Indoor and outdoor artificial light at night (ALAN) and cancer risk: A systematic review and meta-analysis of multiple cancer sites and with a critical appraisal of exposure assessment.

Exposure to artificial light-at-night (ALAN) has been linked to cancer risk. Few meta-analyses on this topic have reviewed only breast cancer. This study aimed to systematically review and meta-analyze existing studies on ALAN exposure and cancer incidence, thoroughly evaluating exposure assessment quality. We considered observational studies (cohort, case-control, cross-sectional) on ALAN exposure (indoor and outdoor) and cancer incidence, measured by relative risk, hazard ratio, and odds ratio. We searched six databases, two registries, and Google Scholar from inception until April 17, 2024. Quality of studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Random-effects meta-analysis was used to estimate relative risks (RR) and 95 % confidence intervals (CI) for ALAN exposures. We identified 9835 studies and included 28 for qualitative synthesis with 2,508,807 individuals (15 cohort, 13 case-control). Out of the included studies, 20 studies on breast cancer (731,493 individuals) and 2 studies on prostate cancer (53,254 individuals) were used for quantitative synthesis. Higher levels of outdoor ALAN were associated with breast cancer risk (meta-estimate = 1.12, 95 % CI 1.03-1.23 (I

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