Abstract
ObjectiveBecause most risk factors for melanoma are immutable constitutional factors such as skin type, it is important to more fully understand the relationship between melanoma risk and sun exposure, one of the few modifiable risk factors for the disease. The goal of this case–control study was to quantify the risks of melanoma associated with UV exposure at different periods of life. Methods: Cases were 386 patients between the ages of 35 and 74 who were diagnosed with primary cutaneous melanoma within the Seattle–Puget Sound area during 1997. Controls were 727 participants of the same age and geographic area, selected by random-digit dialing. A telephone interview included a complete residential history, lifetime sun exposure history (days in the summer sun for at least 4h at each place of residence), and personal characteristics. UV exposure was calculated based on satellite data on potential erythemal exposure at each place of residence, years at each location and time spent in the sun at each location. Logistic regression was used to estimate odds ratios (OR) and 95 confidence intervals (CI) reflecting the risk of melanoma associated with UV exposure, after adjustment for age, sex, income, tendency to burn and sunburns during ages 2–10. Results: Among women, lifetime UV exposure was associated with melanoma risk (adjusted OR=1.99 for highest versus lowest quartile, 95 CI: 0.95–3.03, p for trend=0.008). There were significant trends for UV exposure during ages 1–10, 11–20 and 31–40 (all p<0.02). Among men, there were no significant associations at any time period, but lifetime UV exposure was associated with higher risk for men who had a tendency toward severe or painful sunburns (OR= 2.85 for highest versus lowest quartile, 95 CI: 0.84–9.64, p for trend=0.04). Conclusion: The differing results by sex are not easily interpretable, though it may be useful to target those with a higher sensitivity to the sun when formulating messages for prevention of melanoma by lowering exposure to UV.
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References
LA Ries PA Wingo DS Miller et al. (2000) ArticleTitleThe annual report to the nation on the status of cancer, 1973–1997, with a special section on colorectal cancer Cancer 88 2398–2424
H Beitner SE Norell U Ringborg GBM Wennersten (1990) ArticleTitleMalignant melanoma: aetiological importance of individual pigmentation and sun exposure. Br J Dermatol 122 43–51
J Espinosa Arranz JJ Sanchez Hernandez P Bravo Fernandez et al. (1999) ArticleTitleCutaneous malignant melanoma and sun exposure in Spain Melanoma Res 9 199–205
S Graham J Marshall B Haughey et al. (1985) ArticleTitleAn inquiry into the epidemiology of melanoma Am J Epidemiol 122 606–619
CD Holman BK Armstrong (1984) ArticleTitlePigmentary traits, ethnic origin, benign nevi, and family history as risk factors for cutaneous malignant melanoma J Natl Cancer Inst 72 257–266
RM MacKie T Freudenberger TC Aitchison (1989) ArticleTitlePersonal risk factor chart for cutaneous melanoma The Lancet 2 487–490
A Osterlind MA Tucker BJ Stone OM Jenson (1988) ArticleTitleThe Danish case-control study of cutaneous malignant melanoma. II. Importance of UV-light exposure Int J Cancer 42 319–324
TE Robsahm S Tretli (2001) ArticleTitleCutaneous malignant melanoma in Norway: variation by region of residence before and after the age 17 Cancer Causes Contr 12 569–576
MA Weinstock GA Colditz WC Willett MJ Stampfer et al. (1989) ArticleTitleNonfamilial cutaneous melanoma incidence in women associated with sun exposure before 20 years of age Pediatrics 84 199–204
N Dubin BS Pasternack M Moseson (1990) ArticleTitleSimultaneous assessment of risk factors for malignant melanoma and non-melanoma skin lesions, with emphasis on sun exposure and related variables Int J Epidemiol 19 811–819
JJ Grob J Gouvernet D Aymar et al. (1990) ArticleTitleCount of benign melanocytic nevi as a major indicator of risk for nonfamilial nodular and superficial spreading melanoma Cancer 6 387–395
MG Le PA Cabanes V Desvignes et al. (1992) ArticleTitleOral contraceptive use and risk of cutaneous malignant melanoma in a case–control study of French women Cancer Causes Contr 3 199–205
N Dubin M Moseson BS Pasternek (1986) ArticleTitleEpidemiology of malignant melanoma: pigmentary traits, ultraviolet radiation, and the identification of high-risk populations Recent Results in Cancer Res 102 56–75
JM Elwood SM Whitehead J Davison M Stewart M Galt (1990) ArticleTitleMalignant melanoma in England: risks associated with naevi, freckles, social class, hair colour, and sunburn Int J Epidemiol 19 801–810
C Garbe S Kruger R Stadler I Guggenmoos-Holzmann CE Oranos (1989) ArticleTitleMarkers and relative risk in a German population for developing malignant melanoma Int J Dermatol 28 517–523
E White CS Kirkpatrick JAH Lee (1994) ArticleTitleCase–control study of malignant melanoma in Washington state Am J Epidemiol 139 857–868
Miller B, Kolonel L, Berstein L, et al. Racial/Ethnic Patterns of Cancer in the United States 1988–1992, National Cancer Institute. Bethesda, MD: NIH Pub #96-4104; 1996.
