bours\u0026rdquo;, and Centro Estatal de Oncolog\u0026iacute;a \u0026ldquo;Dr. Ernesto Rivera Claisse\u0026rdquo;. Informed written consent for research and publication was obtained before data collection from the patient or her closest relative in the case of deceased patients.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eBreast Cancer Cases from 2013 to 2023\u003c/h2\u003e \u003cp\u003eBetween 2013 and 2019, a total of 914 cases of breast cancer were diagnosed in both public and private hospitals in Hermosillo, Sonora, Mexico, according to a study by Villa-Guillen et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. An updated database now shows that between 2013 and 2023, there were a total of 1,394 cases of breast cancer diagnosed, representing a 52% increase within five years. The study collected data from public and private hospitals, and the database created is the first breast cancer census for this city in the past ten years.\u003c/p\u003e \u003cp\u003eThis information was used to construct a digital map, which depicted the neighborhoods in Hermosillo that had reported cases of breast cancer between 2013 and 2023. Out of a total of 756 neighborhoods, 290 (38.36%) had at least one case of breast cancer, while the remaining 466 (61.64%) did not have any reports of breast cancer. The neighborhoods containing at least one case are depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The greatest numbers (25 cases or more) are concentrated in seven neighborhoods. Of those, five are in Hermosillo\u0026rsquo;s downtown. Those are 57 cases for Balderrama (CVEASEN 2603000010022), 43 cases for Olivares (CVEASEN 2603000010138), 42 cases for San Benito (CVEASEN 2603000010196), 42 cases for Centro (CVEASEN 2603000010043), and 33 cases for Jes\u0026uacute;s Garc\u0026iacute;a (CVEASEN 2603000010096). Moreover, there is one neighborhood in the west with 38 cases (Sahuaro, CVEASEN 2603000010191), and one neighborhood in the south with 40 cases (Palo Verde, CVEASEN 2603000010142). This is to be expected, as those neighborhoods have the highest numbers of females of 18 years old or older per 100,000 inhabitants (Balderrama with 4,467; Olivares with 4,364; San Benito with 3,200; Centro with 1,745; Jes\u0026uacute;s Garc\u0026iacute;a with 3,488; Sahuaro with 4,843; and Palo Verde with 4,858 females) (\u003cb\u003esee\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eIndustrialized Areas\u003c/h2\u003e \u003cp\u003eTo further evaluate the potential association between breast cancer prevalence and industrialized areas, a digital map was constructed for targeting neighborhoods with at least six active, hazard-generator industries.\u003c/p\u003e \u003cp\u003eAccording to the INEGI Census 2020, 3,697 industries met the criteria for hazard-generators. To represent industrialized areas visually, the data was projected onto a map using ArcGIS v. 10.8.2 and converted to UTM 12 N. The resulting map revealed that out of 756 neighborhoods located in Hermosillo, 95 (12.57%) were industrialized areas (pale blue for 6 to 83 active industries, and navy blue for 84 or more industries), while the remaining 661 (87.43%) were categorized as non-industrialized locations (white color). Those are depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eIndustrialized Areas and Breast Cancer Cases per Neighborhood\u003c/h2\u003e \u003cp\u003eA digital map was utilized to highlight industrialized areas in the neighborhoods with (\u003cb\u003esee\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003ea) and without breast cancer cases (\u003cb\u003esee\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003eb) during ten years of follow-up. Non-industrialized areas are depicted in white color. It is noticeable that highly industrialized neighborhoods in Hermosillo\u0026rsquo;s downtown match with those reporting the highest numbers of breast cancer cases (\u003cb\u003esee\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cb\u003eand\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003ea).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTo compare industrialized areas with locations without breast cancer cases, a digital map was created for cancer-free neighborhoods. A total of 472 neighborhoods had no reports of breast cancer during the ten years of observance. Interestingly, most of those neighborhoods are considered non-industrialized areas (98.94%), with only five of them categorized as industrialized (1.06%) (\u003cb\u003esee\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003eb).