- Split View
-
Views
-
Cite
Cite
Loïc Le Marchand, Barbara S. Saltzman, Jean H. Hankin, Lynne R. Wilkens, Adrian A. Franke, Steven J. Morris, Laurence N. Kolonel, Sun Exposure, Diet, and Melanoma in Hawaii Caucasians, American Journal of Epidemiology, Volume 164, Issue 3, 1 August 2006, Pages 232–245, https://doi.org/10.1093/aje/kwj115
- Share Icon Share
Abstract
Much uncertainty remains about the type of sunlight exposure that most increases risk of cutaneous melanoma and the role of diet. The authors conducted a population-based case-control study (1986–1992) of Caucasians living on Oahu, Hawaii; included were 278 cases and age- and sex-matched controls. Plasma samples were measured for retinol, carotenoids, and alpha-tocopherol by high-pressure liquid chromatography. Selenium was measured in blood and toenails by neutron activation. Celtic and English ancestries, migration to Hawaii before age 20 years, fair complexion, inability to tan, and family history of skin cancer, as well as height, hours spent in the summer sun, blistering sunburns during adolescence, and moles, all increased melanoma risk. With regard to diet and biomarkers, only alcohol was associated with risk. The odds ratios for increasing tertiles of lifetime ethanol intake were 1.0, 1.2 (95% confidence interval (CI): 0.6, 2.2), and 2.3 (95% CI: 1.2, 4.4) (p for trend = 0.01) for men and 1.0, 1.1 (95% CI: 0.5, 2.4), and 1.7 (95% CI: 0.7, 3.8) (p for trend = 0.19) for women. Dietary lipids were unrelated to risk, but polyunsaturated fat intake appeared to modify the effects of alcohol and toenail selenium on melanoma risk. These data provide additional evidence for the association of constitutional susceptibility factors, intense sun exposure (particularly before age 20 years), and alcohol consumption with melanoma risk.
There is considerable evidence that sun exposure plays a major role in the etiology of cutaneous malignant melanoma (1, 2). Among fair-skinned populations, melanoma incidence is strongly influenced by latitude (2). Fair complexion and propensity to sunburn are major constitutional risk factors for the disease. Various questionnaire assessments of sun exposure have consistently shown positive associations with melanoma risk in observational studies (2). Moreover, ultraviolet (UV)-specific mutations have been found in tumor suppressor genes (e.g., p53, p16), which appear to play a role in melanoma (3, 4). Finally, melanomas have been induced with UVB radiation in human skin xenografts in mice (5). However, there is still considerable uncertainty with regard to the timing and pattern of sun exposure (intermittent or chronic) that increase risk the most. Studies of migrants to Australia and California have suggested a critical role for childhood exposure (6–8), but data are still limited. Studies conducted in Australia have also shown a dose-response effect with cumulative sun exposure (9, 10), whereas those conducted at higher latitudes (e.g., in Canada and Denmark) have suggested a predominant role for intermittent, intense sun exposure (11, 12).
The difficulty in precisely defining the sunlight-melanoma relation may come from the existence of modifying factors. Diet is one possible such factor that has remained relatively unexplored despite suggestive evidence from experimental studies (13). Retinoids are known to inhibit growth of murine and human melanoma cell lines (14, 15). Dietary antioxidants, such as carotenoids, tocopherols, and vitamin C, have been shown to protect mice against UV carcinogenesis, possibly because of an umbrageous effect, quenching of free radicals, and/or enhanced immunocompetence (16–18). Vitamin C and alpha-tocopherol have been shown to act as growth inhibitors in melanoma cell cultures (19, 20). In contrast, a diet rich in polyunsaturated fat (PUFA) has been found to potentiate formation of UV-induced tumors in mice (21), and a high-fat diet given to hairless mice seemed to eliminate the ability of beta-carotene to inhibit UV carcinogenesis (22).
The human data on diet and melanoma are still limited. Although trans-retinoic acid has been used topically to treat melanoma (23), epidemiologic studies have usually not found intake of retinoid-rich foods (24–26) or plasma retinol (26) to be associated with the risk of melanoma. Similarly, no clear relation has been found between melanoma risk and dietary antioxidants or PUFA, although the suggestion of an inverse association was observed with carotenoids, vitamin D, and alpha-tocopherol intakes in past case-control studies (25–27). Vitamin C from foods was found to actually increase the risk of melanoma in the Nurses' Health Studies I and II, especially among higher risk sun-sensitive women (28). In another prospective study in Norway, cod liver oil and PUFA intakes were associated with an increased risk, and drinking coffee with a decreased risk, of melanoma in women (29). No association was present for men (29). Finally, a direct association has been observed between alcohol consumption and risk of melanoma in some studies (26, 27, 30–32), but not in others (25, 29).
In an attempt to further clarify these relations, we conducted a population-based case-control study among Caucasians living on the tropical island of Oahu, Hawaii. A majority of this population is composed of migrants from the US mainland and experiences high rates of melanoma.
MATERIALS AND METHODS
The protocol for this study was approved by the relevant ethics committees, and we obtained written informed consent from all participants. Patients for this study were identified through the rapid-reporting system of the Hawaii Tumor Registry, a member of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Eligible cases were all Oahu residents diagnosed in 1986–1987 (prevalent cases) or newly diagnosed during 1988–1992 (incident cases) with a first histologically confirmed invasive or in situ malignant melanoma of the skin in the nine major hospitals of Oahu or in dermatopathology laboratories. Only those subjects with four grandparents of pure Caucasian origin were included. Patients with a previous history of melanoma or who were less than 18 years of age or more than 79 years of age at diagnosis were excluded. An interview was completed for 67.5 percent (167 males, 111 females) of the eligible cases. Reasons for nonparticipation included death before contact (3.8 percent), refusal (10.6 percent), severe illness (1.4 percent), physician refusal (1.4 percent), and inability to locate (15.3 percent). The median interval between diagnosis and interview was 12 months (interquartile range, 7–24 months). A fasting blood sample and toenail specimens were collected from 92.1 percent and 84.5 percent of the interviewed cases, respectively. Pathology slides were reviewed by a single pathologist who confirmed the diagnosis among the 85 percent of the cases for whom pathology slides were available.
Controls were selected randomly from a list of Caucasian Oahu residents interviewed by the Hawaii State Department of Health as part of a health survey of a 2 percent random sample of state households that took place annually during the same period as case identification. One control was matched to each case on sex and age (±2.5 years), and race was confirmed as Caucasian for each grandparent. The overall participation rate for the controls was 60.6 percent. Reasons for nonparticipation included refusal (15.2 percent), inability to locate (21.7 percent), serious illness (1.3 percent), and death (1.1 percent). A fasting blood sample and toenail specimens were obtained for 92.8 percent and 84.5 percent of interviewed controls, respectively.
In-person interviews were conducted during the period 1988–1992 at the subjects' homes by trained interviewers. Generally, members of a case-control pair were interviewed by the same interviewer. The questionnaire included detailed information on demographics (including birthplace, age at arrival in Hawaii, and grandparents' country of origin), propensity to sunburn and ability to tan, numbers of episodes of blistering sunburns during different periods of life (ages 0–9, 10–17, 18–29, and ≥30 years and the 5 years prior to diagnosis (cases) or the past 5 years (controls)), numbers of hours spent in the sun in a bathing suit and light clothing in the summer during various periods of life (ages 8–10 and 20–24 and the past 5 years), history of vacations during which extensive sun exposure occurred, residential history, freckling patterns at different life periods, and lifetime smoking and alcohol use as well as a quantitative food frequency questionnaire containing more than 200 items (33). In addition, the interviewer assessed the skin color of the left upper inner arm with a skin tone template (34) and counted all raised nevi palpable on both arms that were larger than 2 mm. Subjects were also asked to identify their hair color at age 18 years by selecting a swatch of hair of the same color. Weight (in light clothing) and height were measured to the closest kilogram and centimeter, respectively. The subjects were also instructed on how to count moles on their entire body (successively, all moles, and those 5 mm or larger) following a structured protocol with a mirror. They were given a form providing step-by-step instructions for the mole count that 88.5 percent of the subjects filled out and mailed back.
As part of the interview, subjects also reported their average frequencies of consumption and average portion sizes of those foods eaten at least 12 times during the past year. Colored photographs of most food items, showing three different portion sizes, as well as measuring cups and spoons, were used during the interview to facilitate quantification of intakes. The food composition data were based primarily on the nutrient database of the US Department of Agriculture (35) and were supplemented with data from other primary sources and other research and commercial publications. Participants were also asked about the use of vitamin and mineral supplements during the past year, including vitamins A, C, D, and E; beta-carotene; calcium; iron; selenium; and multivitamins.
Blood samples were processed within 2 hours of collection, and the blood components were stored at −80°C. Plasma samples were protected from UV light until measurement. Plasma carotenoids and vitamin C were determined by validated high-pressure liquid chromatography and colorimetric assays, respectively (36). To measure total selenium, whole blood and plasma specimens were transferred by mass (range, 0.05–0.2 g) to selenium-free high-density polyethylene vials having a capacity of approximately 0.5 ml. The samples were air dried, capped, and irradiated for 5–10 seconds at a neutron flux of approximately 8E13 n/cm2 per second to populate the Se-77m radioactive state (half life, 17.4 seconds). The irradiated samples were transferred to a high-resolution gamma-ray spectrometer, where the photon emissions from Se-77m were quantified. Selenium concentrations were determined by standard comparison. The same procedure was used to measure protein-bound selenium in serum or plasma except that the sample was first dialyzed through a 12,000-Da cellulose membrane against 18 mega-ohm water at 4°C and then lyophilized. The method used to analyze the samples in this study was a modification of one described by McKown and Morris (37). Erythrocyte selenium was normalized to sex-specific average hematocrit values by using the following equation: Se(E) = {[Se(WB) × d(WB)] − [(1 − H) × Se(P) × d(P)]} × [H(mean)/H], where Se(E) is the selenium content in the erythrocytes from 1 ml of whole blood normalized to the overall mean hematocrit; Se(WB) is the selenium concentration in 1 g of the whole-blood sample; d(WB) = 1.058 g/ml and is the density of whole blood; H is the hematocrit as a decimal fraction; H(mean) is the sex-specific average hematocrit; Se(P) is the total selenium concentration in 1 g of plasma; and d(P) = 1.027 g/ml and is the density of the plasma sample.
For statistical analyses other than those including laboratory data, we used conditional logistic regression models to compute odds ratios and 95 percent confidence intervals for tertiles or quartiles of the exposure variables, with adjustment for covariates. Separate models were run for males and females. Dose-response relations were tested by including in the models a trend variable, assigned the median value for each quantile. Blood and toenail samples were not obtained for all subjects; therefore, for analyses using plasma variables and toenail selenium, unconditional logistic regression models were calculated by using data for all available cases and controls, adjusting for the matching criterion age. The regressions were repeated by using conditional logistic models for the complete case-control pairs with specimens. The estimates between the models did not differ significantly, and only unconditional logistic regression models are reported in this paper. Nutrient intakes were adjusted for calories by the method of residuals (38).
Grandparents' ancestry was modeled as four variables representing the summary categories: southern European, English, Celtic (Welsh, Irish, or Scottish), and western and central European. A weight of 0.25 was assigned to each grandparent's reported nationality, so the sum across variables is 1. For example, if a subject had two grandparents of English descent, one from Spain, and one from Germany, the variables would be assigned the following scores: southern European = 0.25, English = 0.50, Celtic = 0, and western and central European = 0.25. The southern European variable was not included in the model because it was the reference category. The following factors were used as adjustment variables in various models: height (continuous), education (high school or less vs. more than high school), hair color, number of blistering sunburns at ages 10–17 years (continuous), ability to tan, lifetime ethanol intake (continuous), hematocrit (continuous) for erythrocyte selenium analysis, and recent use of selenium-containing shampoo (yes vs. no) for toenail selenium analyses. The categorical adjustment variables are represented by indicator variables for the groups in tables 1–4 .
