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How to make your company think like a customer by F Robinson and J Brown

For too many companies, ensuring that every customer has a tailored experience remains an elusive goal. Indeed, in a 2010 survey of more than 140 North American companies, just 3 percent were identified as truly “customer-centric organizations.” Fully a third were found to be “customer oblivious.”

The stakes are high. Some studies suggest that failing to deliver a high-quality customer experience can result in a staggering erosion of a company’s customer base—a loss of as much as 50 percent over a five-year period.

Why do some companies succeed while so many fail? Often, the cause is internal barriers. Even the best-intentioned attempts at customer-centricity can be sabotaged by siloed strategies, organizations, processes, technologies and data, which can result in disconnected sales, marketing and service functions. Your customer views all of your functions and business units as a single company. Shouldn’t you?

Merely adding customer-centricity to your vision statement isn’t enough. Thinking like your customer is the first challenge, and delivering a positive customer experience is even harder. Achieving customer-centricity requires rethinking the way business is done. And this, in turn, requires a holistic approach that encompasses everything from analytics and insights to strategy and customer experience, from operating model design and execution to governance and transformation management.

Identifying the obstacles
The rethinking begins by breaking down the challenge into its constituent parts.

Your competition is expanding. In the past, competitive intelligence from outside your industry wasn’t required. But today’s consumers compare their experience with your company not just to their interactions with your immediate competitors but to their experiences with companies in general. The pampered luxury car customer expects the same attention from the cable provider and at the retail store at the mall. Are you prepared to meet that expectation?

Your customers are evolving. The traditional shopper has been joined by the digitally oriented, multichannel customer; as a result, operating models must accommodate both. The traditional customer may still be reluctant to share personal information, but the growing base of digital customers tends to be more open with data, especially if it is used to provide them with a better product or service experience.

Nike did exactly that with its Nike + iPod Sport Kit, partnering with Apple to change the running shoe forever. Anticipating that runners would be eager to adopt technology and online channels to augment their training, the company developed a sensor for the left shoe that sends workout data wirelessly to an iPod. The sensor tracks distance, time, pace and calories burned—and even tells runners if they’ve beaten their personal best. Back at home, Nike’s online portal enables the runner to plot goals and compete with others. Can you identify similar ways to reinvent yourself as markets evolve?

The voice of dissatisfaction echoes louder than ever before. Social media sites and online research are accelerating word of mouth. According to conventional wisdom, a dissatisfied customer might tell 10 people of a negative experience; today, social media enables that same customer to reach thousands with a few keystrokes. Do you have a strategy to address negative feedback hitting the Web?

You must kill the back-office mentality. The days of a cloistered back office are over. What once seemed like smart organization—discrete processes, databases and designated teams designed for efficiency—creates siloed operating models that prevent companies from coordinating interactions and customer experiences. Is there a backroom firewall at your company that’s become a liability?

You need effective connectivity, not just flashy capabilities. Few companies understand what actually happens as a customer moves from one interaction to another. To offer the best customer experience, it is necessary to connect customer-facing and non-customer-facing functions. For example, an increasing number of companies are connecting internal data and analytical capabilities such as “next-best-action” decision making to enable contact centers and sales forces to dynamically drive interactions based on real-time customer insight. Look closely at your own company: Are handoffs seamless and informed? Are the right people armed with the right information, at the right time, to anticipate and address customer needs?

Having familiarized yourself with the obstacles in the dramatically altered customer environment, you can begin to build a framework for a customer-centric operating model. There are five areas of focus surrounding the customer.

 

Analysis and insights
Your strategy and operations must be guided by the people they’re meant to serve: your customers.

Once you’ve resolved to pursue customer-centricity, market research and analytics can help you understand what you’re aiming for. Next, auditing your company’s current performance in meeting customer needs and wants can help you improve your products and services.

Research conducted by Wells Fargo offers a case in point. Even as account holders flock to new services online, at ATMs and via mobile devices, the bank’s analysis revealed that 60 percent of ATM transactions are made by customers who still prefer banking with a teller.