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eHot Spots of Breast Cancer Prevalence\u003c/h2\u003e \u003cp\u003eA hot spot analysis (ArcGIS v. 10.8.2) was conducted to identify neighborhoods of interest that may have high rates of breast cancer among the female population aged 18 or older. The analysis revealed that there were four neighborhoods of interest with a high prevalence of breast cancer (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.0005). The neighborhoods found with this approach might represent areas of interest, as there could be a potential relationship (trend) between high breast cancer prevalence in industrialized areas (\u003cb\u003esee\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e). All four neighborhoods of interest for breast cancer prevalence were in a cluster (Las Lomas, CVEASEN 2603000010686; Urbi Villa del Rey II Secci\u0026oacute;n Etapa I, CVEASEN 2603000010638; El Jito, CVEASEN 2603000010097; Urbi Villa del Rey III, CVEASEN 2603000010635), particularly in the southeast of Hermosillo (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Of those, the highest prevalence of breast cancer (7,826 per 100,000 females) was found in a neighborhood of interest (Las Lomas, CVEASEN 2603000010686), which is also an industrialized area with seven active industries. For this reason, further analysis was conducted to evaluate the potential association between those neighborhoods of interest and industrialized areas.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between Hot Spots of Breast Cancer Prevalence and Industrialized Areas\u003c/h2\u003e \u003cp\u003e290 neighborhoods had at least one breast cancer case. Results show a hot spot comprising four neighborhoods, which are regions of interest (\u003cb\u003esee\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Those may present a trend for an association between breast cancer prevalence and industrialized areas. In this hot spot, two neighborhoods (Las Lomas, CVEASEN 2603000010686; and El Jito, CVEASEN 2603000010097) are targeted as industrialized areas according to the criteria previously mentioned (0.69%), while the remaining two neighborhoods of this cluster (Urbi Villa del Rey II Secci\u0026oacute;n Etapa I, CVEASEN 2603000010638; and Urbi Villa del Rey III, CVEASEN 2603000010635), were considered as not industrialized locations (0.69%). In contrast, 36 locations were industrialized areas but not areas of interest for breast cancer prevalence (12.41%), and 250 neighborhoods were non-industrialized areas but had no registries of breast cancer cases (86.21%).\u003c/p\u003e \u003cp\u003eAccording to the odds ratio, there is a \u003cem\u003etrend\u003c/em\u003e between hot spots of breast cancer prevalence and industrialized areas (OR\u0026thinsp;=\u0026thinsp;6.94, 95% CI (0.94, 50.8), p-value\u0026thinsp;=\u0026thinsp;0.05) (\u003cb\u003esee\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The inference procedure requires at least 5 elements in each cell. Therefore, the result OR\u0026thinsp;=\u0026thinsp;6.94 (0.94, 50.8) could be taken as a trend. That means two expressions: a) There is a greater probability that a neighborhood is not industrialized if it is not a hot spot, and b) there is a greater probability that a neighborhood is industrialized if it is a hot spot for breast cancer prevalence.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eBreast Cancer Prevalence by Age Group\u003c/h2\u003e \u003cp\u003eA global trend was obtained for breast cancer prevalence and industrialized areas. To further explore this trend, the sample was analyzed in terms of age groups, which consider age as a breast cancer risk factor. The age groups were divided as follows: 18\u0026ndash;59 years old were in the first age group, 60\u0026ndash;64 years old in the second, and ages 65 years or older made up the third group. Categorization of age groups was performed based on demographics reported by neighborhood according to the INEGI Census 2020. The OR for the three age groups was calculated. For the first age group, Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e6\u003c/span\u003e shows one neighborhood of interest located on the southeast side of the city (Parque Industrial, CVEASEN 2603000010145, see \u003cem\u003eSupp. Table\u0026nbsp;2a\u003c/em\u003e). For the second age group, Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e7\u003c/span\u003e shows three neighborhoods of interest (Villa del Real, CVEASEN 2603000010439; Ar\u0026aacute;ndanos Residencial; CVEASEN 2603000010512; Mini Parque Industrial, CVEASEN 2603000010563, see \u003cem\u003eSupp. Table\u0026nbsp;2b\u003c/em\u003e) located on the northwest side of the city. The association between breast cancer prevalence and industrialized areas was confirmed only for the third age group (\u003cb\u003esee\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e8\u003c/span\u003e), where the hot spot comprises 33 neighborhoods of interest (see \u003cem\u003eSupp. Table\u0026nbsp;2c\u003c/em\u003e) located on the northwest side of the city.