Breast Cancer Risks in California Nail Salon Workers

Institution: Asian Health Services
Investigator(s): Linda  Okahara ,  - Peggy  Reynolds , Ph.D. -
Award Cycle: 2007 (Cycle 13) Grant #: 13BB-3401 Award: $317,610
Award Type: CRC Full Research Award
Research Priorities
Prevention & Risk Reduction>Risk reduction and identification

This is a collaboration with: 13BB-3400 -

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

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

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

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

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

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


Progress Report 1 (2008)
Concerns about the chemical composition of cosmetics have recently garnered considerable attention. Nail salon workers, in particular, have been the focus of health concerns because they routinely handle nail care products containing organic solvents, some of which can cause cancer or affect a woman’s endocrine system. The Northern California Cancer Center (NCCC) partnered with Asian Health Services (AHS), a community health center serving the Asian indigent population, in this continuation project to begin to elucidate the relationship between cosmetic compounds and breast cancer.

This community-research project has two main components: 1) a record linkage component in which we will link the cosmetology licensee file to the California Cancer Registry file to assess breast cancer rates in California-licensed nail salon workers and compare them to that of the general population, and 2) an exposure assessment component in which we will recruit a small sample of Vietnamese nail salon workers in the San Francisco bay area to wear a personal air monitor that will measure exposures to select solvent during their workshift. These two study components are designed to complement one another and contribute to understanding the relationship between exposures in nail salons and breast cancer risk.

In the first year of this three-year project, we have made progress in preparing our datasets for record linkage and in preparing to collect air monitoring data. Currently, we are preparing the two population-based data files, the cosmetology licensee file and the California Cancer Registry file, for linkage. Furthermore, to help guide the study, we have convened an Community Advisory Committee comprised of past and current nail salon workers and owners, some of whom are breast cancer survivors. In addition, we are in the process of preparing to conduct pilot tests with three nail salon workers and owners. These pilot tests will inform our survey instrument development and recruitment process of nail salon workers.

In the coming year, we intend to assess breast cancer rates in this workforce and specifically among Vietnamese workers. We will compare these rates to that of the general female population to answer our first research question: Do nail salon workers have higher breast cancer rates than the general population in California? In addition, we will begin the recruitment and air monitoring of Vietnamese nail salon workers to measure select solvent exposure during their workshift. We will use these measurements to answer our second research quesiton: Do Vietnamese nail salon workers have workplace exposures to organic solvents that exceed health-based standards? In addition, we will use questionnaire data to predict factors that significantly influence exposure levels (e.g. shop size, shop ventilation or worker practice).