That insight, along with others, led to Wells Fargo’s decision to tie platforms together, meaning a customer can open an account online, make a deposit at a branch, withdraw cash from an ATM and check balances on a mobile device, confident that everything will work just as it would with a teller. Wells Fargo’s investment in multiple integrated channels thus makes for a unified customer experience.

Your analysis will produce more valuable insights if you keep a few simple rules in mind.

Don’t be afraid to collect criticism. Unaddressed customer feedback can have harmful repercussions, but if you develop the ability to gather and organize customer reactions, you can use them to inform and enhance your operations. Links across functions are usually required, since a poor customer experience with one channel is often communicated through another, only to have a third group tasked with resolution. Think car rentals: Reservations are made online or by phone, then the consumer encounters different employee teams at pickup and drop-off.

Conduct an “enterprise customer experience audit.” The audit aims to assess the effectiveness of customer-facing and internal capabilities of working in unison to deliver the intended customer experience. Navigate a series of interactions with your company from your customer’s perspective, understanding not just the external but also the internal capabilities that drive the experience. Be on the lookout for awkward transitions—for example, where the customer moves from browsing to purchase and on to service, shifting from retail store to Internet or other mediums of communication.

On the back end, determine whether the right information gets to the appropriate people at the right time to delight the customer. The intelligence gained in a customer experience audit will provide the insights required to move from vision to execution.

 

Powerful information
Customer experience audits can act as internal benchmarks as well. If analyzed and conducted routinely, they will guide the journey toward customer-centricity.

Harness the power of reporting and analytics. Tools that provide a 360-degree view of customer profile information, preferences and behaviors give leaders in customer-centricity a more complete understanding of their customers. By building on such a foundation with technologies that drive predictive modeling and next-best-action decision making, you can anticipate a customer’s needs or actions in order to tailor messages or offers to that customer, distinguishing your company from the competition.

Although some companies long ago implemented vital strategies like these, few have fully realized the potential. One financial services provider has, however. A multichannel analytics strategy that drew upon Web and phone data provided insights into which channels were preferred by customers in different age brackets. By matching the evolving financial and insurance needs of aging customers with its products, the company improved both service delivery and marketing effectiveness.

Understanding industry dynamics, assessing your internal capabilities and leveraging insights to deliver responsive service and make operational improvements are all essential to enhancing the experience of your customers.

 

Strategy and customer experience
Customer experience is the North Star of your company’s strategy.

Simple insight can lead to powerful business models. Take leading online shoe retailer Zappos.com. In typical offbeat style, Zappos calls its policy “WOW,” and it reflects a basic insight into selling footwear: No consumer can know from a catalog whether a shoe fits. So Zappos offers free shipping and returns. By removing the risks, Zappos makes shopping online the next-best thing to walking into a shoe store.

Again, a few simple principles:

Design from the top down and the bottom up via a “customer experience blueprint.” First, define the big picture by establishing a strategic vision. Next, define what “good” looks like on the ground, outlining the ideal customer experience blueprint at the tactical level. Make clear for your employees the step-by-step path you expect your customers to follow. When compared to your existing enterprise architecture, the blueprint can reveal changes that will ease customer access, and may offer insights into how to phase in such changes. Finally, connect the top-down vision with the bottom-up blueprint, and define the roadmap to make both a reality.

There are lots of ways to rearrange resources, whether they’re people, processes, technologies or data. But leaders in customer-centricity have found that the right plan creates both customer value and business value. Zappos is a prime example.

Establish collaborative planning across functions and business units. Isolated planning can lead to fragmentation—the survival of those dreaded silos—at the product or functional level, or both. Integrated planning—going to market with a cohesive, unified approach and integrated customer experience blueprint—leads to compatibility between customer and product strategies and collaborative execution across business units and customer-facing functions.

Consider expanding core products and services. Adopting a customer-centric strategy may require growth beyond the current product portfolio or service model. Think of Nike as a purveyor of digital fitness services, or Ford Motor Co. as a provider of electric vehicle management services. The two companies provided important new value propositions to their customers by shifting both their product lines and operating models.