. | Males . | . | . | . | Females . | . | . | . | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | No. of cases . | No. of controls . | OR† . | 95% CI† . | No. of cases . | No. of controls . | OR† . | 95% CI† . | ||||||
Grandparents' ancestry‡ | ||||||||||||||
Southern European | 27.75 | 41.50 | 1.0 | 20.00 | 28.25 | 1.0 | ||||||||
English | 38.50 | 38.50 | 1.8 | 0.8, 4.2 | 29.50 | 22.25 | 3.6 | 1.1, 1.9 | ||||||
Celtic | 50.75 | 39.75 | 2.8 | 1.2, 6.5 | 26.25 | 31.25 | 1.3 | 0.5, 3.5 | ||||||
Western and central European | 50.00 | 47.25 | 1.9 | 0.9, 4.2 | 35.25 | 29.25 | 2.7 | 0.9, 7.9 | ||||||
Birthplace | ||||||||||||||
Hawaii | 22 | 22 | 1.0 | 11 | 16 | 1.0 | ||||||||
Elsewhere | 145 | 145 | 1.0 | 0.5, 1.9 | 100 | 95 | 1.6 | 0.7, 3.6 | ||||||
Age at arrival in Hawaii | ||||||||||||||
Born in Hawaii | 22 | 22 | 1.0 | 11 | 16 | 1.0 | ||||||||
1–19 years | 23 | 14 | 1.6 | 0.7, 3.9 | 19 | 15 | 1.9 | 0.7, 5.6 | ||||||
20–24 years | 19 | 18 | 1.1 | 0.4, 2.5 | 19 | 20 | 1.4 | 0.5, 4.3 | ||||||
25–29 years | 30 | 25 | 1.3 | 0.6, 2.8 | 20 | 20 | 1.5 | 0.5, 4.1 | ||||||
≥30 years | 73 | 88 | 0.8 | 0.4, 1.6 | 42 | 40 | 1.5 | 0.6, 3.6 | ||||||
No. of years lived in Hawaii | ||||||||||||||
≤10 | 31 | 46 | 1.0 | 32 | 38 | 1.0 | ||||||||
11–19 | 40 | 34 | 1.8 | 0.9, 3.5 | 33 | 26 | 1.5 | 0.7, 3.0 | ||||||
20–31 | 41 | 47 | 1.4 | 0.7, 2.6 | 25 | 26 | 1.1 | 0.5, 2.4 | ||||||
≥32 | 55 | 40 | 2.4 | 1.2, 4.8 | 21 | 21 | 1.2 | 0.5, 2.8 | ||||||
p for trend = 0.04 | p for trend = 0.72 | |||||||||||||
Education | ||||||||||||||
≤High school | 27 | 39 | 1.0 | 15 | 36 | 1.0 | ||||||||
Junior college | 43 | 48 | 1.5 | 0.8, 2.9 | 51 | 33 | 3.6 | 1.7, 8.0 | ||||||
College | 44 | 34 | 2.0 | 1.0, 4.2 | 24 | 26 | 2.6 | 1.0, 6.4 | ||||||
Graduate school | 50 | 46 | 1.7 | 0.9, 3.4 | 21 | 16 | 3.3 | 1.3, 8.3 | ||||||
p for trend = 0.12 | p for trend = 0.05 | |||||||||||||
Smoking status | ||||||||||||||
Never | 71 | 61 | 1.0 | 58 | 51 | 1.0 | ||||||||
Former smoker | 74 | 73 | 0.9 | 0.5, 1.4 | 39 | 37 | 0.9 | 0.5, 1.8 | ||||||
Current smoker | 22 | 33 | 0.5 | 0.3, 1.0 | 14 | 23 | 0.5 | 0.2, 1.2 | ||||||
Drinking status | ||||||||||||||
Never | 22 | 36 | 1.0 | 35 | 42 | 1.0 | ||||||||
Former drinker | 35 | 36 | 1.6 | 0.8, 3.4 | 30 | 29 | 1.3 | 0.6, 2.6 | ||||||
Current drinker | 110 | 95 | 1.9 | 1.0, 3.4 | 46 | 40 | 1.5 | 0.7, 2.9 | ||||||
Weight§ | ||||||||||||||
Q1 | 43 | 41 | 1.0 | 25 | 34 | 1.0 | ||||||||
Q2 | 42 | 41 | 1.0 | 0.5, 1.8 | 30 | 22 | 1.9 | 0.9, 4.2 | ||||||
Q3 | 38 | 45 | 0.8 | 0.4, 1.5 | 33 | 24 | 1.9 | 0.9, 4.0 | ||||||
Q4 | 44 | 40 | 1.1 | 0.6, 2.0 | 23 | 31 | 1.0 | 0.5, 2.3 | ||||||
p for trend = 0.93 | p for trend = 0.60 | |||||||||||||
Height¶ | ||||||||||||||
Q1 | 36 | 49 | 1.0 | 20 | 37 | 1.0 | ||||||||
Q2 | 40 | 45 | 1.2 | 0.7, 2.2 | 30 | 26 | 2.2 | 1.0, 4.6 | ||||||
Q3 | 37 | 45 | 1.1 | 0.6, 2.1 | 29 | 31 | 2.0 | 0.9, 4.4 | ||||||
Q4 | 54 | 28 | 2.5 | 1.3, 5.0 | 32 | 17 | 4.4 | 1.7, 11.1 | ||||||
p for trend = 0.006 | p for trend = 0.003 | |||||||||||||
Body mass index# | ||||||||||||||
Q1 | 48 | 35 | 1.0 | 33 | 23 | 1.0 | ||||||||
Q2 | 40 | 44 | 0.6 | 0.3, 1.2 | 26 | 29 | 0.7 | 0.3, 1.4 | ||||||
Q3 | 39 | 44 | 0.6 | 0.3, 1.2 | 30 | 26 | 0.8 | 0.4, 1.8 | ||||||
Q4 | 40 | 44 | 0.7 | 0.4, 1.2 | 22 | 33 | 0.5 | 0.2, 1.0 | ||||||
p for trend = 0.24 | p for trend = 0.06 |
. | Males . | . | . | . | Females . | . | . | . | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | No. of cases . | No. of controls . | OR† . | 95% CI† . | No. of cases . | No. of controls . | OR† . | 95% CI† . | ||||||
Grandparents' ancestry‡ | ||||||||||||||
Southern European | 27.75 | 41.50 | 1.0 | 20.00 | 28.25 | 1.0 | ||||||||
English | 38.50 | 38.50 | 1.8 | 0.8, 4.2 | 29.50 | 22.25 | 3.6 | 1.1, 1.9 | ||||||
Celtic | 50.75 | 39.75 | 2.8 | 1.2, 6.5 | 26.25 | 31.25 | 1.3 | 0.5, 3.5 | ||||||
Western and central European | 50.00 | 47.25 | 1.9 | 0.9, 4.2 | 35.25 | 29.25 | 2.7 | 0.9, 7.9 | ||||||
Birthplace | ||||||||||||||
Hawaii | 22 | 22 | 1.0 | 11 | 16 | 1.0 | ||||||||
Elsewhere | 145 | 145 | 1.0 | 0.5, 1.9 | 100 | 95 | 1.6 | 0.7, 3.6 | ||||||
Age at arrival in Hawaii | ||||||||||||||
Born in Hawaii | 22 | 22 | 1.0 | 11 | 16 | 1.0 | ||||||||
1–19 years | 23 | 14 | 1.6 | 0.7, 3.9 | 19 | 15 | 1.9 | 0.7, 5.6 | ||||||
20–24 years | 19 | 18 | 1.1 | 0.4, 2.5 | 19 | 20 | 1.4 | 0.5, 4.3 | ||||||
25–29 years | 30 | 25 | 1.3 | 0.6, 2.8 | 20 | 20 | 1.5 | 0.5, 4.1 | ||||||
≥30 years | 73 | 88 | 0.8 | 0.4, 1.6 | 42 | 40 | 1.5 | 0.6, 3.6 | ||||||
No. of years lived in Hawaii | ||||||||||||||
≤10 | 31 | 46 | 1.0 | 32 | 38 | 1.0 | ||||||||
11–19 | 40 | 34 | 1.8 | 0.9, 3.5 | 33 | 26 | 1.5 | 0.7, 3.0 | ||||||
20–31 | 41 | 47 | 1.4 | 0.7, 2.6 | 25 | 26 | 1.1 | 0.5, 2.4 | ||||||
≥32 | 55 | 40 | 2.4 | 1.2, 4.8 | 21 | 21 | 1.2 | 0.5, 2.8 | ||||||
p for trend = 0.04 | p for trend = 0.72 | |||||||||||||
Education | ||||||||||||||
≤High school | 27 | 39 | 1.0 | 15 | 36 | 1.0 | ||||||||
Junior college | 43 | 48 | 1.5 | 0.8, 2.9 | 51 | 33 | 3.6 | 1.7, 8.0 | ||||||
College | 44 | 34 | 2.0 | 1.0, 4.2 | 24 | 26 | 2.6 | 1.0, 6.4 | ||||||
Graduate school | 50 | 46 | 1.7 | 0.9, 3.4 | 21 | 16 | 3.3 | 1.3, 8.3 | ||||||
p for trend = 0.12 | p for trend = 0.05 | |||||||||||||
Smoking status | ||||||||||||||
Never | 71 | 61 | 1.0 | 58 | 51 | 1.0 | ||||||||
Former smoker | 74 | 73 | 0.9 | 0.5, 1.4 | 39 | 37 | 0.9 | 0.5, 1.8 | ||||||
Current smoker | 22 | 33 | 0.5 | 0.3, 1.0 | 14 | 23 | 0.5 | 0.2, 1.2 | ||||||
Drinking status | ||||||||||||||
Never | 22 | 36 | 1.0 | 35 | 42 | 1.0 | ||||||||
Former drinker | 35 | 36 | 1.6 | 0.8, 3.4 | 30 | 29 | 1.3 | 0.6, 2.6 | ||||||
Current drinker | 110 | 95 | 1.9 | 1.0, 3.4 | 46 | 40 | 1.5 | 0.7, 2.9 | ||||||
Weight§ | ||||||||||||||
Q1 | 43 | 41 | 1.0 | 25 | 34 | 1.0 | ||||||||
Q2 | 42 | 41 | 1.0 | 0.5, 1.8 | 30 | 22 | 1.9 | 0.9, 4.2 | ||||||
Q3 | 38 | 45 | 0.8 | 0.4, 1.5 | 33 | 24 | 1.9 | 0.9, 4.0 | ||||||
Q4 | 44 | 40 | 1.1 | 0.6, 2.0 | 23 | 31 | 1.0 | 0.5, 2.3 | ||||||
p for trend = 0.93 | p for trend = 0.60 | |||||||||||||
Height¶ | ||||||||||||||
Q1 | 36 | 49 | 1.0 | 20 | 37 | 1.0 | ||||||||
Q2 | 40 | 45 | 1.2 | 0.7, 2.2 | 30 | 26 | 2.2 | 1.0, 4.6 | ||||||
Q3 | 37 | 45 | 1.1 | 0.6, 2.1 | 29 | 31 | 2.0 | 0.9, 4.4 | ||||||
Q4 | 54 | 28 | 2.5 | 1.3, 5.0 | 32 | 17 | 4.4 | 1.7, 11.1 | ||||||
p for trend = 0.006 | p for trend = 0.003 | |||||||||||||
Body mass index# | ||||||||||||||
Q1 | 48 | 35 | 1.0 | 33 | 23 | 1.0 | ||||||||
Q2 | 40 | 44 | 0.6 | 0.3, 1.2 | 26 | 29 | 0.7 | 0.3, 1.4 | ||||||
Q3 | 39 | 44 | 0.6 | 0.3, 1.2 | 30 | 26 | 0.8 | 0.4, 1.8 | ||||||
Q4 | 40 | 44 | 0.7 | 0.4, 1.2 | 22 | 33 | 0.5 | 0.2, 1.0 | ||||||
p for trend = 0.24 | p for trend = 0.06 |
Cases and controls were matched on age.
Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by conditional logistic regression.
Modeled as four variables representing the summary categories: southern European, English, Celtic (Welsh, Irish, and Scottish), and western and central European. A weight of 0.25 was assigned to each grandparent's reported nationality, so that the sum across variables is 1. The southern European variable was not included in the model because it was considered the reference group.
Quartile (Q) cutpoints for weight in kilograms: males—≤74, 75–82, 83–90, ≥91; females—≤56, 57–61, 62–69, ≥70.
Quartile cutpoints for height in centimeters: males—≤172, 173–178, 179–182, ≥183; females—≤161, 162–165, 166–169, ≥171.
Quartile cutpoints for body mass index in kg/m2 (weight (kg)/height (m)2): males—≤23.8, 23.9–26.0, 26.1–28.6, ≥28.7; females—≤20.4, 20.5–22.8, 22.9–26.1, ≥26.2.
. | Males . | . | . | . | Females . | . | . | . | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | No. of cases . | No. of controls . | OR† . | 95% CI† . | No. of cases . | No. of controls . | OR† . | 95% CI† . | ||||||
Grandparents' ancestry‡ | ||||||||||||||
Southern European | 27.75 | 41.50 | 1.0 | 20.00 | 28.25 | 1.0 | ||||||||
English | 38.50 | 38.50 | 1.8 | 0.8, 4.2 | 29.50 | 22.25 | 3.6 | 1.1, 1.9 | ||||||
Celtic | 50.75 | 39.75 | 2.8 | 1.2, 6.5 | 26.25 | 31.25 | 1.3 | 0.5, 3.5 | ||||||
Western and central European | 50.00 | 47.25 | 1.9 | 0.9, 4.2 | 35.25 | 29.25 | 2.7 | 0.9, 7.9 | ||||||
Birthplace | ||||||||||||||
Hawaii | 22 | 22 | 1.0 | 11 | 16 | 1.0 | ||||||||
Elsewhere | 145 | 145 | 1.0 | 0.5, 1.9 | 100 | 95 | 1.6 | 0.7, 3.6 | ||||||
Age at arrival in Hawaii | ||||||||||||||
Born in Hawaii | 22 | 22 | 1.0 | 11 | 16 | 1.0 | ||||||||
1–19 years | 23 | 14 | 1.6 | 0.7, 3.9 | 19 | 15 | 1.9 | 0.7, 5.6 | ||||||
20–24 years | 19 | 18 | 1.1 | 0.4, 2.5 | 19 | 20 | 1.4 | 0.5, 4.3 | ||||||
25–29 years | 30 | 25 | 1.3 | 0.6, 2.8 | 20 | 20 | 1.5 | 0.5, 4.1 | ||||||
≥30 years | 73 | 88 | 0.8 | 0.4, 1.6 | 42 | 40 | 1.5 | 0.6, 3.6 | ||||||
No. of years lived in Hawaii | ||||||||||||||
≤10 | 31 | 46 | 1.0 | 32 | 38 | 1.0 | ||||||||
11–19 | 40 | 34 | 1.8 | 0.9, 3.5 | 33 | 26 | 1.5 | 0.7, 3.0 | ||||||
20–31 | 41 | 47 | 1.4 | 0.7, 2.6 | 25 | 26 | 1.1 | 0.5, 2.4 | ||||||
≥32 | 55 | 40 | 2.4 | 1.2, 4.8 | 21 | 21 | 1.2 | 0.5, 2.8 | ||||||
p for trend = 0.04 | p for trend = 0.72 | |||||||||||||
Education | ||||||||||||||
≤High school | 27 | 39 | 1.0 | 15 | 36 | 1.0 | ||||||||
Junior college | 43 | 48 | 1.5 | 0.8, 2.9 | 51 | 33 | 3.6 | 1.7, 8.0 | ||||||
College | 44 | 34 | 2.0 | 1.0, 4.2 | 24 | 26 | 2.6 | 1.0, 6.4 | ||||||
Graduate school | 50 | 46 | 1.7 | 0.9, 3.4 | 21 | 16 | 3.3 | 1.3, 8.3 | ||||||
p for trend = 0.12 | p for trend = 0.05 | |||||||||||||
Smoking status | ||||||||||||||
Never | 71 | 61 | 1.0 | 58 | 51 | 1.0 | ||||||||
Former smoker | 74 | 73 | 0.9 | 0.5, 1.4 | 39 | 37 | 0.9 | 0.5, 1.8 | ||||||
Current smoker | 22 | 33 | 0.5 | 0.3, 1.0 | 14 | 23 | 0.5 | 0.2, 1.2 | ||||||
Drinking status | ||||||||||||||
Never | 22 | 36 | 1.0 | 35 | 42 | 1.0 | ||||||||
Former drinker | 35 | 36 | 1.6 | 0.8, 3.4 | 30 | 29 | 1.3 | 0.6, 2.6 | ||||||
Current drinker | 110 | 95 | 1.9 | 1.0, 3.4 | 46 | 40 | 1.5 | 0.7, 2.9 | ||||||
Weight§ | ||||||||||||||
Q1 | 43 | 41 | 1.0 | 25 | 34 | 1.0 | ||||||||
Q2 | 42 | 41 | 1.0 | 0.5, 1.8 | 30 | 22 | 1.9 | 0.9, 4.2 | ||||||
Q3 | 38 | 45 | 0.8 | 0.4, 1.5 | 33 | 24 | 1.9 | 0.9, 4.0 | ||||||
Q4 | 44 | 40 | 1.1 | 0.6, 2.0 | 23 | 31 | 1.0 | 0.5, 2.3 | ||||||
p for trend = 0.93 | p for trend = 0.60 | |||||||||||||
Height¶ | ||||||||||||||
Q1 | 36 | 49 | 1.0 | 20 | 37 | 1.0 | ||||||||
Q2 | 40 | 45 | 1.2 | 0.7, 2.2 | 30 | 26 | 2.2 | 1.0, 4.6 | ||||||
Q3 | 37 | 45 | 1.1 | 0.6, 2.1 | 29 | 31 | 2.0 | 0.9, 4.4 | ||||||
Q4 | 54 | 28 | 2.5 | 1.3, 5.0 | 32 | 17 | 4.4 | 1.7, 11.1 | ||||||
p for trend = 0.006 | p for trend = 0.003 | |||||||||||||
Body mass index# | ||||||||||||||
Q1 | 48 | 35 | 1.0 | 33 | 23 | 1.0 | ||||||||
Q2 | 40 | 44 | 0.6 | 0.3, 1.2 | 26 | 29 | 0.7 | 0.3, 1.4 | ||||||
Q3 | 39 | 44 | 0.6 | 0.3, 1.2 | 30 | 26 | 0.8 | 0.4, 1.8 | ||||||
Q4 | 40 | 44 | 0.7 | 0.4, 1.2 | 22 | 33 | 0.5 | 0.2, 1.0 | ||||||
p for trend = 0.24 | p for trend = 0.06 |
. | Males . | . | . | . | Females . | . | . | . | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | No. of cases . | No. of controls . | OR† . | 95% CI† . | No. of cases . | No. of controls . | OR† . | 95% CI† . | ||||||
Grandparents' ancestry‡ | ||||||||||||||
Southern European | 27.75 | 41.50 | 1.0 | 20.00 | 28.25 | 1.0 | ||||||||
English | 38.50 | 38.50 | 1.8 | 0.8, 4.2 | 29.50 | 22.25 | 3.6 | 1.1, 1.9 | ||||||
Celtic | 50.75 | 39.75 | 2.8 | 1.2, 6.5 | 26.25 | 31.25 | 1.3 | 0.5, 3.5 | ||||||
Western and central European | 50.00 | 47.25 | 1.9 | 0.9, 4.2 | 35.25 | 29.25 | 2.7 | 0.9, 7.9 | ||||||
Birthplace | ||||||||||||||
Hawaii | 22 | 22 | 1.0 | 11 | 16 | 1.0 | ||||||||
Elsewhere | 145 | 145 | 1.0 | 0.5, 1.9 | 100 | 95 | 1.6 | 0.7, 3.6 | ||||||
Age at arrival in Hawaii | ||||||||||||||
Born in Hawaii | 22 | 22 | 1.0 | 11 | 16 | 1.0 | ||||||||
1–19 years | 23 | 14 | 1.6 | 0.7, 3.9 | 19 | 15 | 1.9 | 0.7, 5.6 | ||||||
20–24 years | 19 | 18 | 1.1 | 0.4, 2.5 | 19 | 20 | 1.4 | 0.5, 4.3 | ||||||
25–29 years | 30 | 25 | 1.3 | 0.6, 2.8 | 20 | 20 | 1.5 | 0.5, 4.1 | ||||||
≥30 years | 73 | 88 | 0.8 | 0.4, 1.6 | 42 | 40 | 1.5 | 0.6, 3.6 | ||||||
No. of years lived in Hawaii | ||||||||||||||
≤10 | 31 | 46 | 1.0 | 32 | 38 | 1.0 | ||||||||
11–19 | 40 | 34 | 1.8 | 0.9, 3.5 | 33 | 26 | 1.5 | 0.7, 3.0 | ||||||
20–31 | 41 | 47 | 1.4 | 0.7, 2.6 | 25 | 26 | 1.1 | 0.5, 2.4 | ||||||
≥32 | 55 | 40 | 2.4 | 1.2, 4.8 | 21 | 21 | 1.2 | 0.5, 2.8 | ||||||
p for trend = 0.04 | p for trend = 0.72 | |||||||||||||
Education | ||||||||||||||
≤High school | 27 | 39 | 1.0 | 15 | 36 | 1.0 | ||||||||
Junior college | 43 | 48 | 1.5 | 0.8, 2.9 | 51 | 33 | 3.6 | 1.7, 8.0 | ||||||
College | 44 | 34 | 2.0 | 1.0, 4.2 | 24 | 26 | 2.6 | 1.0, 6.4 | ||||||
Graduate school | 50 | 46 | 1.7 | 0.9, 3.4 | 21 | 16 | 3.3 | 1.3, 8.3 | ||||||
p for trend = 0.12 | p for trend = 0.05 | |||||||||||||
Smoking status | ||||||||||||||
Never | 71 | 61 | 1.0 | 58 | 51 | 1.0 | ||||||||
Former smoker | 74 | 73 | 0.9 | 0.5, 1.4 | 39 | 37 | 0.9 | 0.5, 1.8 | ||||||
Current smoker | 22 | 33 | 0.5 | 0.3, 1.0 | 14 | 23 | 0.5 | 0.2, 1.2 | ||||||
Drinking status | ||||||||||||||
Never | 22 | 36 | 1.0 | 35 | 42 | 1.0 | ||||||||
Former drinker | 35 | 36 | 1.6 | 0.8, 3.4 | 30 | 29 | 1.3 | 0.6, 2.6 | ||||||
Current drinker | 110 | 95 | 1.9 | 1.0, 3.4 | 46 | 40 | 1.5 | 0.7, 2.9 | ||||||
Weight§ | ||||||||||||||
Q1 | 43 | 41 | 1.0 | 25 | 34 | 1.0 | ||||||||
Q2 | 42 | 41 | 1.0 | 0.5, 1.8 | 30 | 22 | 1.9 | 0.9, 4.2 | ||||||
Q3 | 38 | 45 | 0.8 | 0.4, 1.5 | 33 | 24 | 1.9 | 0.9, 4.0 | ||||||
Q4 | 44 | 40 | 1.1 | 0.6, 2.0 | 23 | 31 | 1.0 | 0.5, 2.3 | ||||||
p for trend = 0.93 | p for trend = 0.60 | |||||||||||||
Height¶ | ||||||||||||||
Q1 | 36 | 49 | 1.0 | 20 | 37 | 1.0 | ||||||||
Q2 | 40 | 45 | 1.2 | 0.7, 2.2 | 30 | 26 | 2.2 | 1.0, 4.6 | ||||||
Q3 | 37 | 45 | 1.1 | 0.6, 2.1 | 29 | 31 | 2.0 | 0.9, 4.4 | ||||||
Q4 | 54 | 28 | 2.5 | 1.3, 5.0 | 32 | 17 | 4.4 | 1.7, 11.1 | ||||||
p for trend = 0.006 | p for trend = 0.003 | |||||||||||||
Body mass index# | ||||||||||||||
Q1 | 48 | 35 | 1.0 | 33 | 23 | 1.0 | ||||||||
Q2 | 40 | 44 | 0.6 | 0.3, 1.2 | 26 | 29 | 0.7 | 0.3, 1.4 | ||||||
Q3 | 39 | 44 | 0.6 | 0.3, 1.2 | 30 | 26 | 0.8 | 0.4, 1.8 | ||||||
Q4 | 40 | 44 | 0.7 | 0.4, 1.2 | 22 | 33 | 0.5 | 0.2, 1.0 | ||||||
p for trend = 0.24 | p for trend = 0.06 |
Cases and controls were matched on age.
Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by conditional logistic regression.
Modeled as four variables representing the summary categories: southern European, English, Celtic (Welsh, Irish, and Scottish), and western and central European. A weight of 0.25 was assigned to each grandparent's reported nationality, so that the sum across variables is 1. The southern European variable was not included in the model because it was considered the reference group.
Quartile (Q) cutpoints for weight in kilograms: males—≤74, 75–82, 83–90, ≥91; females—≤56, 57–61, 62–69, ≥70.
Quartile cutpoints for height in centimeters: males—≤172, 173–178, 179–182, ≥183; females—≤161, 162–165, 166–169, ≥171.
Quartile cutpoints for body mass index in kg/m2 (weight (kg)/height (m)2): males—≤23.8, 23.9–26.0, 26.1–28.6, ≥28.7; females—≤20.4, 20.5–22.8, 22.9–26.1, ≥26.2.
. | Males . | . | . | . | Females . | . | . | . | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | ||||||
Hair color | ||||||||||||||
Black/dark brown | 43 | 65 | 1.0 | 21 | 37 | 1.0 | ||||||||
Medium brown | 33 | 46 | 0.9 | 0.5, 1.7 | 27 | 31 | 1.6 | 0.7, 4.0 | ||||||
Light brown | 28 | 17 | 2.3 | 1.1, 4.8 | 14 | 10 | 1.6 | 0.5, 4.8 | ||||||
Light/dark blonde/red | 63 | 39 | 2.5 | 1.4, 4.5 | 49 | 33 | 2.4 | 1.1, 5.1 | ||||||
Eye color | ||||||||||||||
Black/dark brown | 6 | 16 | 1.0 | 6 | 13 | 1.0 | ||||||||
Medium brown | 18 | 26 | 2.0 | 0.6, 7.0 | 7 | 16 | 0.8 | 0.2, 3.0 | ||||||
Light brown | 11 | 9 | 3.4 | 0.9, 12.6 | 9 | 6 | 2.2 | 0.5, 10.0 | ||||||
Green/hazel/grey | 61 | 57 | 2.9 | 1.0, 8.5 | 47 | 49 | 1.2 | 0.4, 3.7 | ||||||
Blue | 71 | 59 | 3.6 | 1.2, 10.9 | 42 | 27 | 2.1 | 0.6, 7.0 | ||||||
Skin color of left upper inner arm | ||||||||||||||
Dark | 30 | 53 | 1.0 | 19 | 24 | 1.0 | ||||||||
Medium dark | 32 | 33 | 1.9 | 0.9, 3.8 | 21 | 20 | 1.6 | 0.6, 4.3 | ||||||
Medium light | 51 | 45 | 2.0 | 1.0, 3.8 | 31 | 26 | 1.6 | 0.6, 4.1 | ||||||
Light | 54 | 36 | 2.8 | 1.5, 5.4 | 40 | 41 | 1.1 | 0.4, 2.5 | ||||||
Propensity to sunburn | ||||||||||||||
Tan only | 11 | 23 | 1.0 | 8 | 11 | 1.0 | ||||||||
Mild burn and tanning | 88 | 85 | 2.1 | 0.9, 4.7 | 47 | 54 | 0.7 | 0.2, 2.1 | ||||||
Severe burn and peeling | 56 | 50 | 2.5 | 1.1, 5.9 | 46 | 34 | 1.0 | 0.3, 3.1 | ||||||
Severe burn and blistering | 10 | 7 | 2.6 | 0.7, 9.4 | 9 | 11 | 0.5 | 0.1, 2.2 | ||||||
Ability to tan | ||||||||||||||
Dark tan | 44 | 53 | 1.0 | 15 | 29 | 1.0 | ||||||||
Moderate tan | 75 | 84 | 1.1 | 0.7, 1.9 | 56 | 48 | 2.6 | 1.1, 6.1 | ||||||
Mild tan and peeling | 40 | 25 | 1.9 | 1.0, 3.8 | 28 | 28 | 2.4 | 0.9, 6.3 | ||||||
Only freckling, no tan | 8 | 5 | 2.1 | 0.6, 7.0 | 12 | 6 | 5.4 | 1.1, 26.2 | ||||||
Family history of nonmelanoma skin cancer | ||||||||||||||
No | 146 | 157 | 1.0 | 94 | 106 | 1.0 | ||||||||
Yes | 21 | 10 | 2.3 | 0.9, 6.1 | 17 | 5 | 10.0 | 2.0, 49.6 | ||||||
Family history of malignant melanoma | ||||||||||||||
No | 156 | 164 | 1.0 | 101 | 110 | 1.0 | ||||||||
Yes | 11 | 3 | 3.8 | 0.8, 17.9 | 10 | 1 | 11.2 | 1.3, 97.0 |
. | Males . | . | . | . | Females . | . | . | . | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | ||||||
Hair color | ||||||||||||||
Black/dark brown | 43 | 65 | 1.0 | 21 | 37 | 1.0 | ||||||||
Medium brown | 33 | 46 | 0.9 | 0.5, 1.7 | 27 | 31 | 1.6 | 0.7, 4.0 | ||||||
Light brown | 28 | 17 | 2.3 | 1.1, 4.8 | 14 | 10 | 1.6 | 0.5, 4.8 | ||||||
Light/dark blonde/red | 63 | 39 | 2.5 | 1.4, 4.5 | 49 | 33 | 2.4 | 1.1, 5.1 | ||||||
Eye color | ||||||||||||||
Black/dark brown | 6 | 16 | 1.0 | 6 | 13 | 1.0 | ||||||||
Medium brown | 18 | 26 | 2.0 | 0.6, 7.0 | 7 | 16 | 0.8 | 0.2, 3.0 | ||||||
Light brown | 11 | 9 | 3.4 | 0.9, 12.6 | 9 | 6 | 2.2 | 0.5, 10.0 | ||||||
Green/hazel/grey | 61 | 57 | 2.9 | 1.0, 8.5 | 47 | 49 | 1.2 | 0.4, 3.7 | ||||||
Blue | 71 | 59 | 3.6 | 1.2, 10.9 | 42 | 27 | 2.1 | 0.6, 7.0 | ||||||
Skin color of left upper inner arm | ||||||||||||||
Dark | 30 | 53 | 1.0 | 19 | 24 | 1.0 | ||||||||
Medium dark | 32 | 33 | 1.9 | 0.9, 3.8 | 21 | 20 | 1.6 | 0.6, 4.3 | ||||||
Medium light | 51 | 45 | 2.0 | 1.0, 3.8 | 31 | 26 | 1.6 | 0.6, 4.1 | ||||||
Light | 54 | 36 | 2.8 | 1.5, 5.4 | 40 | 41 | 1.1 | 0.4, 2.5 | ||||||
Propensity to sunburn | ||||||||||||||
Tan only | 11 | 23 | 1.0 | 8 | 11 | 1.0 | ||||||||
Mild burn and tanning | 88 | 85 | 2.1 | 0.9, 4.7 | 47 | 54 | 0.7 | 0.2, 2.1 | ||||||
Severe burn and peeling | 56 | 50 | 2.5 | 1.1, 5.9 | 46 | 34 | 1.0 | 0.3, 3.1 | ||||||
Severe burn and blistering | 10 | 7 | 2.6 | 0.7, 9.4 | 9 | 11 | 0.5 | 0.1, 2.2 | ||||||
Ability to tan | ||||||||||||||
Dark tan | 44 | 53 | 1.0 | 15 | 29 | 1.0 | ||||||||
Moderate tan | 75 | 84 | 1.1 | 0.7, 1.9 | 56 | 48 | 2.6 | 1.1, 6.1 | ||||||
Mild tan and peeling | 40 | 25 | 1.9 | 1.0, 3.8 | 28 | 28 | 2.4 | 0.9, 6.3 | ||||||
Only freckling, no tan | 8 | 5 | 2.1 | 0.6, 7.0 | 12 | 6 | 5.4 | 1.1, 26.2 | ||||||
Family history of nonmelanoma skin cancer | ||||||||||||||
No | 146 | 157 | 1.0 | 94 | 106 | 1.0 | ||||||||
Yes | 21 | 10 | 2.3 | 0.9, 6.1 | 17 | 5 | 10.0 | 2.0, 49.6 | ||||||
Family history of malignant melanoma | ||||||||||||||
No | 156 | 164 | 1.0 | 101 | 110 | 1.0 | ||||||||
Yes | 11 | 3 | 3.8 | 0.8, 17.9 | 10 | 1 | 11.2 | 1.3, 97.0 |
Cases and controls were matched on age.
Total numbers of subjects vary because of missing data.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), and alcohol drinking status (indicator variables representing categories in table 1) by using conditional logistic regression.
