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I read the article by Park et al. (2014) which was published in your journal with great interest. The article suggested a hypothesis of the number of vehicles or consumption of gasoline as a risk factor of breast cancer incidence in Korea using an ecological study. After reading carefully the article, I would like to point several issues which should be considered. First, interpreting results obtained from an ecological study should be caution because of notoriously ecological fallacy, which was declared as the methodological limitation by the authors. Thus the epidemiological causation ask to distinguish the concept of correlation and association. While the authors suggested the hypothesis based on the positive ‘relations’, it need to make the concept clear. Second, the authors stressed that the numbers of motor vehicles or the amount of gasoline were just proxy markers of the air pollution caused by traffic emission, which meant environmental pollutions resulted from industrialization. However, there would be so many surrogates of industrialization, such as degree of sewage disposal (contaminated water), penetration rate of cellular phone (electromagnetic field), and so on. Thus using the number of motor vehicles or the amount of gasoline as a proxy markers of environmental pollution should be limited in suggesting one of risk factors in breast cancer. Third, the authors treated the time trend of incidence rate of breast cancer as the outcome. This depends on changing level of compliance on mass screening program, increasing sensitivity of screening modalities, improving accuracy of cancer registry information, as well as the change of targeting exposures. It is sorry that the authors did not take them into careful consideration. Forth, the geographic information of Korea Central Cancer Registry supplying the nationwide and regional cancer incidence data in Korean is indicated just as the address at the first registry, not birth place or the place of longest dwelling. Thus the suggesting mechanism of hypothesized air pollution at birth would not be appropriate in the article. Last, the trends in breast cancer incidences by age groups in Korean women between 2002 and 2010 showed that the age group of the highest incidence rate have kept as 45-49 years old for 8 years (Bae, NCC). This fact makes us doubt the hypothesis. LETTER to the EDITOR

Hypothesis of Consumption of Gasoline as a Risk Factor of Breast Cancer Incidence in Korea in an Ecological Study