The proposition doesn’t have to be that big or far-reaching. US restaurant chain Applebee’s, for example, expanded its menu and provided increased nutrition information in a partnership with Weight Watchers International. Adopting the Weight Watchers points system helped reposition Applebee’s as a restaurant offering healthy choices to customers looking for healthier lifestyles.

 

Operating model design and execution
A successful operating model merges strategies, people, processes, technologies and data.

Designing and implementing an operating model means taking a holistic approach as you address issues ranging from corporate culture to IT. While the biggest challenge is to achieve unity in design and execution, that often means—once again—dismantling silos. As with an orchestra, everyone must play from the same score and follow the conductor if an operating model is to produce a harmonious customer experience.

Refine customer-focused processes. Connecting processes, linking organizational structures and integrating systems can ease the flow of information. Be prepared to define customer-impacting processes as they will define activities, drive technology and channel requirements, and define roles and responsibilities. A customer-focused process architecture makes clear where customer handoffs occur; which steps shape the customer experience; and how data, technology, processes and people must be leveraged.

Build new internal- and external-facing capabilities. Some companies using advanced CRM capabilities know whether the customer contacting the call center has previously voiced opinions about a product online, prompting the agent who answers to deliver relevant messaging or offers. The result is a more personalized interaction.

Keep in mind that new platforms such as online portals, capabilities like mobile-enabled video chat and other advanced tools are not, in themselves, the answer. During the customer-centric transformation, technology becomes an important focus across the company as new foundational, operational, process management and decision-making technologies are needed to manage the operating model. The result will be greater precision in executing the customer experience blueprint.

Consider connectivity. Collaboration is key in a customer-centric operating model. Once your company decides to break the silos, you must decide how this should happen. The answer, dependent on culture, could vary from formally connecting processes across the organization to fostering collaboration in a less structured way. Before redefining an operating model, examine your company’s capacity for collaboration. Processes are very structured at some organizations; at others, they are more flexible. How does collaboration work in your company? Is there a willingness to change? Be realistic about what is appropriate for your company’s culture. If the changes seem too radical in the short term, consider smaller steps that can be made now and plan for larger shifts over time. Leverage individual objectives and incentive compensation to get employees moving in the direction of collaboration.

 

Governance
This is the glue that holds together a customer-centric operating model.

As your company shifts from a product-centric to a customer-centric model, there are many questions to ask when establishing governance. Among the most important: How flexible do you want your vision to be? How are decisions made, and who has the power to make them? Both questions affect the essential tension between maintaining discipline and encouraging creativity.

By definition, governance is about making decisions and handling exceptions. Yet too rigid an approach may limit innovation and the autonomy of individual managers to make the best decision for their parts of the business. On the other hand, leaders need to be wary of promoting an undisciplined “Wild West” mentality. Deciding where to draw such lines requires a thoughtful reading of company culture and behaviors.

Typically, governance involves creating a board from various customer-facing and impacting functions that is responsible for an array of issues, including maintaining the vision, creating a roadmap for evolving enterprise architecture, initiating an approach for sourcing new capabilities and stemming deviations from customer-centric decisions. Governance is the conductor; when one section starts playing from a different score, the sound of the whole orchestra changes.

Maintain a shared vision and control scope. Adhering to a vision can be difficult because different stakeholders have different priorities and new information can drive decision makers to stray from the path. Visions evolve based on new insights, but traditionally, that evolution is deliberate. When individuals are asked to adhere to a vision they do not fully understand, they tend to make decisions that are not aligned with that vision, thus requiring governance. If one function within the organization deviates from the larger plan, a formal escalation process needs to be in place to manage any potential negative impact. The governance team needs to be in a position to make the right calls so that everyone keeps focused on the same goals.

Be explicit about who owns customer relationships. The governance board must decide where ownership lies based on the company and its products; it can be at the corporate, franchise or brand level. Clear ownership of the customer helps to ensure a deliberate and consistent customer experience. If ownership is not clear, inconsistent customer experiences or internal turf battles for share of voice may ensue. If multiple business units or brands within a company have overlapping customer segments, the company will need to be careful not to oversaturate its customers with proactive and unsolicited communications.