. | Males . | . | . | . | Females . | . | . | . | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | ||||||
Hair color | ||||||||||||||
Black/dark brown | 43 | 65 | 1.0 | 21 | 37 | 1.0 | ||||||||
Medium brown | 33 | 46 | 0.9 | 0.5, 1.7 | 27 | 31 | 1.6 | 0.7, 4.0 | ||||||
Light brown | 28 | 17 | 2.3 | 1.1, 4.8 | 14 | 10 | 1.6 | 0.5, 4.8 | ||||||
Light/dark blonde/red | 63 | 39 | 2.5 | 1.4, 4.5 | 49 | 33 | 2.4 | 1.1, 5.1 | ||||||
Eye color | ||||||||||||||
Black/dark brown | 6 | 16 | 1.0 | 6 | 13 | 1.0 | ||||||||
Medium brown | 18 | 26 | 2.0 | 0.6, 7.0 | 7 | 16 | 0.8 | 0.2, 3.0 | ||||||
Light brown | 11 | 9 | 3.4 | 0.9, 12.6 | 9 | 6 | 2.2 | 0.5, 10.0 | ||||||
Green/hazel/grey | 61 | 57 | 2.9 | 1.0, 8.5 | 47 | 49 | 1.2 | 0.4, 3.7 | ||||||
Blue | 71 | 59 | 3.6 | 1.2, 10.9 | 42 | 27 | 2.1 | 0.6, 7.0 | ||||||
Skin color of left upper inner arm | ||||||||||||||
Dark | 30 | 53 | 1.0 | 19 | 24 | 1.0 | ||||||||
Medium dark | 32 | 33 | 1.9 | 0.9, 3.8 | 21 | 20 | 1.6 | 0.6, 4.3 | ||||||
Medium light | 51 | 45 | 2.0 | 1.0, 3.8 | 31 | 26 | 1.6 | 0.6, 4.1 | ||||||
Light | 54 | 36 | 2.8 | 1.5, 5.4 | 40 | 41 | 1.1 | 0.4, 2.5 | ||||||
Propensity to sunburn | ||||||||||||||
Tan only | 11 | 23 | 1.0 | 8 | 11 | 1.0 | ||||||||
Mild burn and tanning | 88 | 85 | 2.1 | 0.9, 4.7 | 47 | 54 | 0.7 | 0.2, 2.1 | ||||||
Severe burn and peeling | 56 | 50 | 2.5 | 1.1, 5.9 | 46 | 34 | 1.0 | 0.3, 3.1 | ||||||
Severe burn and blistering | 10 | 7 | 2.6 | 0.7, 9.4 | 9 | 11 | 0.5 | 0.1, 2.2 | ||||||
Ability to tan | ||||||||||||||
Dark tan | 44 | 53 | 1.0 | 15 | 29 | 1.0 | ||||||||
Moderate tan | 75 | 84 | 1.1 | 0.7, 1.9 | 56 | 48 | 2.6 | 1.1, 6.1 | ||||||
Mild tan and peeling | 40 | 25 | 1.9 | 1.0, 3.8 | 28 | 28 | 2.4 | 0.9, 6.3 | ||||||
Only freckling, no tan | 8 | 5 | 2.1 | 0.6, 7.0 | 12 | 6 | 5.4 | 1.1, 26.2 | ||||||
Family history of nonmelanoma skin cancer | ||||||||||||||
No | 146 | 157 | 1.0 | 94 | 106 | 1.0 | ||||||||
Yes | 21 | 10 | 2.3 | 0.9, 6.1 | 17 | 5 | 10.0 | 2.0, 49.6 | ||||||
Family history of malignant melanoma | ||||||||||||||
No | 156 | 164 | 1.0 | 101 | 110 | 1.0 | ||||||||
Yes | 11 | 3 | 3.8 | 0.8, 17.9 | 10 | 1 | 11.2 | 1.3, 97.0 |
. | Males . | . | . | . | Females . | . | . | . | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | ||||||
Hair color | ||||||||||||||
Black/dark brown | 43 | 65 | 1.0 | 21 | 37 | 1.0 | ||||||||
Medium brown | 33 | 46 | 0.9 | 0.5, 1.7 | 27 | 31 | 1.6 | 0.7, 4.0 | ||||||
Light brown | 28 | 17 | 2.3 | 1.1, 4.8 | 14 | 10 | 1.6 | 0.5, 4.8 | ||||||
Light/dark blonde/red | 63 | 39 | 2.5 | 1.4, 4.5 | 49 | 33 | 2.4 | 1.1, 5.1 | ||||||
Eye color | ||||||||||||||
Black/dark brown | 6 | 16 | 1.0 | 6 | 13 | 1.0 | ||||||||
Medium brown | 18 | 26 | 2.0 | 0.6, 7.0 | 7 | 16 | 0.8 | 0.2, 3.0 | ||||||
Light brown | 11 | 9 | 3.4 | 0.9, 12.6 | 9 | 6 | 2.2 | 0.5, 10.0 | ||||||
Green/hazel/grey | 61 | 57 | 2.9 | 1.0, 8.5 | 47 | 49 | 1.2 | 0.4, 3.7 | ||||||
Blue | 71 | 59 | 3.6 | 1.2, 10.9 | 42 | 27 | 2.1 | 0.6, 7.0 | ||||||
Skin color of left upper inner arm | ||||||||||||||
Dark | 30 | 53 | 1.0 | 19 | 24 | 1.0 | ||||||||
Medium dark | 32 | 33 | 1.9 | 0.9, 3.8 | 21 | 20 | 1.6 | 0.6, 4.3 | ||||||
Medium light | 51 | 45 | 2.0 | 1.0, 3.8 | 31 | 26 | 1.6 | 0.6, 4.1 | ||||||
Light | 54 | 36 | 2.8 | 1.5, 5.4 | 40 | 41 | 1.1 | 0.4, 2.5 | ||||||
Propensity to sunburn | ||||||||||||||
Tan only | 11 | 23 | 1.0 | 8 | 11 | 1.0 | ||||||||
Mild burn and tanning | 88 | 85 | 2.1 | 0.9, 4.7 | 47 | 54 | 0.7 | 0.2, 2.1 | ||||||
Severe burn and peeling | 56 | 50 | 2.5 | 1.1, 5.9 | 46 | 34 | 1.0 | 0.3, 3.1 | ||||||
Severe burn and blistering | 10 | 7 | 2.6 | 0.7, 9.4 | 9 | 11 | 0.5 | 0.1, 2.2 | ||||||
Ability to tan | ||||||||||||||
Dark tan | 44 | 53 | 1.0 | 15 | 29 | 1.0 | ||||||||
Moderate tan | 75 | 84 | 1.1 | 0.7, 1.9 | 56 | 48 | 2.6 | 1.1, 6.1 | ||||||
Mild tan and peeling | 40 | 25 | 1.9 | 1.0, 3.8 | 28 | 28 | 2.4 | 0.9, 6.3 | ||||||
Only freckling, no tan | 8 | 5 | 2.1 | 0.6, 7.0 | 12 | 6 | 5.4 | 1.1, 26.2 | ||||||
Family history of nonmelanoma skin cancer | ||||||||||||||
No | 146 | 157 | 1.0 | 94 | 106 | 1.0 | ||||||||
Yes | 21 | 10 | 2.3 | 0.9, 6.1 | 17 | 5 | 10.0 | 2.0, 49.6 | ||||||
Family history of malignant melanoma | ||||||||||||||
No | 156 | 164 | 1.0 | 101 | 110 | 1.0 | ||||||||
Yes | 11 | 3 | 3.8 | 0.8, 17.9 | 10 | 1 | 11.2 | 1.3, 97.0 |
Cases and controls were matched on age.
Total numbers of subjects vary because of missing data.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), and alcohol drinking status (indicator variables representing categories in table 1) by using conditional logistic regression.
. | Males . | . | . | . | Females . | . | . | . | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | ||||||
No. of freckles 5 years ago | ||||||||||||||
0 | 143 | 154 | 1.0 | 72 | 83 | 1.0 | ||||||||
1–25 | 20 | 10 | 2.3 | 1.0, 5.4 | 25 | 22 | 1.3 | 0.6, 2.6 | ||||||
≥26 | 4 | 3 | 1.3 | 0.3, 6.4 | 14 | 6 | 5.7 | 1.1, 24.0 | ||||||
p for trend = 0.12 | p for trend = 0.02 | |||||||||||||
No. of palpable moles ≥2 mm on arms | ||||||||||||||
0 | 99 | 136 | 1.0 | 49 | 80 | 1.0 | ||||||||
1 | 28 | 15 | 2.9 | 1.3, 6.4 | 27 | 19 | 1.4 | 0.6, 3.2 | ||||||
2 | 14 | 7 | 3.5 | 1.9, 18.2 | 14 | 6 | 3.6 | 1.2, 11.5 | ||||||
≥3 | 21 | 4 | 5.8 | 1.9, 18.2 | 20 | 5 | 7.7 | 1.6, 37.3 | ||||||
p for trend = 0.0004 | p for trend = 0.005 | |||||||||||||
Self-reported total no. of moles | ||||||||||||||
0–2 | 31 | 61 | 1.0 | 17 | 38 | 1.0 | ||||||||
3–14 | 38 | 34 | 2.1 | 1.1, 4.0 | 33 | 29 | 2.2 | 0.9, 5.3 | ||||||
≥15 | 55 | 29 | 3.5 | 1.9, 6.8 | 34 | 17 | 4.8 | 1.7, 13.5 | ||||||
p for trend = 0.008 | p for trend = 0.004 | |||||||||||||
Self-reported total no. of large moles (≥5 mm) | ||||||||||||||
0 | 40 | 94 | 1.0 | 30 | 66 | 1.0 | ||||||||
1–2 | 38 | 28 | 5.5 | 2.3, 12.9 | 20 | 16 | 2.6 | 0.8, 8.5 | ||||||
≥3 | 63 | 27 | 6.5 | 2.9, 14.4 | 47 | 16 | 14.8 | 4.2, 52.1 | ||||||
p for trend < 0.001 | p for trend < 0.001 | |||||||||||||
Personal history of nonmelanoma skin cancer | ||||||||||||||
No | 97 | 138 | 1.0 | 90 | 103 | 1.0 | ||||||||
Yes | 70 | 29 | 3.3 | 1.8, 6.2 | 21 | 8 | 2.8 | 1.0, 7.4 |
. | Males . | . | . | . | Females . | . | . | . | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | ||||||
No. of freckles 5 years ago | ||||||||||||||
0 | 143 | 154 | 1.0 | 72 | 83 | 1.0 | ||||||||
1–25 | 20 | 10 | 2.3 | 1.0, 5.4 | 25 | 22 | 1.3 | 0.6, 2.6 | ||||||
≥26 | 4 | 3 | 1.3 | 0.3, 6.4 | 14 | 6 | 5.7 | 1.1, 24.0 | ||||||
p for trend = 0.12 | p for trend = 0.02 | |||||||||||||
No. of palpable moles ≥2 mm on arms | ||||||||||||||
0 | 99 | 136 | 1.0 | 49 | 80 | 1.0 | ||||||||
1 | 28 | 15 | 2.9 | 1.3, 6.4 | 27 | 19 | 1.4 | 0.6, 3.2 | ||||||
2 | 14 | 7 | 3.5 | 1.9, 18.2 | 14 | 6 | 3.6 | 1.2, 11.5 | ||||||
≥3 | 21 | 4 | 5.8 | 1.9, 18.2 | 20 | 5 | 7.7 | 1.6, 37.3 | ||||||
p for trend = 0.0004 | p for trend = 0.005 | |||||||||||||
Self-reported total no. of moles | ||||||||||||||
0–2 | 31 | 61 | 1.0 | 17 | 38 | 1.0 | ||||||||
3–14 | 38 | 34 | 2.1 | 1.1, 4.0 | 33 | 29 | 2.2 | 0.9, 5.3 | ||||||
≥15 | 55 | 29 | 3.5 | 1.9, 6.8 | 34 | 17 | 4.8 | 1.7, 13.5 | ||||||
p for trend = 0.008 | p for trend = 0.004 | |||||||||||||
Self-reported total no. of large moles (≥5 mm) | ||||||||||||||
0 | 40 | 94 | 1.0 | 30 | 66 | 1.0 | ||||||||
1–2 | 38 | 28 | 5.5 | 2.3, 12.9 | 20 | 16 | 2.6 | 0.8, 8.5 | ||||||
≥3 | 63 | 27 | 6.5 | 2.9, 14.4 | 47 | 16 | 14.8 | 4.2, 52.1 | ||||||
p for trend < 0.001 | p for trend < 0.001 | |||||||||||||
Personal history of nonmelanoma skin cancer | ||||||||||||||
No | 97 | 138 | 1.0 | 90 | 103 | 1.0 | ||||||||
Yes | 70 | 29 | 3.3 | 1.8, 6.2 | 21 | 8 | 2.8 | 1.0, 7.4 |
Cases and controls were matched on age.
Total numbers of subjects vary because of missing data.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), and alcohol drinking status (refer to the categories in table 1) by conditional logistic regression.
. | Males . | . | . | . | Females . | . | . | . | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | ||||||
No. of freckles 5 years ago | ||||||||||||||
0 | 143 | 154 | 1.0 | 72 | 83 | 1.0 | ||||||||
1–25 | 20 | 10 | 2.3 | 1.0, 5.4 | 25 | 22 | 1.3 | 0.6, 2.6 | ||||||
≥26 | 4 | 3 | 1.3 | 0.3, 6.4 | 14 | 6 | 5.7 | 1.1, 24.0 | ||||||
p for trend = 0.12 | p for trend = 0.02 | |||||||||||||
No. of palpable moles ≥2 mm on arms | ||||||||||||||
0 | 99 | 136 | 1.0 | 49 | 80 | 1.0 | ||||||||
1 | 28 | 15 | 2.9 | 1.3, 6.4 | 27 | 19 | 1.4 | 0.6, 3.2 | ||||||
2 | 14 | 7 | 3.5 | 1.9, 18.2 | 14 | 6 | 3.6 | 1.2, 11.5 | ||||||
≥3 | 21 | 4 | 5.8 | 1.9, 18.2 | 20 | 5 | 7.7 | 1.6, 37.3 | ||||||
p for trend = 0.0004 | p for trend = 0.005 | |||||||||||||
Self-reported total no. of moles | ||||||||||||||
0–2 | 31 | 61 | 1.0 | 17 | 38 | 1.0 | ||||||||
3–14 | 38 | 34 | 2.1 | 1.1, 4.0 | 33 | 29 | 2.2 | 0.9, 5.3 | ||||||
≥15 | 55 | 29 | 3.5 | 1.9, 6.8 | 34 | 17 | 4.8 | 1.7, 13.5 | ||||||
p for trend = 0.008 | p for trend = 0.004 | |||||||||||||
Self-reported total no. of large moles (≥5 mm) | ||||||||||||||
0 | 40 | 94 | 1.0 | 30 | 66 | 1.0 | ||||||||
1–2 | 38 | 28 | 5.5 | 2.3, 12.9 | 20 | 16 | 2.6 | 0.8, 8.5 | ||||||
≥3 | 63 | 27 | 6.5 | 2.9, 14.4 | 47 | 16 | 14.8 | 4.2, 52.1 | ||||||
p for trend < 0.001 | p for trend < 0.001 | |||||||||||||
Personal history of nonmelanoma skin cancer | ||||||||||||||
No | 97 | 138 | 1.0 | 90 | 103 | 1.0 | ||||||||
Yes | 70 | 29 | 3.3 | 1.8, 6.2 | 21 | 8 | 2.8 | 1.0, 7.4 |
. | Males . | . | . | . | Females . | . | . | . | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | No. of cases . | No. of controls . | OR‡ . | 95% CI‡ . | ||||||
No. of freckles 5 years ago | ||||||||||||||
0 | 143 | 154 | 1.0 | 72 | 83 | 1.0 | ||||||||
1–25 | 20 | 10 | 2.3 | 1.0, 5.4 | 25 | 22 | 1.3 | 0.6, 2.6 | ||||||
≥26 | 4 | 3 | 1.3 | 0.3, 6.4 | 14 | 6 | 5.7 | 1.1, 24.0 | ||||||
p for trend = 0.12 | p for trend = 0.02 | |||||||||||||
No. of palpable moles ≥2 mm on arms | ||||||||||||||
0 | 99 | 136 | 1.0 | 49 | 80 | 1.0 | ||||||||
1 | 28 | 15 | 2.9 | 1.3, 6.4 | 27 | 19 | 1.4 | 0.6, 3.2 | ||||||
2 | 14 | 7 | 3.5 | 1.9, 18.2 | 14 | 6 | 3.6 | 1.2, 11.5 | ||||||
≥3 | 21 | 4 | 5.8 | 1.9, 18.2 | 20 | 5 | 7.7 | 1.6, 37.3 | ||||||
p for trend = 0.0004 | p for trend = 0.005 | |||||||||||||
Self-reported total no. of moles | ||||||||||||||
0–2 | 31 | 61 | 1.0 | 17 | 38 | 1.0 | ||||||||
3–14 | 38 | 34 | 2.1 | 1.1, 4.0 | 33 | 29 | 2.2 | 0.9, 5.3 | ||||||
≥15 | 55 | 29 | 3.5 | 1.9, 6.8 | 34 | 17 | 4.8 | 1.7, 13.5 | ||||||
p for trend = 0.008 | p for trend = 0.004 | |||||||||||||
Self-reported total no. of large moles (≥5 mm) | ||||||||||||||
0 | 40 | 94 | 1.0 | 30 | 66 | 1.0 | ||||||||
1–2 | 38 | 28 | 5.5 | 2.3, 12.9 | 20 | 16 | 2.6 | 0.8, 8.5 | ||||||
≥3 | 63 | 27 | 6.5 | 2.9, 14.4 | 47 | 16 | 14.8 | 4.2, 52.1 | ||||||
p for trend < 0.001 | p for trend < 0.001 | |||||||||||||
Personal history of nonmelanoma skin cancer | ||||||||||||||
No | 97 | 138 | 1.0 | 90 | 103 | 1.0 | ||||||||
Yes | 70 | 29 | 3.3 | 1.8, 6.2 | 21 | 8 | 2.8 | 1.0, 7.4 |
Cases and controls were matched on age.
Total numbers of subjects vary because of missing data.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), and alcohol drinking status (refer to the categories in table 1) by conditional logistic regression.