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eWhich group has the greater risk?\u003c/h2\u003e \u003cp\u003eAn analysis was conducted to evaluate the potential association between hot spots of breast cancer prevalence and industrialized areas by age group. The aim was to determine whether age played a role as a confounding variable. The results showed that for the age group of 18 to 59, there was no significant link between the two (OR\u0026thinsp;=\u0026thinsp;1.69, 95% CI (0.07, 41.74), p-value\u0026thinsp;=\u0026thinsp;0.75, refer to Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e9\u003c/span\u003e). Similarly, for the age group of 60 to 64, the association was not statistically significant either (OR\u0026thinsp;=\u0026thinsp;2.56, 95% CI (0.23, 28.46), p-value\u0026thinsp;=\u0026thinsp;0.44, refer to Fig.\u0026nbsp;\u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e10\u003c/span\u003e). However, for the age group of 65+, the study found a statistically significant association between breast cancer hot spots and living in industrialized neighborhoods (OR\u0026thinsp;=\u0026thinsp;2.7, 95% CI (1.27, 5.72), p-value\u0026thinsp;=\u0026thinsp;0.009), refer to Fig.\u0026nbsp;\u003cspan refid=\"Fig12\" class=\"InternalRef\"\u003e11\u003c/span\u003e). That means, there is a greater probability that the neighborhood is a breast cancer hot spot for the elderly group (ages 65 or older) if it is industrialized.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe purpose of this study was to investigate whether there is a connection between living in an industrial area and the prevalence of breast cancer after a decade of follow-up. The analysis shows that there is an association for women aged 65 or older. The risk of developing breast cancer is higher in neighborhoods that have at least six active industries that generate hazardous pollutants. However, for other age groups, this association was not statistically significant. The study identified a global hot spot for breast cancer, which includes four neighborhoods of interest. After adjusting for age, the hot spot was found to consist of 33 neighborhoods located in the northwest area of Hermosillo.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eHot spots of breast cancer prevalence in Hermosillo\u003c/h2\u003e \u003cp\u003eSpatial heterogeneity of breast cancer prevalence exists in Hermosillo, as indicated by hot spot analysis. The study identified four neighborhoods of interest in the southeast and a hot spot in the northwest, which comprises 33 neighborhoods clustered together. After age adjustment, it was found that the prevalence is higher for the elderly group in the northwest region. The study collected breast cancer cases reported from both public and private sectors for 10 years and observed a considerable increase of 52% compared to cases reported from 2013\u0026ndash;2019 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This increase in breast cancer cases and sustained heterogeneity in their geographical distribution highlights the need to target vulnerable populations in Hermosillo city. The study also revealed the location of a hot spot for an elderly group, which is relevant for breast cancer prevention and control.\u003c/p\u003e \u003cp\u003eOther studies support the spatial heterogeneity of breast cancer within Mexico. One such research, conducted by Castrezana-Campos, mapped the incidences of breast cancer per counties across the nation [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The study revealed that 120 counties had higher incidence rates compared to the norm, with Hermosillo as one of those regions of interest. Another study that supports our research is that of Soto-Perez-de-Celis, which showed that breast cancer mortality rates also exhibit spatial heterogeneity within a 10-year timeframe (2001 to 2011), with higher rates detected in the Center-North (APC 1.7%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and Southwest (APC 2.7%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) regions of Mexico [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. It is necessary to further explore other risk factors, such as long-term exposure to hazardous pollutants, to elucidate their implications on morbidity and mortality rates for breast cancer.