Keep track of touchpoints. Analytically driven capabilities and commonsense rules concerning how the company interacts with its customers can prevent oversaturation. A governance committee can help define the appropriate business rules around frequency and cadence of customer touchpoints. When a company proactively engages its customers too frequently, the contacts become spam; therefore, it should establish business rules around the ideal number of customer touchpoints so that the contacts drive a positive experience. Coordination is even more critical when multiple business units or brands share targeted customers.

 

Transformation management
These initiatives integrate new behaviors and allow the business to serve customers without interruptions to operations.

Ensuring adoption of a customer-centric focus across the organization requires a strong leadership commitment to managing change. A traditional project management office won’t be enough. Significant attention needs to be dedicated to the behavioral changes, cultural implications, operational impacts and interim plans.

How do you get to the new? One of the greatest challenges during the transition from the old operating model to the new is building the new model while simultaneously continuing to operate the old without disruption. How do you balance the old world with the new? How do you prepare your team for these changes? Your company’s culture may embrace or resist change, but to realize the full return of customer-centricity programs, employees and vendors need guidance during the transition.

Establish a customer experience champion at the executive level. Dedicated senior leadership involvement demonstrates the importance of the program. It will also make it easier for the organization to evolve its customer vision by having this leader focus on both high-level strategy and tactical execution. This individual will take a cross-functional perspective to connecting the discrete pieces into a comprehensive approach to customer interactions, enforcing the breaking of silos.

Don’t expect these changes to just happen. Some organizations assume these changes will take care of themselves over time. This is rarely the case, so resist the it-just-sort-of-happens mindset. The most successful transforming companies have a robust change management program that includes training—skills and knowledge—and communications.

Create a change management program for training and communications. Some of the most challenging moments of change take place after you go live. Plan for support beyond initial milestones until your organization has truly institutionalized your vision.

__________________________________________________

Customers today expect an imaginative, high-quality experience in a multichannel environment. Failure to adapt to this new reality will mean not only lost business but a growing gap in product development. If you’re not listening and responding to your customers, chances are you’re not anticipating new needs and demands.

Industry leaders are constantly enhancing their customer-centric operating models and raising customer expectations; therefore, it’s critical for your company to get customer-centricity right. Regard this as an opportunity: Your company can leverage new processes, roles and data to create operations capable of making good on your customer-centric promise and growing your business.

But you must put the focus of your company’s thinking on the customer, even if it means entering unchartered waters.

 MyFord Mobile: Serving the digital customer

Fear of the unknown is to be expected—so Ford Motor Co. decided to harness it. Recognizing that owning a 2012 Ford Focus Electric will be a new adventure, the company devised a mobile application called MyFord Mobile to give the customer more control of the electric car experience.

MyFord Mobile will help Focus Electric owners plan trips, monitor their vehicle’s state of charge and receive vehicle alerts. The multipurpose app ranges in capability from identifying cost-effective electricity purchases to helping the owner find where the car is parked.

Electric cars represent the emergence of a new demographic among car owners, and Ford aims to serve customers keen to engage digital capabilities for their convenience. Are there ways you can anticipate your customers’ needs and, in turn, drive brand advocacy? (Back to story. )

Sidebar 2 | LEGO: Beyond the block
For decades, LEGO has been the dominant manufacturer of interlocking bricks for children. But as consumers have increasingly shifted playtime to the digital frontier, the Danish company has introduced new capabilities: What used to be just a box of plastic bricks is now a multichannel experience that neatly adapts the timeless LEGO product to the high-tech tastes of today’s consumer.

LEGO’s operating model enables connectivity, creating links between its traditional, store-bought products and new, flashy digital channels and services. Children can learn to build like the pros through an MBA—“Master Builder Academy”—program, which sends subscribers new models with special building instructions directly to their home every two months, and allows builders to show off their creations in an online community. Teens can now test their building skills through mobile phone applications and challenge their friends to build-offs using their tablets.