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No. . | No. of cases . | No. of controls . | OR† . | 95% CI† . | No. . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Blistering sunburns at ages 0–9 years | ||||||||||||||||||
0 | 130 | 131 | 1.0 | 0 | 83 | 91 | 1.0 | |||||||||||
1–4 | 19 | 16 | 0.9 | 0.4, 2.2 | 1–3 | 10 | 8 | 1.2 | 0.3, 4.4 | |||||||||
≥5 | 18 | 20 | 0.7 | 0.4, 1.5 | ≥4 | 17 | 11 | 1.2 | 0.4, 3.8 | |||||||||
p for trend = 0.34 | p for trend = 0.58 | |||||||||||||||||
Blistering sunburns at ages 10–17 years | ||||||||||||||||||
0 | 94 | 111 | 1.0 | 0 | 50 | 73 | 1.0 | |||||||||||
1–4 | 27 | 23 | 1.2 | 0.6, 2.2 | 1–3 | 25 | 13 | 2.4 | 0.9, 6.2 | |||||||||
5–12 | 22 | 18 | 1.2 | 0.6, 2.6 | 4–10 | 15 | 12 | 3.3 | 1.0, 10.0 | |||||||||
≥13 | 24 | 15 | 2.0 | 0.9, 4.6 | ≥11 | 20 | 12 | 1.9 | 0.7, 6.7 | |||||||||
p for trend = 0.09 | p for trend = 0.13 | |||||||||||||||||
Blistering sunburns at ages 18–29 years | ||||||||||||||||||
0 | 115 | 115 | 1.0 | 0 | 65 | 75 | 1.0 | |||||||||||
1–3 | 17 | 24 | 0.6 | 0.3, 1.3 | 1–3 | 16 | 17 | 0.6 | 0.3, 1.6 | |||||||||
≥4 | 35 | 28 | 1.3 | 0.7, 2.4 | ≥4 | 27 | 19 | 1.5 | 0.7, 3.5 | |||||||||
p for trend = 0.57 | p for trend = 0.52 | |||||||||||||||||
Blistering sunburns in the past 5 years | ||||||||||||||||||
0 | 146 | 157 | 1.0 | 0 | 105 | 102 | 1.0 | |||||||||||
≥1 | 21 | 10 | 5.4 | 1.7, 16.7 | ≥1 | 5 | 8 | 0.8 | 0.2, 3.4 | |||||||||
Hours during the summer months wearing a bathing suit‡at ages 8–10 years | ||||||||||||||||||
0 | 74 | 88 | 1.0 | 0 | 35 | 52 | 1.0 | |||||||||||
1–32 | 32 | 30 | 1.2 | 0.6, 2.3 | 1–20 | 28 | 17 | 2.1 | 0.8, 5.4 | |||||||||
33–80 | 27 | 31 | 0.9 | 0.4, 1.8 | 21–64 | 21 | 23 | 1.4 | 0.5, 3.7 | |||||||||
≥81 | 34 | 18 | 2.0 | 0.9, 4.4 | ≥65 | 26 | 18 | 3.4 | 1.2, 9.1 | |||||||||
p for trend = 0.14 | p for trend = 0.03 | |||||||||||||||||
Hours during the summer months wearing a bathing suit‡at ages 20–24 years | ||||||||||||||||||
0 | 76 | 97 | 1.0 | 0 | 23 | 40 | 1.0 | |||||||||||
1–16 | 35 | 31 | 1.3 | 0.7, 2.5 | 1–12 | 22 | 25 | 1.3 | 0.4, 3.9 | |||||||||
17–40 | 32 | 20 | 2.1 | 1.1, 4.3 | 13–32 | 33 | 29 | 2.4 | 0.9, 6.5 | |||||||||
≥41 | 24 | 19 | 1.5 | 0.7, 3.1 | ≥33 | 32 | 16 | 6.0 | 1.8, 19.8 | |||||||||
P for trend = 0.13 | p for trend = 0.001 | |||||||||||||||||
Hours during the summer months wearing a bathing suit‡in the past 5 years | ||||||||||||||||||
0 | 86 | 108 | 1.0 | 0 | 31 | 56 | 1.0 | |||||||||||
1–12 | 29 | 26 | 1.4 | 0.6, 3.0 | 1–8 | 31 | 26 | 2.1 | 0.8, 5.6 | |||||||||
13–24 | 23 | 16 | 1.9 | 0.8, 4.4 | 9–20 | 25 | 13 | 4.8 | 1.7, 13.4 | |||||||||
≥25 | 29 | 17 | 2.5 | 1.2, 5.4 | ≥21 | 23 | 15 | 3.3 | 1.1, 10.10 | |||||||||
p for trend = 0.01 | p for trend = 0.01 | |||||||||||||||||
Hours worked outdoors over lifetime | ||||||||||||||||||
≤438 | 42 | 42 | 1.0 | 0 | 45 | 58 | 1.0 | |||||||||||
439–1,644 | 41 | 43 | 1.0 | 0.5, 2.0 | 1–330 | 17 | 16 | 1.3 | 0.6, 3.8 | |||||||||
1,645–3,360 | 38 | 46 | 0.7 | 0.4, 1.5 | 331–864 | 22 | 13 | 1.8 | 0.8, 4.2 | |||||||||
≥3,361 | 46 | 36 | 1.3 | 0.7, 2.7 | ≥865 | 18 | 15 | 1.2 | 0.5, 3.0 | |||||||||
p for trend = 0.36 | p for trend = 0.59 |
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No. . | No. of cases . | No. of controls . | OR† . | 95% CI† . | No. . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Blistering sunburns at ages 0–9 years | ||||||||||||||||||
0 | 130 | 131 | 1.0 | 0 | 83 | 91 | 1.0 | |||||||||||
1–4 | 19 | 16 | 0.9 | 0.4, 2.2 | 1–3 | 10 | 8 | 1.2 | 0.3, 4.4 | |||||||||
≥5 | 18 | 20 | 0.7 | 0.4, 1.5 | ≥4 | 17 | 11 | 1.2 | 0.4, 3.8 | |||||||||
p for trend = 0.34 | p for trend = 0.58 | |||||||||||||||||
Blistering sunburns at ages 10–17 years | ||||||||||||||||||
0 | 94 | 111 | 1.0 | 0 | 50 | 73 | 1.0 | |||||||||||
1–4 | 27 | 23 | 1.2 | 0.6, 2.2 | 1–3 | 25 | 13 | 2.4 | 0.9, 6.2 | |||||||||
5–12 | 22 | 18 | 1.2 | 0.6, 2.6 | 4–10 | 15 | 12 | 3.3 | 1.0, 10.0 | |||||||||
≥13 | 24 | 15 | 2.0 | 0.9, 4.6 | ≥11 | 20 | 12 | 1.9 | 0.7, 6.7 | |||||||||
p for trend = 0.09 | p for trend = 0.13 | |||||||||||||||||
Blistering sunburns at ages 18–29 years | ||||||||||||||||||
0 | 115 | 115 | 1.0 | 0 | 65 | 75 | 1.0 | |||||||||||
1–3 | 17 | 24 | 0.6 | 0.3, 1.3 | 1–3 | 16 | 17 | 0.6 | 0.3, 1.6 | |||||||||
≥4 | 35 | 28 | 1.3 | 0.7, 2.4 | ≥4 | 27 | 19 | 1.5 | 0.7, 3.5 | |||||||||
p for trend = 0.57 | p for trend = 0.52 | |||||||||||||||||
Blistering sunburns in the past 5 years | ||||||||||||||||||
0 | 146 | 157 | 1.0 | 0 | 105 | 102 | 1.0 | |||||||||||
≥1 | 21 | 10 | 5.4 | 1.7, 16.7 | ≥1 | 5 | 8 | 0.8 | 0.2, 3.4 | |||||||||
Hours during the summer months wearing a bathing suit‡at ages 8–10 years | ||||||||||||||||||
0 | 74 | 88 | 1.0 | 0 | 35 | 52 | 1.0 | |||||||||||
1–32 | 32 | 30 | 1.2 | 0.6, 2.3 | 1–20 | 28 | 17 | 2.1 | 0.8, 5.4 | |||||||||
33–80 | 27 | 31 | 0.9 | 0.4, 1.8 | 21–64 | 21 | 23 | 1.4 | 0.5, 3.7 | |||||||||
≥81 | 34 | 18 | 2.0 | 0.9, 4.4 | ≥65 | 26 | 18 | 3.4 | 1.2, 9.1 | |||||||||
p for trend = 0.14 | p for trend = 0.03 | |||||||||||||||||
Hours during the summer months wearing a bathing suit‡at ages 20–24 years | ||||||||||||||||||
0 | 76 | 97 | 1.0 | 0 | 23 | 40 | 1.0 | |||||||||||
1–16 | 35 | 31 | 1.3 | 0.7, 2.5 | 1–12 | 22 | 25 | 1.3 | 0.4, 3.9 | |||||||||
17–40 | 32 | 20 | 2.1 | 1.1, 4.3 | 13–32 | 33 | 29 | 2.4 | 0.9, 6.5 | |||||||||
≥41 | 24 | 19 | 1.5 | 0.7, 3.1 | ≥33 | 32 | 16 | 6.0 | 1.8, 19.8 | |||||||||
P for trend = 0.13 | p for trend = 0.001 | |||||||||||||||||
Hours during the summer months wearing a bathing suit‡in the past 5 years | ||||||||||||||||||
0 | 86 | 108 | 1.0 | 0 | 31 | 56 | 1.0 | |||||||||||
1–12 | 29 | 26 | 1.4 | 0.6, 3.0 | 1–8 | 31 | 26 | 2.1 | 0.8, 5.6 | |||||||||
13–24 | 23 | 16 | 1.9 | 0.8, 4.4 | 9–20 | 25 | 13 | 4.8 | 1.7, 13.4 | |||||||||
≥25 | 29 | 17 | 2.5 | 1.2, 5.4 | ≥21 | 23 | 15 | 3.3 | 1.1, 10.10 | |||||||||
p for trend = 0.01 | p for trend = 0.01 | |||||||||||||||||
Hours worked outdoors over lifetime | ||||||||||||||||||
≤438 | 42 | 42 | 1.0 | 0 | 45 | 58 | 1.0 | |||||||||||
439–1,644 | 41 | 43 | 1.0 | 0.5, 2.0 | 1–330 | 17 | 16 | 1.3 | 0.6, 3.8 | |||||||||
1,645–3,360 | 38 | 46 | 0.7 | 0.4, 1.5 | 331–864 | 22 | 13 | 1.8 | 0.8, 4.2 | |||||||||
≥3,361 | 46 | 36 | 1.3 | 0.7, 2.7 | ≥865 | 18 | 15 | 1.2 | 0.5, 3.0 | |||||||||
p for trend = 0.36 | p for trend = 0.59 |
Cases and controls were matched on age.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), hair color (refer to the categories in table 2), ability to tan (refer to the categories in table 2), and drinking status (refer to the categories in table 1) by conditional logistic regression.
In direct sunlight between 9:00 a.m. and 4:00 p.m.
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No. . | No. of cases . | No. of controls . | OR† . | 95% CI† . | No. . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Blistering sunburns at ages 0–9 years | ||||||||||||||||||
0 | 130 | 131 | 1.0 | 0 | 83 | 91 | 1.0 | |||||||||||
1–4 | 19 | 16 | 0.9 | 0.4, 2.2 | 1–3 | 10 | 8 | 1.2 | 0.3, 4.4 | |||||||||
≥5 | 18 | 20 | 0.7 | 0.4, 1.5 | ≥4 | 17 | 11 | 1.2 | 0.4, 3.8 | |||||||||
p for trend = 0.34 | p for trend = 0.58 | |||||||||||||||||
Blistering sunburns at ages 10–17 years | ||||||||||||||||||
0 | 94 | 111 | 1.0 | 0 | 50 | 73 | 1.0 | |||||||||||
1–4 | 27 | 23 | 1.2 | 0.6, 2.2 | 1–3 | 25 | 13 | 2.4 | 0.9, 6.2 | |||||||||
5–12 | 22 | 18 | 1.2 | 0.6, 2.6 | 4–10 | 15 | 12 | 3.3 | 1.0, 10.0 | |||||||||
≥13 | 24 | 15 | 2.0 | 0.9, 4.6 | ≥11 | 20 | 12 | 1.9 | 0.7, 6.7 | |||||||||
p for trend = 0.09 | p for trend = 0.13 | |||||||||||||||||
Blistering sunburns at ages 18–29 years | ||||||||||||||||||
0 | 115 | 115 | 1.0 | 0 | 65 | 75 | 1.0 | |||||||||||
1–3 | 17 | 24 | 0.6 | 0.3, 1.3 | 1–3 | 16 | 17 | 0.6 | 0.3, 1.6 | |||||||||
≥4 | 35 | 28 | 1.3 | 0.7, 2.4 | ≥4 | 27 | 19 | 1.5 | 0.7, 3.5 | |||||||||
p for trend = 0.57 | p for trend = 0.52 | |||||||||||||||||
Blistering sunburns in the past 5 years | ||||||||||||||||||
0 | 146 | 157 | 1.0 | 0 | 105 | 102 | 1.0 | |||||||||||
≥1 | 21 | 10 | 5.4 | 1.7, 16.7 | ≥1 | 5 | 8 | 0.8 | 0.2, 3.4 | |||||||||
Hours during the summer months wearing a bathing suit‡at ages 8–10 years | ||||||||||||||||||
0 | 74 | 88 | 1.0 | 0 | 35 | 52 | 1.0 | |||||||||||
1–32 | 32 | 30 | 1.2 | 0.6, 2.3 | 1–20 | 28 | 17 | 2.1 | 0.8, 5.4 | |||||||||
33–80 | 27 | 31 | 0.9 | 0.4, 1.8 | 21–64 | 21 | 23 | 1.4 | 0.5, 3.7 | |||||||||
≥81 | 34 | 18 | 2.0 | 0.9, 4.4 | ≥65 | 26 | 18 | 3.4 | 1.2, 9.1 | |||||||||
p for trend = 0.14 | p for trend = 0.03 | |||||||||||||||||
Hours during the summer months wearing a bathing suit‡at ages 20–24 years | ||||||||||||||||||
0 | 76 | 97 | 1.0 | 0 | 23 | 40 | 1.0 | |||||||||||
1–16 | 35 | 31 | 1.3 | 0.7, 2.5 | 1–12 | 22 | 25 | 1.3 | 0.4, 3.9 | |||||||||
17–40 | 32 | 20 | 2.1 | 1.1, 4.3 | 13–32 | 33 | 29 | 2.4 | 0.9, 6.5 | |||||||||
≥41 | 24 | 19 | 1.5 | 0.7, 3.1 | ≥33 | 32 | 16 | 6.0 | 1.8, 19.8 | |||||||||
P for trend = 0.13 | p for trend = 0.001 | |||||||||||||||||
Hours during the summer months wearing a bathing suit‡in the past 5 years | ||||||||||||||||||
0 | 86 | 108 | 1.0 | 0 | 31 | 56 | 1.0 | |||||||||||
1–12 | 29 | 26 | 1.4 | 0.6, 3.0 | 1–8 | 31 | 26 | 2.1 | 0.8, 5.6 | |||||||||
13–24 | 23 | 16 | 1.9 | 0.8, 4.4 | 9–20 | 25 | 13 | 4.8 | 1.7, 13.4 | |||||||||
≥25 | 29 | 17 | 2.5 | 1.2, 5.4 | ≥21 | 23 | 15 | 3.3 | 1.1, 10.10 | |||||||||
p for trend = 0.01 | p for trend = 0.01 | |||||||||||||||||
Hours worked outdoors over lifetime | ||||||||||||||||||
≤438 | 42 | 42 | 1.0 | 0 | 45 | 58 | 1.0 | |||||||||||
439–1,644 | 41 | 43 | 1.0 | 0.5, 2.0 | 1–330 | 17 | 16 | 1.3 | 0.6, 3.8 | |||||||||
1,645–3,360 | 38 | 46 | 0.7 | 0.4, 1.5 | 331–864 | 22 | 13 | 1.8 | 0.8, 4.2 | |||||||||
≥3,361 | 46 | 36 | 1.3 | 0.7, 2.7 | ≥865 | 18 | 15 | 1.2 | 0.5, 3.0 | |||||||||
p for trend = 0.36 | p for trend = 0.59 |
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No. . | No. of cases . | No. of controls . | OR† . | 95% CI† . | No. . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Blistering sunburns at ages 0–9 years | ||||||||||||||||||
0 | 130 | 131 | 1.0 | 0 | 83 | 91 | 1.0 | |||||||||||
1–4 | 19 | 16 | 0.9 | 0.4, 2.2 | 1–3 | 10 | 8 | 1.2 | 0.3, 4.4 | |||||||||
≥5 | 18 | 20 | 0.7 | 0.4, 1.5 | ≥4 | 17 | 11 | 1.2 | 0.4, 3.8 | |||||||||
p for trend = 0.34 | p for trend = 0.58 | |||||||||||||||||
Blistering sunburns at ages 10–17 years | ||||||||||||||||||
0 | 94 | 111 | 1.0 | 0 | 50 | 73 | 1.0 | |||||||||||
1–4 | 27 | 23 | 1.2 | 0.6, 2.2 | 1–3 | 25 | 13 | 2.4 | 0.9, 6.2 | |||||||||
5–12 | 22 | 18 | 1.2 | 0.6, 2.6 | 4–10 | 15 | 12 | 3.3 | 1.0, 10.0 | |||||||||
≥13 | 24 | 15 | 2.0 | 0.9, 4.6 | ≥11 | 20 | 12 | 1.9 | 0.7, 6.7 | |||||||||
p for trend = 0.09 | p for trend = 0.13 | |||||||||||||||||
Blistering sunburns at ages 18–29 years | ||||||||||||||||||
0 | 115 | 115 | 1.0 | 0 | 65 | 75 | 1.0 | |||||||||||
1–3 | 17 | 24 | 0.6 | 0.3, 1.3 | 1–3 | 16 | 17 | 0.6 | 0.3, 1.6 | |||||||||
≥4 | 35 | 28 | 1.3 | 0.7, 2.4 | ≥4 | 27 | 19 | 1.5 | 0.7, 3.5 | |||||||||
p for trend = 0.57 | p for trend = 0.52 | |||||||||||||||||
Blistering sunburns in the past 5 years | ||||||||||||||||||
0 | 146 | 157 | 1.0 | 0 | 105 | 102 | 1.0 | |||||||||||
≥1 | 21 | 10 | 5.4 | 1.7, 16.7 | ≥1 | 5 | 8 | 0.8 | 0.2, 3.4 | |||||||||
Hours during the summer months wearing a bathing suit‡at ages 8–10 years | ||||||||||||||||||
0 | 74 | 88 | 1.0 | 0 | 35 | 52 | 1.0 | |||||||||||
1–32 | 32 | 30 | 1.2 | 0.6, 2.3 | 1–20 | 28 | 17 | 2.1 | 0.8, 5.4 | |||||||||
33–80 | 27 | 31 | 0.9 | 0.4, 1.8 | 21–64 | 21 | 23 | 1.4 | 0.5, 3.7 | |||||||||
≥81 | 34 | 18 | 2.0 | 0.9, 4.4 | ≥65 | 26 | 18 | 3.4 | 1.2, 9.1 | |||||||||
p for trend = 0.14 | p for trend = 0.03 | |||||||||||||||||
Hours during the summer months wearing a bathing suit‡at ages 20–24 years | ||||||||||||||||||
0 | 76 | 97 | 1.0 | 0 | 23 | 40 | 1.0 | |||||||||||
1–16 | 35 | 31 | 1.3 | 0.7, 2.5 | 1–12 | 22 | 25 | 1.3 | 0.4, 3.9 | |||||||||
17–40 | 32 | 20 | 2.1 | 1.1, 4.3 | 13–32 | 33 | 29 | 2.4 | 0.9, 6.5 | |||||||||
≥41 | 24 | 19 | 1.5 | 0.7, 3.1 | ≥33 | 32 | 16 | 6.0 | 1.8, 19.8 | |||||||||
P for trend = 0.13 | p for trend = 0.001 | |||||||||||||||||
Hours during the summer months wearing a bathing suit‡in the past 5 years | ||||||||||||||||||
0 | 86 | 108 | 1.0 | 0 | 31 | 56 | 1.0 | |||||||||||
1–12 | 29 | 26 | 1.4 | 0.6, 3.0 | 1–8 | 31 | 26 | 2.1 | 0.8, 5.6 | |||||||||
13–24 | 23 | 16 | 1.9 | 0.8, 4.4 | 9–20 | 25 | 13 | 4.8 | 1.7, 13.4 | |||||||||
≥25 | 29 | 17 | 2.5 | 1.2, 5.4 | ≥21 | 23 | 15 | 3.3 | 1.1, 10.10 | |||||||||
p for trend = 0.01 | p for trend = 0.01 | |||||||||||||||||
Hours worked outdoors over lifetime | ||||||||||||||||||
≤438 | 42 | 42 | 1.0 | 0 | 45 | 58 | 1.0 | |||||||||||
439–1,644 | 41 | 43 | 1.0 | 0.5, 2.0 | 1–330 | 17 | 16 | 1.3 | 0.6, 3.8 | |||||||||
1,645–3,360 | 38 | 46 | 0.7 | 0.4, 1.5 | 331–864 | 22 | 13 | 1.8 | 0.8, 4.2 | |||||||||
≥3,361 | 46 | 36 | 1.3 | 0.7, 2.7 | ≥865 | 18 | 15 | 1.2 | 0.5, 3.0 | |||||||||
p for trend = 0.36 | p for trend = 0.59 |
Cases and controls were matched on age.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), hair color (refer to the categories in table 2), ability to tan (refer to the categories in table 2), and drinking status (refer to the categories in table 1) by conditional logistic regression.