AR Kristal E White JR Davis et al. (1993) ArticleTitleEffects of enhanced calling efforts on response rates, estimates of health behavior, and costs in a telephone health survey using random-digit dialing Public Health Rep 108 372–379
P Autier JF Dore O Gefeller et al. (1997) ArticleTitleMelanoma risk and residence in sunny areas. EORTC Melanoma Co-operative Group. European Organization for Research and Treatment of Cancer Br. J. Cancer 76 1521–1524
DJ Holman BK Armstrong (1984) ArticleTitleCutaneous malignant melanoma and indicators of total accumulated exposure to the sun: an analysis separating histogenetic types JNCI 73 75–82
JAH Lee (1997) ArticleTitleDeclining effect of latitude on melanoma mortality rates in the United States Am J Epidemiol 146 413–417
JAH Lee J Scotto (1993) ArticleTitleMelanoma: linked temporal and latitude changes in the United States Cancer Causes and Contr 4 413–418
J Dunn-Lane B Herity MJ Moriarty R Conroy (1993) ArticleTitleA case control study of malignant melanoma Irish Medical J 86 57–59
JM Elwood RP Gallagher GB Hill JCG Pearson (1985) ArticleTitleCutaneous melanoma in relation to intermittent and constant sun exposure—The Western Canada Melanoma Study Int J Cancer 35 427–433
CDJ Holman BK Armstrong PJ Heenen (1986) ArticleTitleRelationship of cutaneous malignant melanoma to individual sunlight-exposure habits JNCI 76 403–414
O Klepp K Magnus (1979) ArticleTitleSome environmental and bodily characteristics of melanoma patients. A case–control study Int J Cancer 23 482–486
RM MacKie T. Aitchison (1982) ArticleTitleSevere sunburn and subsequent risk of primary cutaneous malignant melanoma in Scotland Br J Cancer 46 955–960
PJ Nelemans H Groenendal L Kiemeney et al. (1993) ArticleTitleEffect of intermittent exposure to sunlight on melanoma risk among indoor workers and sun-sensitive individuals Environ Health Prospectives 101 252–255
A Green (1984) ArticleTitleSun exposure and the risk of melanoma Aust J Derm 25 99–102
TR Fears CC Bird Dt Guerry et al. (2002) ArticleTitleAverage midrange ultraviolet radiation flux and time outdoors predict melanoma risk Cancer Res 62 3992–3996
P Kaskel S Sander M Kron et al. (2001) ArticleTitleOutdoor activities in childhood: a protective factor for cutaneous melanoma? Results of a case-control study in 271 matched pairs Br J Dermatol 145 602–609
MA Weinstock GA Colditz WC Willett et al. (1991) ArticleTitleMelanoma and the sun: the effect of swimsuits and a ‘‘healthy’’ tan on the risk of nonfamilial malignant melanoma in women Am J Epidemiol 134 462–470