Free brown-bag seminar for bay area employees for holistic wellness and sound financial lifestyle

Dear HR,

I would like to offer a free brown bag seminar to your employees, 12-1pm, M-F in the bay area at your campus or online (anymeeting.com).

You may decide any of the following topics:

  • Quality Tools, CAPA, Complaints management (What the FDA checks for)
  • Financial Planning 101 for risk free and tax free investment/savings plan
  • 4D Discipline of Excellence by Franklin Covey
  • Alzheimer ’s disease (Everything you need to know)
  • Health 101 from your health coach

About the speaker:

Connie Dello Buono, speaker, writer, health and finance blogger,  teacher, author, retirement planner, care home administrator, health coach, finance coach, Quality Assurance consultant for medical device and bio-pharma industries. Connie worked in the bay area since 1994 for companies such as Acer, Intel, Abbott, Roche,Genentech, Nektar, Applied Biosystems, Lifescan, Thermofisher, Philipps Health care, Varian Medical Systems, Nike and many other companies. She blogs about health and finance at clubalthea.com and had been helping families save tax free with no market risk and live healthy lifestyles. She founded Motherhealth Inc for affordable senior care and Green Research Institute for sustainability. She can be reached a 408-854-1883 motherhealth@gmail.com

Donations to Motherhealth Inc 501c3 or Green Research Institute 501c3 is greatly appreciated. 1708 Hallmark Lane San Jose CA 95124, Connie Dello Buono , CEO

Sincerely,

Connie Dello Buono

Ask for referrals

Dear Friends,
You may forward this email to others. Do you know anyone:

  •  who needs to save with returns between 8-13%?
  •  who wants to reallocate their idle money such as CDs and high-risk investments such as 401k to one that has no market risk, guaranteed at 2.5%, safe and secured with at least 5 indexing strategies?
  •  who wants to retire early?
  •  who wants to have a super charge Roth IRA with no income limits and limits of $5k saving per year?
  •  who wants to have access to the cash accumulation every year, especially during retirement years?
  •  who wants to have access to funds from $100k to $1.5M when cancer , stroke or disability occurs?
  •  who wants an index Universal Life policy to leave an estate to their children at a stroke of a pen?
  •  who needs a college fund or funds for special projects and other emergencies?
 
I have solutions to all of the above and will give a lifetime service to the families I serve.
In addition, I now have over 950 blogs/articles in my website for access related to health and finance , www.clubalthea.com .
 
If you have problems related to sleep, digestion , losing weight, hair loss or other health related issues, I have tips and DIY healing ways (those that you can do it with lifestyle changes). I can share all my blogs/articles at www.clubalthea.com , just email me if you want them in ebook format.
 
Please be reminded of our dance party on July 12 at cherylburkedance.com in Mt View CA and you may bring everyone.  It is a celebration of what we all did for the first 6 months of this year, the 18th birthday of my daughter Esther and my becoming full time in my business of helping families save tax free with no market risk for their lifetime retirement income.
 
Please email me at least 6 people who can benefit from my financial service with extra health tips on the side. I will take care of them as you would.
 
The company I serve is 169 yr old , National Life Group/Life Insurance Company of the Southwest.
 
Regards,

 

— 

Connie Dello Buono , CA Life Lic 0G60621
wealth strategist
helping others receive funds when sick 
& a tax free retirement savings with zero market risk
1708 Hallmark Lane San Jose CA 95124
 
PS. We pay referral agents, who will or have a Life and Health Ins license. We are in 50 US states.
 
Tip from Franklin Covey: Put a date on our goal, focus on that which is wildly important, measure our activities to reach our goals, be accountable and follow up.

Give your children an extraordinary opportunity or expose them to it by Malcom Gladwell

The 10,000 Hour Rule

“In Hamburg, we had to play for eight hours”

The section comes from Chapter 2, immediately after a list of the seventy-five richest people in history.

Do you know what’s interesting about that list? Of the 75 names, an astonishing 14 are Americans born within nine years of each other in the mid 19th century. Think about that for a moment. Historians start with Cleopatra and the Pharaohs and comb through every year in human history ever since, looking in every corner of the world for evidence of extraordinary wealth, and almost 20 percent of the names they end up with come from a single generation in a single country.