In direct sunlight between 9:00 a.m. and 4:00 p.m.
RESULTS
The mean age at interview was 53.7 years (standard deviation, 15.0; range, 22–81) for cases and 52.1 years (standard deviation, 15.0; range, 19–83) for controls. Ninety-three percent of our subjects were born in the United States. The location of melanoma in cases was as follows: males—trunk (53.3 percent), head and neck (19.8 percent), arms (15.6 percent), and legs (11.4 percent); females—legs (34.3 percent), trunk (34.2 percent), arms (19.8 percent), and head and neck (10.8 percent). Sixty-two percent of the cases had an invasive tumor and 35 percent an in-situ melanoma (for eight cases, stage was unknown). The histologic type distribution among cases was as follows: superficial spreading melanoma, 53.2 percent; lentigo maligna, 21.9 percent; nodular melanoma, 3.2 percent; not otherwise specified, 20.1 percent; and other, 1.6 percent.
Table 1 presents the distribution of cases and controls by demographic variables, smoking and drinking status, and body size, separately for each sex. Based on grandparents' ancestry, cases, compared with controls, were more likely to be of English, Celtic, or western or central European origin and less likely to be of southern European origin. Cases were not more likely to be born in Hawaii. When the melanoma risk of migrants was compared with that of Hawaii-born subjects by age at arrival in the state, in both sexes, the highest risk was observed for those who moved to Hawaii before age 20 years, although these increased risks were not statistically significant. Numbers of years lived in Hawaii was directly associated with risk for men only. Proportion of life lived in Hawaii was not associated with risk for either sex (data not shown). For both sexes, cases were also more likely to have some college education and to drink alcoholic beverages regularly. No clear association with smoking status, pack-years of smoking, or weight was observed. However, for both sexes, height was directly associated with risk in a dose-dependent manner, with odds ratios of 2.5 (95 percent confidence interval: 1.3, 3.5) and 4.4 (95 percent confidence interval: 1.7, 11.1) for the fourth compared with the first quartile in males and females, respectively. Risk estimates were also computed for body surface area {[(weight in kg)0.425 × (height in m)0.725] × 71.84}, but they were found to be weaker than those for height (results not shown).
The association of pigmentation and skin reaction to sunlight with melanoma is presented in table 2, after adjustment for height, education, and alcohol drinking status. Cases were more likely to have light-colored hair and eyes. Dark skin color was inversely associated with risk for men, whereas no association was observed for women regarding this variable. Among men, but not among women, cases had a greater propensity to sunburn when first exposed to summer sun. However, for both sexes, controls, compared with cases, reported a greater ability to tan as a result of repeated sun exposure. A family history of both nonmelanoma skin cancer and malignant melanoma in parents or siblings was associated with risk, although the odds ratios were statistically significant for women only.
Table 3 shows the risk of melanoma associated with freckling and moles. For both sexes, cases were more likely to report more freckling at ages 12 and 25 years (data not shown) as well as 5 years ago. In addition, for both sexes, the number of palpable moles on the subjects' arms, as recorded by the interviewer, and the total number of moles self-reported by the subjects were strongly associated with melanoma in a dose-dependent fashion. The risk estimates were strongest for the subset of the self-reported moles that were 5 mm or larger. A personal history of nonmelanoma skin cancer was also associated with a threefold increase in melanoma risk for both sexes.
The association between measures of sun exposure and melanoma is presented in table 4. Taken as a measure of intermittent, intense sun exposure, episodes of blistering sunburns during childhood, adolescence, early adulthood, and the past 5 years showed some degree of association with melanoma risk for both sexes, although the most consistent dose-response relation was seen for ages 10–17 years. The amount of time spent in direct sunlight in a bathing suit in the summer was used as a measure of sun exposure at different periods of life (ages 8–10 and 20–24 years and the past 5 years). A pattern of increased risk was observed for each life period for both sexes, although the most consistent dose-response relation was found for exposure during the past 5 years. Finally, the lifetime number of hours worked outside was not a predictor of risk for our population.
Table 5 presents the melanoma risk associated with intake of calories and macronutrients, after adjusting for height, education, hair color, number of blistering sunburns at ages 10–17 years, ability to tan, and total number of moles. No association was found with calories, total fat, saturated fat, and monounsaturated fat for either sex, and with PUFA for males. There was a suggestion of an association with PUFA intake for women that did not reach statistical significance (p for trend = 0.08). No association was found between melanoma risk and intake of omega-3 or omega-6 fatty acids (data not shown). However, a direct association with lifetime alcohol consumption was statistically significant for men only. This association appeared stronger for hard liquor than for beer or wine (table 6).
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Energy (kcal) | ||||||||||||||||||
≤1,777 | 59 | 53 | 1.0 | ≤1,429 | 35 | 38 | 1.0 | |||||||||||
1,778–2,575 | 49 | 61 | 0.7 | 0.4, 1.3 | 1,430–1,975 | 42 | 33 | 1.5 | 0.7, 3.7 | |||||||||
≥2,576 | 59 | 53 | 1.0 | 0.5, 1.9 | ≥1,976 | 34 | 40 | 1.0 | 0.4, 2.4 | |||||||||
p for trend = 0.85 | p for trend = 0.90 | |||||||||||||||||
Total fat (g) | ||||||||||||||||||
≤85 | 59 | 53 | 1.0 | ≤69 | 40 | 34 | 1.0 | |||||||||||
86–98 | 53 | 58 | 1.0 | 0.6, 1.7 | 70–82 | 33 | 42 | 0.6 | 0.3, 1.4 | |||||||||
≥99 | 55 | 56 | 1.0 | 0.6, 1.8 | ≥83 | 38 | 35 | 1.0 | 0.4, 2.1 | |||||||||
p for trend = 0.99 | p for trend = 0.95 | |||||||||||||||||
Polyunsaturated fat (g) | ||||||||||||||||||
≤22 | 58 | 53 | 1.0 | ≤18 | 35 | 39 | 1.0 | |||||||||||
23–26 | 52 | 59 | 0.7 | 0.4, 1.3 | 19–23 | 33 | 41 | 0.7 | 0.3, 1.7 | |||||||||
≥27 | 57 | 55 | 0.9 | 0.5, 1.6 | ≥24 | 43 | 31 | 1.9 | 0.8, 4.2 | |||||||||
p for trend = 0.80 | p for trend = 0.08 | |||||||||||||||||
Saturated fat (g) | ||||||||||||||||||
≤25 | 53 | 59 | 1.0 | ≤21 | 39 | 34 | 1.0 | |||||||||||
26–30 | 58 | 53 | 1.2 | 0.6, 2.1 | 22–24 | 40 | 36 | 0.9 | 0.4, 1.9 | |||||||||
≥31 | 56 | 55 | 1.0 | 0.9, 1.7 | ≥25 | 32 | 41 | 0.7 | 0.3, 1.5 | |||||||||
p for trend = 0.79 | p for trend = 0.33 | |||||||||||||||||
Polyunsaturated fat/saturated fat ratio | ||||||||||||||||||
≤0.76 | 57 | 55 | 1.0 | ≤0.80 | 33 | 41 | 1.0 | |||||||||||
0.77–0.99 | 57 | 53 | 1.1 | 0.6, 2.0 | 0.81–1.06 | 37 | 37 | 1.2 | 0.6, 2.6 | |||||||||
≥1.0 | 53 | 59 | 1.0 | 0.6, 1.9 | ≥1.07 | 41 | 33 | 1.7 | 0.7, 4.1 | |||||||||
p for trend = 0.91 | p for trend = 0.20 | |||||||||||||||||
Monounsaturated fat (mg) | ||||||||||||||||||
≤30 | 52 | 59 | 1.0 | ≤24 | 42 | 31 | 1.0 | |||||||||||
31–34 | 60 | 51 | 1.3 | 0.7, 2.4 | 25–27 | 34 | 42 | 0.6 | 0.3, 1.4 | |||||||||
≥35 | 55 | 57 | 1.0 | 0.6, 1.8 | ≥28 | 35 | 38 | 0.7 | 0.3, 1.5 | |||||||||
p for trend = 0.87 | p for trend = 0.43 | |||||||||||||||||
Ethanol (g) | ||||||||||||||||||
≤0.05 | 48 | 64 | 1.0 | ≤0.01 | 31 | 42 | 1.0 | |||||||||||
0.06–16.0 | 54 | 57 | 1.3 | 0.7, 2.2 | 0.02–3.99 | 42 | 34 | 2.0 | 0.9, 4.4 | |||||||||
≥16.1 | 65 | 46 | 1.4 | 0.8, 2.5 | ≥4.00 | 38 | 35 | 1.5 | 0.7, 3.4 | |||||||||
p for trend = 0.33 | p for trend = 0.70 | |||||||||||||||||
Lifetime ethanol (g) | ||||||||||||||||||
≤45,420 | 47 | 65 | 1.0 | ≥0 | 35 | 43 | 1.0 | |||||||||||
45,421–265,001 | 52 | 59 | 1.2 | 0.6, 2.2 | 1–48,660 | 36 | 35 | 1.1 | 0.5, 2.4 | |||||||||
≥265,002 | 68 | 43 | 2.3 | 1.2, 4.4 | ≥48,661 | 40 | 33 | 1.7 | 0.7, 3.8 | |||||||||
p for trend = 0.01 | p for trend = 0.19 |
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Energy (kcal) | ||||||||||||||||||
≤1,777 | 59 | 53 | 1.0 | ≤1,429 | 35 | 38 | 1.0 | |||||||||||
1,778–2,575 | 49 | 61 | 0.7 | 0.4, 1.3 | 1,430–1,975 | 42 | 33 | 1.5 | 0.7, 3.7 | |||||||||
≥2,576 | 59 | 53 | 1.0 | 0.5, 1.9 | ≥1,976 | 34 | 40 | 1.0 | 0.4, 2.4 | |||||||||
p for trend = 0.85 | p for trend = 0.90 | |||||||||||||||||
Total fat (g) | ||||||||||||||||||
≤85 | 59 | 53 | 1.0 | ≤69 | 40 | 34 | 1.0 | |||||||||||
86–98 | 53 | 58 | 1.0 | 0.6, 1.7 | 70–82 | 33 | 42 | 0.6 | 0.3, 1.4 | |||||||||
≥99 | 55 | 56 | 1.0 | 0.6, 1.8 | ≥83 | 38 | 35 | 1.0 | 0.4, 2.1 | |||||||||
p for trend = 0.99 | p for trend = 0.95 | |||||||||||||||||
Polyunsaturated fat (g) | ||||||||||||||||||
≤22 | 58 | 53 | 1.0 | ≤18 | 35 | 39 | 1.0 | |||||||||||
23–26 | 52 | 59 | 0.7 | 0.4, 1.3 | 19–23 | 33 | 41 | 0.7 | 0.3, 1.7 | |||||||||
≥27 | 57 | 55 | 0.9 | 0.5, 1.6 | ≥24 | 43 | 31 | 1.9 | 0.8, 4.2 | |||||||||
p for trend = 0.80 | p for trend = 0.08 | |||||||||||||||||
Saturated fat (g) | ||||||||||||||||||
≤25 | 53 | 59 | 1.0 | ≤21 | 39 | 34 | 1.0 | |||||||||||
26–30 | 58 | 53 | 1.2 | 0.6, 2.1 | 22–24 | 40 | 36 | 0.9 | 0.4, 1.9 | |||||||||
≥31 | 56 | 55 | 1.0 | 0.9, 1.7 | ≥25 | 32 | 41 | 0.7 | 0.3, 1.5 | |||||||||
p for trend = 0.79 | p for trend = 0.33 | |||||||||||||||||
Polyunsaturated fat/saturated fat ratio | ||||||||||||||||||
≤0.76 | 57 | 55 | 1.0 | ≤0.80 | 33 | 41 | 1.0 | |||||||||||
0.77–0.99 | 57 | 53 | 1.1 | 0.6, 2.0 | 0.81–1.06 | 37 | 37 | 1.2 | 0.6, 2.6 | |||||||||
≥1.0 | 53 | 59 | 1.0 | 0.6, 1.9 | ≥1.07 | 41 | 33 | 1.7 | 0.7, 4.1 | |||||||||
p for trend = 0.91 | p for trend = 0.20 | |||||||||||||||||
Monounsaturated fat (mg) | ||||||||||||||||||
≤30 | 52 | 59 | 1.0 | ≤24 | 42 | 31 | 1.0 | |||||||||||
31–34 | 60 | 51 | 1.3 | 0.7, 2.4 | 25–27 | 34 | 42 | 0.6 | 0.3, 1.4 | |||||||||
≥35 | 55 | 57 | 1.0 | 0.6, 1.8 | ≥28 | 35 | 38 | 0.7 | 0.3, 1.5 | |||||||||
p for trend = 0.87 | p for trend = 0.43 | |||||||||||||||||
Ethanol (g) | ||||||||||||||||||
≤0.05 | 48 | 64 | 1.0 | ≤0.01 | 31 | 42 | 1.0 | |||||||||||
0.06–16.0 | 54 | 57 | 1.3 | 0.7, 2.2 | 0.02–3.99 | 42 | 34 | 2.0 | 0.9, 4.4 | |||||||||
≥16.1 | 65 | 46 | 1.4 | 0.8, 2.5 | ≥4.00 | 38 | 35 | 1.5 | 0.7, 3.4 | |||||||||
p for trend = 0.33 | p for trend = 0.70 | |||||||||||||||||
Lifetime ethanol (g) | ||||||||||||||||||
≤45,420 | 47 | 65 | 1.0 | ≥0 | 35 | 43 | 1.0 | |||||||||||
45,421–265,001 | 52 | 59 | 1.2 | 0.6, 2.2 | 1–48,660 | 36 | 35 | 1.1 | 0.5, 2.4 | |||||||||
≥265,002 | 68 | 43 | 2.3 | 1.2, 4.4 | ≥48,661 | 40 | 33 | 1.7 | 0.7, 3.8 | |||||||||
p for trend = 0.01 | p for trend = 0.19 |
Cases and controls were matched on age.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), hair color (refer to the categories in table 2), number of blistering sunburns at ages 10–17 years (continuous), ability to tan (refer to the categories in table 2), and lifetime ethanol intake (continuous) (except ethanol and lifetime ethanol) by conditional logistic regression. Nutrient intakes were adjusted for energy by the method of residuals except for lifetime ethanol (drinks/week × weeks).