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBreast Cancer Prevalence and Industrialized Areas\u003c/h2\u003e \u003cp\u003eThe present study has found a \u003cem\u003etrend\u003c/em\u003e between breast cancer rates and living in industrialized areas. The study shows that women living in industrialized regions are almost seven times more likely to develop breast cancer. The unadjusted odds ratio is 6.94 with a 95% confidence interval of 0.94 to 50.8 and a p-value of 0.05. This trend is particularly pronounced for women aged 65 or older. The adjusted odds ratio confirms that there is an association between a hot spot for breast cancer prevalence and living in an industrialized area (OR\u0026thinsp;=\u0026thinsp;2.7, 95% CI (1.27\u0026ndash;5.72), p-value\u0026thinsp;=\u0026thinsp;0.009). The findings suggest that the risk of developing breast cancer is higher in areas with at least six industries that produce hazardous materials.\u003c/p\u003e \u003cp\u003eThese results are consistent with a previous study by Castrezana-Campos, which identified the city of Hermosillo as one of the 120 counties where industrial pollution was linked to breast cancer incidence [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, the previous study did not include important factors such as age and length of time living in the same location. Therefore, this study's findings provide valuable information for future research in this area about which age groups could be included in future research.\u003c/p\u003e \u003cp\u003eThe present study provides evidence supporting a link between breast cancer and residential exposure to hazardous pollutants derived from industrial activities. A case-control study conducted in Spain found an association between breast cancer risk and residential proximity (between 1 to 3 km) to specific industrial installations (OR\u0026thinsp;=\u0026thinsp;1.30, 95% CI (1.00, 1.69)) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This association was particularly strong for organic chemical industries (OR\u0026thinsp;=\u0026thinsp;2.12, 95% CI (1.20, 3.76)), food and beverages (OR\u0026thinsp;=\u0026thinsp;1.87, 95% CI (1.26, 2.78)), ceramics (OR\u0026thinsp;=\u0026thinsp;4.71, 95% CI (1.62, 13.66)), surface treatment with organic solvents (OR\u0026thinsp;=\u0026thinsp;2.00, 95% CI (1.23, 3.24)), surface treatment of plastics and metals (OR\u0026thinsp;=\u0026thinsp;1.51, 95% CI (1.06, 2.14)), pesticides (OR\u0026thinsp;=\u0026thinsp;2.09 95% CI (1.14, 3.82)), and dichlorometane (OR\u0026thinsp;=\u0026thinsp;2.09, 95% CI (1.28, 3.40)) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Exposure to hazardous air pollutants was related to higher breast cancer for women residing in urban areas [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Long-term exposure to particulate matter (PM\u003csub\u003e2.5\u003c/sub\u003e or smaller) was related to hormonal-responsive breast cancers in non-Hispanic whites living in the US (HR\u0026thinsp;=\u0026thinsp;1.10, 95% CI (1.04, 1.17)) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. On the same lines, the Sisters Study found associations between PM\u003csub\u003e2.5\u003c/sub\u003e and breast cancer risk [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A meta-analysis found that exposure to a 10 \u0026micro;g/m3 increase in nitrogen dioxide (NO\u003csub\u003e2\u003c/sub\u003e), a marker for traffic pollution, is related to a 3% increased risk for breast cancer [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Another research work within the Sisters Study indicated no association between postmenopausal breast cancer and long-term exposure (from 2003 to 2009) to mercury (HR\u0026thinsp;=\u0026thinsp;1.3, 95% CI (0.96, 1.3)), cadmium (HR\u0026thinsp;=\u0026thinsp;1.1, 95% CI (0.96, 1.3)), and lead (HR\u0026thinsp;=\u0026thinsp;1.1, 95% CI (0.98, 1.3)) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. A cohort study conducted in California found no meaningful links between invasive breast cancers with long-term exposure to hazardous air pollutants during a follow-up of 1989 to 2011 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Finally, a review found a higher risk for breast cancer with nitrogen dioxide (NO\u003csub\u003e2\u003c/sub\u003e) and nitrogen oxide (NOx) levels, but little evidence regarding exposure to particulate matter, except nickel and vanadium [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. One possible explanation for the discrepancy among studies is that most studies only focus on breast cancer cases detected in adulthood, without considering the potential risk factors during periods of biological susceptibility, such as pregnancy and puberty [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Additionally, different sources of hazardous air pollutants can result in varying levels of exposure and produce diverse effects. All the above reasons highlight the need to evaluate these sources in diverse populations to fully understand their health impact [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThe study has shown that there is a variation in breast cancer risk depending on the location, with industrial areas having a higher risk. This finding could lead to the implementation of measures to prevent and control breast cancer in elderly women (ages 65+). One of the strengths of the study is that it only included cases with a verifiable ID address and at least ten years of residence in the same neighborhood, which allowed for the assessment of residential exposure to industrial areas.\u003c/p\u003e \u003cp\u003eHowever, it is important to consider some limitations of the study to evaluate the results accurately. One of the limitations is the potential influence of a family history of breast cancer in the study group. Additionally, it is necessary to consider the impact of occupational exposure to hazards that patients may have had, particularly during puberty and pregnancy. Further research is needed to confirm the effects of long-term residential exposure to hazardous air pollutants, including studies analyzing particulate matter and heavy metals in urban dust. Efforts are currently underway to address these issues.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eIt has been observed that there is a strong link between living in industrial areas and higher rates of breast cancer in certain areas, referred to as \"hot spots\". In Hermosillo's northwest, a hot spot was identified, which comprises 33 neighborhoods, confirming the correlation between breast cancer prevalence and industrial areas among elderly women aged 65 and over. This research work examines breast cancer cases in Hermosillo over a period of 10 years, and confirms the spatial differences observed in a previous study conducted over a period of 5 years. It is important to focus on vulnerable populations who are exposed to hazards in their residential areas and to develop effective ecological practices to prevent such exposure. Additionally, stronger screening programs should be implemented for early breast cancer diagnosis. Further research on a larger scale is necessary in other cities in Sonora, Mexico, to validate these findings.\u003c/p\u003e"},{"header":"Declarations","content":"The first author was the recipient of the Consortium Arizona \u0026ndash; Mexico (CAZMEX) Funding in 2018 for Postdoctoral Stays. Resources for the present work were derived from this funding.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting Interests\u003c/strong\u003e \u003cp\u003eThe authors and collaborators of this work have no relevant financial or non-financial interests to disclose.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eD.E. Villa-Guillen conceived of the presented idea, conducted and developed the geospatial analysis, coordinated the collaborations and data collection, and wrote the manuscript with support from J.A. Villa-Carrillo.J.A. Villa-Carrillo contributed to developing the presented idea, conducted the statistical analysis, and wrote the manuscript with support from D.E. Villa-Guillen.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe are very grateful to all the institutions that collaborated in this work: Health Secretariat of Sonora State, IMSS UMF No. 37, Hospital San Jos\u0026eacute; Hermosillo, ISSSTE Hospital Fernando C. Ocaranza, CIMA, Cl\u0026iacute;nica del Noroeste, Hospital General del Estado de Sonora \u0026ldquo;Dr. Ernesto Ramos Bours\u0026rdquo;, Centro Estatal de Oncolog\u0026iacute;a \u0026ldquo;Dr. Ernesto Rivera Claisse\u0026rdquo;, and INEGI. Special thanks to Dr. Mata-Valenzuela, Dr. Tecuanhuey-Tl\u0026aacute;huel, Dr. \u0026Aacute;vila-Monteverde, Dr. Fierros-Greenhouse, Dr. Gonzalez-Zepeda, Dr. Corral-Villegas, Dr. Aguilar-Gutierrez, Dr. Rojas-Camarena, Dr. Durazo-Cons, Dr. Luque-Morales, Dr. Aguilar-Peraza, and Dr. Cordon-Guillen for their collaboration through their institutions. Thanks to the students Andres Galvez-Arevalo, Kenneth Garcia-Castellon, Yoahanna Guzman-Hernandez, Karla Ortega-Landa, Fatima Pelayo-Rodriguez, Jose Silva-Romero, and Rogelio Ure\u0026ntilde;a-Acosta for their support with data collection and in acquiring informed consent from the patients analyzed in this work.