Climate change, environmental exposures, and breast cancer: advancing climate-resilient oncology through sustainable...

Climate change is increasingly recognized as a major determinant of human health, yet its implications for breast cancer prevention, progression, and healthcare delivery remain insufficiently integrated into global cancer control strategies. Breast cancer, the most commonly diagnosed malignancy among women worldwide, is influenced by a complex interplay of genetic, hormonal, environmental, and socioeconomic factors, many of which are being reshaped by climate change. This narrative review examines the intersections between climate change, environmental exposures, and breast cancer within the framework of the United Nations Sustainable Development Goal 13 (Climate Action). Current evidence indicates that climate-driven environmental changes-including worsening air pollution, wildfire emissions, endocrine-disrupting chemicals, pesticide exposure, water contamination, and food system disruptions-may contribute to breast carcinogenesis through mechanisms involving oxidative stress, chronic inflammation, immune dysregulation, endocrine perturbation, and epigenetic modification. The review further highlights that susceptibility may differ across molecular subtypes, with endocrine-disrupting chemicals having greater relevance to hormone receptor-positive disease, while inflammatory and immune-mediated pathways may influence more aggressive phenotypes, although subtype-specific evidence remains limited. Beyond biological mechanisms, climate-related disasters disrupt breast cancer screening, diagnosis, treatment continuity, and survivorship care, disproportionately affecting socioeconomically disadvantaged populations through interactions with established determinants of health, including healthcare access, lifestyle factors, and structural inequities. The review critically evaluates the current alignment between SDG 13 and breast cancer control, identifying important gaps in the integration of oncology into national climate adaptation policies while highlighting opportunities for climate-resilient health systems, green oncology, exposomics, artificial intelligence, and precision environmental health.