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Energy (kcal) | ||||||||||||||||||
≤1,777 | 59 | 53 | 1.0 | ≤1,429 | 35 | 38 | 1.0 | |||||||||||
1,778–2,575 | 49 | 61 | 0.7 | 0.4, 1.3 | 1,430–1,975 | 42 | 33 | 1.5 | 0.7, 3.7 | |||||||||
≥2,576 | 59 | 53 | 1.0 | 0.5, 1.9 | ≥1,976 | 34 | 40 | 1.0 | 0.4, 2.4 | |||||||||
p for trend = 0.85 | p for trend = 0.90 | |||||||||||||||||
Total fat (g) | ||||||||||||||||||
≤85 | 59 | 53 | 1.0 | ≤69 | 40 | 34 | 1.0 | |||||||||||
86–98 | 53 | 58 | 1.0 | 0.6, 1.7 | 70–82 | 33 | 42 | 0.6 | 0.3, 1.4 | |||||||||
≥99 | 55 | 56 | 1.0 | 0.6, 1.8 | ≥83 | 38 | 35 | 1.0 | 0.4, 2.1 | |||||||||
p for trend = 0.99 | p for trend = 0.95 | |||||||||||||||||
Polyunsaturated fat (g) | ||||||||||||||||||
≤22 | 58 | 53 | 1.0 | ≤18 | 35 | 39 | 1.0 | |||||||||||
23–26 | 52 | 59 | 0.7 | 0.4, 1.3 | 19–23 | 33 | 41 | 0.7 | 0.3, 1.7 | |||||||||
≥27 | 57 | 55 | 0.9 | 0.5, 1.6 | ≥24 | 43 | 31 | 1.9 | 0.8, 4.2 | |||||||||
p for trend = 0.80 | p for trend = 0.08 | |||||||||||||||||
Saturated fat (g) | ||||||||||||||||||
≤25 | 53 | 59 | 1.0 | ≤21 | 39 | 34 | 1.0 | |||||||||||
26–30 | 58 | 53 | 1.2 | 0.6, 2.1 | 22–24 | 40 | 36 | 0.9 | 0.4, 1.9 | |||||||||
≥31 | 56 | 55 | 1.0 | 0.9, 1.7 | ≥25 | 32 | 41 | 0.7 | 0.3, 1.5 | |||||||||
p for trend = 0.79 | p for trend = 0.33 | |||||||||||||||||
Polyunsaturated fat/saturated fat ratio | ||||||||||||||||||
≤0.76 | 57 | 55 | 1.0 | ≤0.80 | 33 | 41 | 1.0 | |||||||||||
0.77–0.99 | 57 | 53 | 1.1 | 0.6, 2.0 | 0.81–1.06 | 37 | 37 | 1.2 | 0.6, 2.6 | |||||||||
≥1.0 | 53 | 59 | 1.0 | 0.6, 1.9 | ≥1.07 | 41 | 33 | 1.7 | 0.7, 4.1 | |||||||||
p for trend = 0.91 | p for trend = 0.20 | |||||||||||||||||
Monounsaturated fat (mg) | ||||||||||||||||||
≤30 | 52 | 59 | 1.0 | ≤24 | 42 | 31 | 1.0 | |||||||||||
31–34 | 60 | 51 | 1.3 | 0.7, 2.4 | 25–27 | 34 | 42 | 0.6 | 0.3, 1.4 | |||||||||
≥35 | 55 | 57 | 1.0 | 0.6, 1.8 | ≥28 | 35 | 38 | 0.7 | 0.3, 1.5 | |||||||||
p for trend = 0.87 | p for trend = 0.43 | |||||||||||||||||
Ethanol (g) | ||||||||||||||||||
≤0.05 | 48 | 64 | 1.0 | ≤0.01 | 31 | 42 | 1.0 | |||||||||||
0.06–16.0 | 54 | 57 | 1.3 | 0.7, 2.2 | 0.02–3.99 | 42 | 34 | 2.0 | 0.9, 4.4 | |||||||||
≥16.1 | 65 | 46 | 1.4 | 0.8, 2.5 | ≥4.00 | 38 | 35 | 1.5 | 0.7, 3.4 | |||||||||
p for trend = 0.33 | p for trend = 0.70 | |||||||||||||||||
Lifetime ethanol (g) | ||||||||||||||||||
≤45,420 | 47 | 65 | 1.0 | ≥0 | 35 | 43 | 1.0 | |||||||||||
45,421–265,001 | 52 | 59 | 1.2 | 0.6, 2.2 | 1–48,660 | 36 | 35 | 1.1 | 0.5, 2.4 | |||||||||
≥265,002 | 68 | 43 | 2.3 | 1.2, 4.4 | ≥48,661 | 40 | 33 | 1.7 | 0.7, 3.8 | |||||||||
p for trend = 0.01 | p for trend = 0.19 |
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Energy (kcal) | ||||||||||||||||||
≤1,777 | 59 | 53 | 1.0 | ≤1,429 | 35 | 38 | 1.0 | |||||||||||
1,778–2,575 | 49 | 61 | 0.7 | 0.4, 1.3 | 1,430–1,975 | 42 | 33 | 1.5 | 0.7, 3.7 | |||||||||
≥2,576 | 59 | 53 | 1.0 | 0.5, 1.9 | ≥1,976 | 34 | 40 | 1.0 | 0.4, 2.4 | |||||||||
p for trend = 0.85 | p for trend = 0.90 | |||||||||||||||||
Total fat (g) | ||||||||||||||||||
≤85 | 59 | 53 | 1.0 | ≤69 | 40 | 34 | 1.0 | |||||||||||
86–98 | 53 | 58 | 1.0 | 0.6, 1.7 | 70–82 | 33 | 42 | 0.6 | 0.3, 1.4 | |||||||||
≥99 | 55 | 56 | 1.0 | 0.6, 1.8 | ≥83 | 38 | 35 | 1.0 | 0.4, 2.1 | |||||||||
p for trend = 0.99 | p for trend = 0.95 | |||||||||||||||||
Polyunsaturated fat (g) | ||||||||||||||||||
≤22 | 58 | 53 | 1.0 | ≤18 | 35 | 39 | 1.0 | |||||||||||
23–26 | 52 | 59 | 0.7 | 0.4, 1.3 | 19–23 | 33 | 41 | 0.7 | 0.3, 1.7 | |||||||||
≥27 | 57 | 55 | 0.9 | 0.5, 1.6 | ≥24 | 43 | 31 | 1.9 | 0.8, 4.2 | |||||||||
p for trend = 0.80 | p for trend = 0.08 | |||||||||||||||||
Saturated fat (g) | ||||||||||||||||||
≤25 | 53 | 59 | 1.0 | ≤21 | 39 | 34 | 1.0 | |||||||||||
26–30 | 58 | 53 | 1.2 | 0.6, 2.1 | 22–24 | 40 | 36 | 0.9 | 0.4, 1.9 | |||||||||
≥31 | 56 | 55 | 1.0 | 0.9, 1.7 | ≥25 | 32 | 41 | 0.7 | 0.3, 1.5 | |||||||||
p for trend = 0.79 | p for trend = 0.33 | |||||||||||||||||
Polyunsaturated fat/saturated fat ratio | ||||||||||||||||||
≤0.76 | 57 | 55 | 1.0 | ≤0.80 | 33 | 41 | 1.0 | |||||||||||
0.77–0.99 | 57 | 53 | 1.1 | 0.6, 2.0 | 0.81–1.06 | 37 | 37 | 1.2 | 0.6, 2.6 | |||||||||
≥1.0 | 53 | 59 | 1.0 | 0.6, 1.9 | ≥1.07 | 41 | 33 | 1.7 | 0.7, 4.1 | |||||||||
p for trend = 0.91 | p for trend = 0.20 | |||||||||||||||||
Monounsaturated fat (mg) | ||||||||||||||||||
≤30 | 52 | 59 | 1.0 | ≤24 | 42 | 31 | 1.0 | |||||||||||
31–34 | 60 | 51 | 1.3 | 0.7, 2.4 | 25–27 | 34 | 42 | 0.6 | 0.3, 1.4 | |||||||||
≥35 | 55 | 57 | 1.0 | 0.6, 1.8 | ≥28 | 35 | 38 | 0.7 | 0.3, 1.5 | |||||||||
p for trend = 0.87 | p for trend = 0.43 | |||||||||||||||||
Ethanol (g) | ||||||||||||||||||
≤0.05 | 48 | 64 | 1.0 | ≤0.01 | 31 | 42 | 1.0 | |||||||||||
0.06–16.0 | 54 | 57 | 1.3 | 0.7, 2.2 | 0.02–3.99 | 42 | 34 | 2.0 | 0.9, 4.4 | |||||||||
≥16.1 | 65 | 46 | 1.4 | 0.8, 2.5 | ≥4.00 | 38 | 35 | 1.5 | 0.7, 3.4 | |||||||||
p for trend = 0.33 | p for trend = 0.70 | |||||||||||||||||
Lifetime ethanol (g) | ||||||||||||||||||
≤45,420 | 47 | 65 | 1.0 | ≥0 | 35 | 43 | 1.0 | |||||||||||
45,421–265,001 | 52 | 59 | 1.2 | 0.6, 2.2 | 1–48,660 | 36 | 35 | 1.1 | 0.5, 2.4 | |||||||||
≥265,002 | 68 | 43 | 2.3 | 1.2, 4.4 | ≥48,661 | 40 | 33 | 1.7 | 0.7, 3.8 | |||||||||
p for trend = 0.01 | p for trend = 0.19 |
Cases and controls were matched on age.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), hair color (refer to the categories in table 2), number of blistering sunburns at ages 10–17 years (continuous), ability to tan (refer to the categories in table 2), and lifetime ethanol intake (continuous) (except ethanol and lifetime ethanol) by conditional logistic regression. Nutrient intakes were adjusted for energy by the method of residuals except for lifetime ethanol (drinks/week × weeks).
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Beer (g) | ||||||||||||||||||
0 | 47 | 64 | 1.0 | 0 | 69 | 76 | 1.0 | |||||||||||
1–86,357 | 57 | 55 | 1.4 | 0.8, 2.7 | 1–22,837 | 22 | 18 | 1.4 | 0.7, 3.1 | |||||||||
≥86,358 | 63 | 48 | 1.7 | 0.9, 3.2 | ≥22,838 | 20 | 17 | 1.3 | 0.6, 2.7 | |||||||||
p for trend = 0.15 | p for trend = 0.48 | |||||||||||||||||
Wine (g) | ||||||||||||||||||
0 | 88 | 107 | 1.0 | 0 | 58 | 59 | 1.0 | |||||||||||
1–46,591 | 46 | 24 | 2.1 | 1.2, 3.9 | 1–20,279 | 25 | 28 | 0.9 | 0.5, 1.8 | |||||||||
≥46,592 | 33 | 36 | 1.0 | 0.5, 1.9 | ≥20,280 | 28 | 24 | 1.2 | 0.6, 2.5 | |||||||||
p for trend = 0.93 | p for trend = 0.52 | |||||||||||||||||
Hard liquor (g) | ||||||||||||||||||
0 | 68 | 102 | 1.0 | 0 | 67 | 76 | 1.0 | |||||||||||
1–132,540 | 47 | 34 | 2.4 | 1.2, 4.8 | 1–59,437 | 20 | 20 | 1.0 | 0.6, 2.3 | |||||||||
≥132,541 | 52 | 31 | 3.0 | 1.5, 6.0 | ≥59,438 | 24 | 15 | 1.4 | 0.9, 7.8 | |||||||||
p for trend = 0.007 | p for trend = 0.09 |
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Beer (g) | ||||||||||||||||||
0 | 47 | 64 | 1.0 | 0 | 69 | 76 | 1.0 | |||||||||||
1–86,357 | 57 | 55 | 1.4 | 0.8, 2.7 | 1–22,837 | 22 | 18 | 1.4 | 0.7, 3.1 | |||||||||
≥86,358 | 63 | 48 | 1.7 | 0.9, 3.2 | ≥22,838 | 20 | 17 | 1.3 | 0.6, 2.7 | |||||||||
p for trend = 0.15 | p for trend = 0.48 | |||||||||||||||||
Wine (g) | ||||||||||||||||||
0 | 88 | 107 | 1.0 | 0 | 58 | 59 | 1.0 | |||||||||||
1–46,591 | 46 | 24 | 2.1 | 1.2, 3.9 | 1–20,279 | 25 | 28 | 0.9 | 0.5, 1.8 | |||||||||
≥46,592 | 33 | 36 | 1.0 | 0.5, 1.9 | ≥20,280 | 28 | 24 | 1.2 | 0.6, 2.5 | |||||||||
p for trend = 0.93 | p for trend = 0.52 | |||||||||||||||||
Hard liquor (g) | ||||||||||||||||||
0 | 68 | 102 | 1.0 | 0 | 67 | 76 | 1.0 | |||||||||||
1–132,540 | 47 | 34 | 2.4 | 1.2, 4.8 | 1–59,437 | 20 | 20 | 1.0 | 0.6, 2.3 | |||||||||
≥132,541 | 52 | 31 | 3.0 | 1.5, 6.0 | ≥59,438 | 24 | 15 | 1.4 | 0.9, 7.8 | |||||||||
p for trend = 0.007 | p for trend = 0.09 |
Cases and controls were matched on age.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), hair color (refer to the categories in table 2), number of blistering sunburns at ages 10–17 years (continuous), and ability to tan (refer to the categories in table 2) by conditional logistic regression.