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during the present work are not publicly available due to compliance with the protection of the clinical data of the patients according to the national regulations of Mexico for research in health institutions [NORMA Oficial Mexicana NOM-024-SSA3-2012, Ley Federal de Protecci\u0026oacute;n de Datos Personales en Posesi\u0026oacute;n de los Particulares]. Partial datasets with IRB approval from the hospitals involved in this research are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKashyap D et al (2022) Global Increase in Breast Cancer Incidence: Risk Factors and Preventive Measures. Biomed Res Int 2022: 9605439. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2022/9605439\u003c/span\u003e\u003cspan address=\"10.1155/2022/9605439\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eINEGI. 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Congreso De La Uni\u0026oacute;n (2010), July 5 Ley Federal de Protecci\u0026oacute;n de Datos Personales en Posesi\u0026oacute;n de los Particulares. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.diputados.gob.mx/LeyesBiblio/pdf/LFPDPPP.pdf\u003c/span\u003e\u003cspan address=\"https://www.diputados.gob.mx/LeyesBiblio/pdf/LFPDPPP.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"breast cancer incidence, industrial pollution","lastPublishedDoi":"10.21203/rs.3.rs-4572147/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4572147/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBreast cancer is a significant public health concern in Sonora, Mexico, which has a history of industrial pollution. Hermosillo, the state capital, exhibits both of these characteristics. Prior studies suggest that living in areas with high levels of pollutants may contribute to a higher incidence of breast cancer, creating what is known as a \"hot spot\" in that specific region.\u003c/p\u003e\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis study aims to assess the potential association between living in an industrialized area and the presence of breast cancer hot spots in Hermosillo.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe research collected clinical data on breast cancer cases between 2013 and 2023 and pinpointed neighborhoods with a high prevalence of breast cancer using hot spot analysis (ArcGIS software version 10.8.2). The odds ratio was used to compare the likelihood of finding a breast cancer case in industrialized areas versus non-industrialized neighborhoods (R version 4.3.1).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study observed a link between industrialized areas and high breast cancer rates (unadjusted OR\u0026thinsp;=\u0026thinsp;6.94, 95% CI (0.94, 50.8), p-value\u0026thinsp;=\u0026thinsp;0.05)), particularly in women aged 65\u0026thinsp;+\u0026thinsp;in 33 industrialized neighborhoods located at Hermosillo's northwest (OR\u0026thinsp;=\u0026thinsp;2.70, 95% CI (1.27, 5.72), p-value\u0026thinsp;=\u0026thinsp;0.009).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn this study cohort, there is a link between industrialized areas and high breast cancer rates in Hermosillo, with hot spots for women aged 65\u0026thinsp;+\u0026thinsp;living in 33 neighborhoods in the city's northwest. Further extensive studies are needed to confirm these findings in other cities in Sonora, Mexico.\u003c/p\u003e","manuscriptTitle":"Identifying Hot Spots of Breast Cancer Prevalence and their Association with Industrialized Areas in Hermosillo, Sonora, Mexico","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-08 17:13:35","doi":"10.21203/rs.3.rs-4572147/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"96c4f8dd-779e-4265-8a75-e437622b32be","owner":[],"postedDate":"July 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-05T13:23:37+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-08 17:13:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4572147","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4572147","identity":"rs-4572147","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}