Here’s the list:

01. John Rockefeller, 1839.
02. Andrew Carnegie, 1835.
28.Frederick Weyerhaeuser, 1834.
33. Jay Gould, 1836.
34. Marshall Field, 1834.
35. George Baker, 1840.
36. Hetty Green, 1834.
44. James G. Fair, 1831.
54. Henry H. Rogers, 1840.
57. J.P. Morgan, 1837.
58. Oliver Payne, 1839.
62. George Pullman, 1831.
64. Peter Widener, 1834.
65. Philip Armor, 1832.

What’s going on here? The answer is obvious, if you think about it. In the 1860′s and 1870′s, the American economy went through perhaps the greatest transformation in its history. This was when the railways were built, and when Wall Street emerged. It was when industrial manufacturing started in earnest. It was when all the rules by which the traditional economy functioned were broken and remade. What that list says is that it really matters how old you were when that transformation happened.

If you were born in the late 1840′s, you missed it. You were too young to take advantage of that moment. If you were born in the 1820′s, you were too old: your mindset was shaped by the pre-Civil War paradigm. But there is a particular, narrow nine-year window that was just perfect for seeing the potential that the future held. All of the 14 men and women on that list had vision and talent. But they also were given an extraordinary opportunity. . .

 

Book source: 

Outliers: The Story of Success by Malcom Gladwell

Maintain a permanent and consistent employment/small business in shaky economy

How do you avoid being in debt? How can you live in the bay area with the changing economy where half of the workers are contract-temp workers.

Many workers in the bay area work two jobs to prepare for any changes in work or the economy. This way, one can avoid debts or collectors.  Those who are burdened with high cost of mortgage, babysitting costs, car payments and other bills are extra careful by creating other avenues of income generation.

Some became landlords, and self-employed.  Some retired grandpas became babysitters to help their children who are working two jobs to pay bills. Some 70plus are still working odd jobs like caregiving and maintenance work.

What is your story to keep up with the changing economy in the bay area?

Please email your story to motherhealth@gmail.com

Breast cancer rate among night shift workers, a study

Light is known to be a potent stimulus for regulating the pineal gland’s production of melatonin and the broader circadian system in humans (11,40–,42). Light not only suppresses nocturnal melatonin secretion but also does so in a characteristic dose–response manner: the brighter the photic stimulus, the greater the suppression of nocturnal melatonin (40). A recent observation among 10 935 visually impaired women (43)underlines a dose-related relationship between visible light and breast cancer risk. The investigators found SIRs for breast cancer of 1.05 (95% CI = 0.84 to 1.3), 0.96 (95% CI = 0.59 to 1.46), 0.79 (95% CI = 0.44 to 1.29), 0.66 (95% CI = 0.24 to 1.44), and 0.47 (95% CI = 0.01 to 2.63) among women with moderate low vision, severe low vision, profound low vision, near-total blindness, and total blindness, respectively. Our own data did not provide sufficient information on intensity of light exposure during night work, but future epidemiologic investigations could define such dose–response estimates in humans.

Several mechanisms have been hypothesized to explain the association of decreased melatonin levels and increased cancer risk. Although the presence of specific melatonin membrane receptors, MT1 (a high-affinity receptor) and MT2 (a low-affinity receptor), has been demonstrated for some time (44, ,45), nuclear receptors also have been found (RZR α [retinoid Z receptor α] and RZR β [retinoid Z receptor β]). Only recently, an attempt was successfully undertaken to clarify whether melatonin is able to influence MCF-7 cell proliferation by modulating cell cycle kinetics in MCF-7 human breast cancer cells in vitro (3). Melatonin increases the expression of p53. A receptor interaction with RZR nuclear melatonin receptors may cause an arrest of MCF-7 cells in the G0/G1 phase of the cell cycle pathway that is mediated by the p53 pathway. Such receptor-mediated effects on hormone-dependent cancers had been proposed before, yet these are the first important steps toward clarification. As a potential free-radical scavenger, melatonin may also protect against cancer by shielding DNA from oxidative damage (46). Other recent work(23) suggests that melatonin acts as an immune-modulating agent, since it affects thymic endocrine activity and interleukin 2 by means of metabolic zinc pool turnover in mice. Finally, disturbances in sleep rhythm can directly promote chemically induced liver carcinogenesis in rodents (16). This is the first rodent model in which light-induced circadian clock suppression directly exerted a cancer-promoting effect on the liver.

