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The Nightingale study: rationale, study design and baseline characteristics of a prospective cohort study on shift work and breast cancer risk among nurses

Anouk Pijpe1, Pauline Slottje2, Cres van Pelt1, Floor Stehmann1, Hans Kromhout2, Flora E van Leeuwen1, Roel CH Vermeulen2 and Matti A Rookus1*

  • * Corresponding author: Matti A Rookus

  • † Equal contributors

Author Affiliations

1 Netherlands Cancer Institute, Department of Epidemiology, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands

2 Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Jenalaan 18d, 3584 CK Utrecht, Utrecht, the Netherlands

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BMC Cancer 2014, 14:47  doi:10.1186/1471-2407-14-47

Published: 29 January 2014



Evidence for the carcinogenicity of shift work in humans is limited because of significant heterogeneity of the results, thus more in-depth research in needed. The Nightingale Study is a nationwide prospective cohort study on occupational exposures and risks of chronic diseases among female nurses and focuses on the potential association between shift work and risk of breast cancer. The study design, methods, and baseline characteristics of the cohort are described.


The source population for the cohort comprised 18 to 65 year old women who were registered as having completed training to be a nurse in the nationwide register for healthcare professionals in the Netherlands. Eligible women were invited to complete a web-based questionnaire including full job history, a detailed section on all domains of shift work (shift system, cumulative exposure, and shift intensity) and potential confounding factors, and an informed consent form for linkage with national (disease) registries. Women were also asked to donate toenail clippings as a source of DNA for genetic analyses. Between October 6, 2011 and February 1, 2012, 31% of the 192,931 women who were invited to participate completed the questionnaire, yielding a sample size of 59,947 cohort members. The mean age of the participants was 46.9 year (standard deviation 11.0 years). Toenail clippings were provided by 23,439 participants (39%).


Results from the Nightingale Study will contribute to the scientific evidence of potential shift work-related health risks among nurses and will help develop preventive measures and policy aimed at reducing these risks.

Shift work; Night work; Occupational exposures; Breast cancer; Chronic disease; Nurses