The results from our study are compatible with a possible oncogenic effect of nighttime light exposure through the melatonin pathway. Although we did not validate self-reported duration of rotating nightshifts, it is likely that our results are accurate, because other self-reports have been highly accurate in this cohort (47), and previous validations of similar questions (e.g., electric blanket use) (48) have shown reasonable reproducibility. Moreover, the prospective design of our study eliminates recall bias. On the other hand, assessment of exposure status with regard to working on rotating night shifts can only be a rough estimate, and misclassification is likely to occur. Since there are more than two comparison groups, even random misclassification may bias the study results in any direction (49). We are concerned that the way we asked for lifetime night work on the 1988 questionnaire may have misled some of the nurses. In the United States, a substantial portion of nurses worked on permanent nightshifts during the period of our investigation (50). These nurses may not have classified themselves as working on rotating shifts, but instead as never-rotating workers, because they may have perceived permanent night work as nonrotating, as opposed to rotating night work. Measurements of melatonin profiles in night workers follow an unidentifiable rhythm and show great variability in the timing of melatonin secretion, thus suggesting that no uniform adaptation of the melatonin rhythm can be achieved in permanent night shift work (51, ,52). Because permanent night workers do not completely entrain to their circadian shift rhythm (53), the average serum melatonin levels among these women would be lower than those of never workers. According to the “melatonin hypothesis,” which states that certain aspects of modern life, such as light at night, may increase breast cancer risk (12, ,54), the permanent night worker would, therefore, be at higher breast cancer risk than a never worker. However, rotating shift workers would still remain at the highest overall risk, because they cannot entrain to their circadian shift rhythm at all and, therefore, would have the lowest melatonin levels. Thus, such misclassification would bias our results toward the null.

Reports about a reduction of plasma melatonin concentration as a general characteristic of healthy aging are conflicting (4, 8, 55, ,56). We controlled for age in various ways, but our results did not change substantially in any of these analyses.

Another potential limitation in our study is that women who work more frequently on night shifts may differ from women who do not in a way that influences risk of breast cancer for which we were not able to control. Even though we controlled for known potential confounding factors, there may still be uncontrolled confounding, such as hormone levels, stress, or other differences in lifestyle. Yet whether to treat factors, such as hormone levels or stress, as confounding factors or rather as intermediate factors that represent a step in the causal chain between exposure and disease would need to be considered.

In conclusion, working on rotating night shifts was associated with a moderately increased breast cancer risk among the female nurses in our cohort. The findings from our study, in combination with the results of earlier work, reduce the likelihood that this association is solely due to chance. Since breast cancer constitutes a huge disease burden in the United States and since a substantial portion of workers engage in shiftwork, it will be necessary to further explore the relationship between light exposure and cancer risk through the melatonin pathway.

http://jnci.oxfordjournals.org/content/93/20/1563.full

———

Researchers at the University of Quebec and the Centre INRS-Institut Armand-Frappier looked at whether working the night shift raised the risk of different cancers in men. Their analysis was based on 3,137 men who had had cancer at one of 11 different sites on their bodies, as well as 512 controls who didn’t have cancer.

Researchers found specifically that working the night shift is linked with a 2.77 times higher risk of prostate cancer, as well as a 1.76 times higher risk of lung cancer, a 2.03 times higher risk of colon cancer, a 1.74 times higher risk of bladder cancer, a 1.31 times higher risk for non-Hodgkin’s lymphoma, a 20.9 times higher risk for rectal cancer and a 2.27 times higher risk for pancreatic cancer.