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Beer (g) | ||||||||||||||||||
0 | 47 | 64 | 1.0 | 0 | 69 | 76 | 1.0 | |||||||||||
1–86,357 | 57 | 55 | 1.4 | 0.8, 2.7 | 1–22,837 | 22 | 18 | 1.4 | 0.7, 3.1 | |||||||||
≥86,358 | 63 | 48 | 1.7 | 0.9, 3.2 | ≥22,838 | 20 | 17 | 1.3 | 0.6, 2.7 | |||||||||
p for trend = 0.15 | p for trend = 0.48 | |||||||||||||||||
Wine (g) | ||||||||||||||||||
0 | 88 | 107 | 1.0 | 0 | 58 | 59 | 1.0 | |||||||||||
1–46,591 | 46 | 24 | 2.1 | 1.2, 3.9 | 1–20,279 | 25 | 28 | 0.9 | 0.5, 1.8 | |||||||||
≥46,592 | 33 | 36 | 1.0 | 0.5, 1.9 | ≥20,280 | 28 | 24 | 1.2 | 0.6, 2.5 | |||||||||
p for trend = 0.93 | p for trend = 0.52 | |||||||||||||||||
Hard liquor (g) | ||||||||||||||||||
0 | 68 | 102 | 1.0 | 0 | 67 | 76 | 1.0 | |||||||||||
1–132,540 | 47 | 34 | 2.4 | 1.2, 4.8 | 1–59,437 | 20 | 20 | 1.0 | 0.6, 2.3 | |||||||||
≥132,541 | 52 | 31 | 3.0 | 1.5, 6.0 | ≥59,438 | 24 | 15 | 1.4 | 0.9, 7.8 | |||||||||
p for trend = 0.007 | p for trend = 0.09 |
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Beer (g) | ||||||||||||||||||
0 | 47 | 64 | 1.0 | 0 | 69 | 76 | 1.0 | |||||||||||
1–86,357 | 57 | 55 | 1.4 | 0.8, 2.7 | 1–22,837 | 22 | 18 | 1.4 | 0.7, 3.1 | |||||||||
≥86,358 | 63 | 48 | 1.7 | 0.9, 3.2 | ≥22,838 | 20 | 17 | 1.3 | 0.6, 2.7 | |||||||||
p for trend = 0.15 | p for trend = 0.48 | |||||||||||||||||
Wine (g) | ||||||||||||||||||
0 | 88 | 107 | 1.0 | 0 | 58 | 59 | 1.0 | |||||||||||
1–46,591 | 46 | 24 | 2.1 | 1.2, 3.9 | 1–20,279 | 25 | 28 | 0.9 | 0.5, 1.8 | |||||||||
≥46,592 | 33 | 36 | 1.0 | 0.5, 1.9 | ≥20,280 | 28 | 24 | 1.2 | 0.6, 2.5 | |||||||||
p for trend = 0.93 | p for trend = 0.52 | |||||||||||||||||
Hard liquor (g) | ||||||||||||||||||
0 | 68 | 102 | 1.0 | 0 | 67 | 76 | 1.0 | |||||||||||
1–132,540 | 47 | 34 | 2.4 | 1.2, 4.8 | 1–59,437 | 20 | 20 | 1.0 | 0.6, 2.3 | |||||||||
≥132,541 | 52 | 31 | 3.0 | 1.5, 6.0 | ≥59,438 | 24 | 15 | 1.4 | 0.9, 7.8 | |||||||||
p for trend = 0.007 | p for trend = 0.09 |
Cases and controls were matched on age.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), hair color (refer to the categories in table 2), number of blistering sunburns at ages 10–17 years (continuous), and ability to tan (refer to the categories in table 2) by conditional logistic regression.
The risk estimates for micronutrient intake and the risk of melanoma are presented in table 7. No inverse association was found for carotenoids, alpha-tocopherol, vitamin C, or retinol. Elevated odds ratios were found for vitamin E from supplements and beta-cryptoxanthin for females. Table 8 presents the results for plasma levels of vitamin C, alpha-tocopherol, carotenoids, and selenium and for erythrocyte and toenail levels of selenium. Direct associations were found for plasma alpha-tocopherol, alpha-carotene, beta-carotene, and beta-cryptoxanthin among males, and for vitamin C among females.
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Retinol from foods (RE) | ||||||||||||||||||
≤1,103 | 54 | 57 | 1.0 | ≤1,011 | 37 | 37 | 1.0 | |||||||||||
1,104–2,084 | 57 | 55 | 1.1 | 0.6, 2.1 | 1,012–1,820 | 37 | 38 | 1.0 | 0.4, 2.5 | |||||||||
≥2,085 | 56 | 55 | 1.1 | 0.5, 2.5 | ≥1,821 | 33 | 40 | 0.9 | 0.4, 2.7 | |||||||||
p for trend = 0.78 | p for trend = 0.95 | |||||||||||||||||
Retinol from supplements (IU) | ||||||||||||||||||
0 | 116 | 111 | 1.0 | ≤0 | 48 | 51 | 1.0 | |||||||||||
1–5,000 | 33 | 34 | 0.9 | 0.5, 1.7 | 1–5,000 | 30 | 41 | 0.7 | 0.3, 1.4 | |||||||||
≥5,001 | 18 | 22 | 0.6 | 0.3, 1.4 | ≥5,001 | 33 | 19 | 1.8 | 0.8, 4.2 | |||||||||
p for trend = 0.30 | p for trend = 0.14 | |||||||||||||||||
Vitamin C from foods (mg) | ||||||||||||||||||
≤113 | 58 | 54 | 1.0 | ≤114 | 34 | 40 | 1.0 | |||||||||||
114–177 | 56 | 55 | 0.8 | 0.4, 1.5 | 115–182 | 33 | 42 | 0.8 | 0.4, 1.8 | |||||||||
≥178 | 53 | 58 | 0.9 | 0.5, 1.6 | ≥183 | 44 | 29 | 1.7 | 0.8, 3.7 | |||||||||
p for trend = 0.73 | p for trend = 0.12 | |||||||||||||||||
Vitamin C from supplements (mg) | ||||||||||||||||||
0 | 91 | 96 | 1.0 | 0–58 | 40 | 47 | 1.0 | |||||||||||
1–350 | 35 | 39 | 0.9 | 0.5, 1.8 | 59–447 | 29 | 35 | 0.8 | 0.4, 1.6 | |||||||||
≥351 | 41 | 32 | 1.4 | 0.8, 2.7 | ≥448 | 42 | 31 | 1.8 | 0.8, 3.8 | |||||||||
p for trend = 0.23 | p for trend = 0.08 | |||||||||||||||||
Alpha-tocopherol from foods (mg) | ||||||||||||||||||
≤8 | 56 | 56 | 1.0 | ≤7 | 37 | 37 | 1.0 | |||||||||||
9–12 | 55 | 56 | 0.9 | 0.5, 1.8 | 8–10 | 34 | 41 | 0.7 | 0.3, 1.5 | |||||||||
≥13 | 56 | 55 | 1.0 | 0.4, 2.3 | ≥11 | 40 | 33 | 1.0 | 0.4, 2.8 | |||||||||
p for trend = 0.91 | p for trend = 0.96 | |||||||||||||||||
Vitamin E from supplements (IU) | ||||||||||||||||||
0 | 100 | 102 | 1.0 | 0 | 46 | 52 | 1.0 | |||||||||||
1–30 | 33 | 38 | 0.8 | 0.4, 1.5 | 1–30 | 27 | 42 | 0.6 | 0.3, 1.3 | |||||||||
≥31 | 34 | 27 | 1.4 | 0.7, 2.8 | ≥31 | 38 | 17 | 2.4 | 1.1, 5.2 | |||||||||
p for trend = 0.27 | p for trend = 0.004 | |||||||||||||||||
Alpha-carotene from foods (μg) | ||||||||||||||||||
≤388 | 54 | 58 | 1.0 | ≤396 | 34 | 40 | 1.0 | |||||||||||
389–942 | 57 | 54 | 1.4 | 0.7, 2.6 | 397–858 | 40 | 35 | 1.7 | 0.8, 3.7 | |||||||||
≥943 | 56 | 55 | 1.2 | 0.6, 2.3 | ≥859 | 37 | 36 | 1.7 | 0.7, 3.8 | |||||||||
p for trend = 0.72 | p for trend = 0.34 | |||||||||||||||||
Beta-carotene from foods (μg) | ||||||||||||||||||
≤2,122 | 53 | 58 | 1.0 | ≤2,116 | 34 | 40 | 1.0 | |||||||||||
2,123–4,146 | 60 | 52 | 1.3 | 0.7, 2.5 | 2,117–4,223 | 42 | 33 | 1.3 | 0.6, 2.9 | |||||||||
≥4,147 | 54 | 57 | 1.0 | 0.5, 2.0 | ≥4,224 | 35 | 38 | 1.1 | 0.4, 2.5 | |||||||||
p for trend = 0.90 | p for trend = 0.99 | |||||||||||||||||
Lutein from foods (μg) | ||||||||||||||||||
≤1,184 | 51 | 61 | 1.0 | ≤1,241 | 34 | 39 | 1.0 | |||||||||||
1,185–1,992 | 62 | 49 | 1.8 | 1.0, 3.5 | 1,242–2,068 | 41 | 35 | 1.3 | 0.6, 2.8 | |||||||||
≥1,993 | 54 | 57 | 1.1 | 0.6, 2.3 | ≥2,069 | 36 | 37 | 1.3 | 0.5, 3.0 | |||||||||
p for trend = 0.97 | p for trend = 0.65 | |||||||||||||||||
Lycopene from foods (μg) | ||||||||||||||||||
≤1,612 | 58 | 54 | 1.0 | ≤1,359 | 43 | 31 | 1.0 | |||||||||||
1,613–3,298 | 53 | 58 | 0.7 | 0.4, 1.3 | 1,360–2,525 | 34 | 41 | 0.5 | 0.2, 1.2 | |||||||||
≥3,299 | 56 | 55 | 0.7 | 0.4, 1.4 | ≥2,526 | 34 | 39 | 0.5 | (0.2–1.2) | |||||||||
p for trend = 0.48 | p for trend = 0.23 | |||||||||||||||||
Beta-cryptoxanthin from foods (μg) | ||||||||||||||||||
≤65 | 48 | 64 | 1.0 | ≤65 | 31 | 43 | 1.0 | |||||||||||
66–217 | 62 | 49 | 1.9 | 1.0, 3.5 | 66–223 | 35 | 40 | 0.9 | 0.4, 1.9 | |||||||||
≥218 | 57 | 54 | 1.3 | 0.8, 2.8 | ≥224 | 45 | 28 | 2.3 | 1.0, 5.2 | |||||||||
p for trend = 0.41 | p for trend = 0.02 |
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Retinol from foods (RE) | ||||||||||||||||||
≤1,103 | 54 | 57 | 1.0 | ≤1,011 | 37 | 37 | 1.0 | |||||||||||
1,104–2,084 | 57 | 55 | 1.1 | 0.6, 2.1 | 1,012–1,820 | 37 | 38 | 1.0 | 0.4, 2.5 | |||||||||
≥2,085 | 56 | 55 | 1.1 | 0.5, 2.5 | ≥1,821 | 33 | 40 | 0.9 | 0.4, 2.7 | |||||||||
p for trend = 0.78 | p for trend = 0.95 | |||||||||||||||||
Retinol from supplements (IU) | ||||||||||||||||||
0 | 116 | 111 | 1.0 | ≤0 | 48 | 51 | 1.0 | |||||||||||
1–5,000 | 33 | 34 | 0.9 | 0.5, 1.7 | 1–5,000 | 30 | 41 | 0.7 | 0.3, 1.4 | |||||||||
≥5,001 | 18 | 22 | 0.6 | 0.3, 1.4 | ≥5,001 | 33 | 19 | 1.8 | 0.8, 4.2 | |||||||||
p for trend = 0.30 | p for trend = 0.14 | |||||||||||||||||
Vitamin C from foods (mg) | ||||||||||||||||||
≤113 | 58 | 54 | 1.0 | ≤114 | 34 | 40 | 1.0 | |||||||||||
114–177 | 56 | 55 | 0.8 | 0.4, 1.5 | 115–182 | 33 | 42 | 0.8 | 0.4, 1.8 | |||||||||
≥178 | 53 | 58 | 0.9 | 0.5, 1.6 | ≥183 | 44 | 29 | 1.7 | 0.8, 3.7 | |||||||||
p for trend = 0.73 | p for trend = 0.12 | |||||||||||||||||
Vitamin C from supplements (mg) | ||||||||||||||||||
0 | 91 | 96 | 1.0 | 0–58 | 40 | 47 | 1.0 | |||||||||||
1–350 | 35 | 39 | 0.9 | 0.5, 1.8 | 59–447 | 29 | 35 | 0.8 | 0.4, 1.6 | |||||||||
≥351 | 41 | 32 | 1.4 | 0.8, 2.7 | ≥448 | 42 | 31 | 1.8 | 0.8, 3.8 | |||||||||
p for trend = 0.23 | p for trend = 0.08 | |||||||||||||||||
Alpha-tocopherol from foods (mg) | ||||||||||||||||||
≤8 | 56 | 56 | 1.0 | ≤7 | 37 | 37 | 1.0 | |||||||||||
9–12 | 55 | 56 | 0.9 | 0.5, 1.8 | 8–10 | 34 | 41 | 0.7 | 0.3, 1.5 | |||||||||
≥13 | 56 | 55 | 1.0 | 0.4, 2.3 | ≥11 | 40 | 33 | 1.0 | 0.4, 2.8 | |||||||||
p for trend = 0.91 | p for trend = 0.96 | |||||||||||||||||
Vitamin E from supplements (IU) | ||||||||||||||||||
0 | 100 | 102 | 1.0 | 0 | 46 | 52 | 1.0 | |||||||||||
1–30 | 33 | 38 | 0.8 | 0.4, 1.5 | 1–30 | 27 | 42 | 0.6 | 0.3, 1.3 | |||||||||
≥31 | 34 | 27 | 1.4 | 0.7, 2.8 | ≥31 | 38 | 17 | 2.4 | 1.1, 5.2 | |||||||||
p for trend = 0.27 | p for trend = 0.004 | |||||||||||||||||
Alpha-carotene from foods (μg) | ||||||||||||||||||
≤388 | 54 | 58 | 1.0 | ≤396 | 34 | 40 | 1.0 | |||||||||||
389–942 | 57 | 54 | 1.4 | 0.7, 2.6 | 397–858 | 40 | 35 | 1.7 | 0.8, 3.7 | |||||||||
≥943 | 56 | 55 | 1.2 | 0.6, 2.3 | ≥859 | 37 | 36 | 1.7 | 0.7, 3.8 | |||||||||
p for trend = 0.72 | p for trend = 0.34 | |||||||||||||||||
Beta-carotene from foods (μg) | ||||||||||||||||||
≤2,122 | 53 | 58 | 1.0 | ≤2,116 | 34 | 40 | 1.0 | |||||||||||
2,123–4,146 | 60 | 52 | 1.3 | 0.7, 2.5 | 2,117–4,223 | 42 | 33 | 1.3 | 0.6, 2.9 | |||||||||
≥4,147 | 54 | 57 | 1.0 | 0.5, 2.0 | ≥4,224 | 35 | 38 | 1.1 | 0.4, 2.5 | |||||||||
p for trend = 0.90 | p for trend = 0.99 | |||||||||||||||||
Lutein from foods (μg) | ||||||||||||||||||
≤1,184 | 51 | 61 | 1.0 | ≤1,241 | 34 | 39 | 1.0 | |||||||||||
1,185–1,992 | 62 | 49 | 1.8 | 1.0, 3.5 | 1,242–2,068 | 41 | 35 | 1.3 | 0.6, 2.8 | |||||||||
≥1,993 | 54 | 57 | 1.1 | 0.6, 2.3 | ≥2,069 | 36 | 37 | 1.3 | 0.5, 3.0 | |||||||||
p for trend = 0.97 | p for trend = 0.65 | |||||||||||||||||
Lycopene from foods (μg) | ||||||||||||||||||
≤1,612 | 58 | 54 | 1.0 | ≤1,359 | 43 | 31 | 1.0 | |||||||||||
1,613–3,298 | 53 | 58 | 0.7 | 0.4, 1.3 | 1,360–2,525 | 34 | 41 | 0.5 | 0.2, 1.2 | |||||||||
≥3,299 | 56 | 55 | 0.7 | 0.4, 1.4 | ≥2,526 | 34 | 39 | 0.5 | (0.2–1.2) | |||||||||
p for trend = 0.48 | p for trend = 0.23 | |||||||||||||||||
Beta-cryptoxanthin from foods (μg) | ||||||||||||||||||
≤65 | 48 | 64 | 1.0 | ≤65 | 31 | 43 | 1.0 | |||||||||||
66–217 | 62 | 49 | 1.9 | 1.0, 3.5 | 66–223 | 35 | 40 | 0.9 | 0.4, 1.9 | |||||||||
≥218 | 57 | 54 | 1.3 | 0.8, 2.8 | ≥224 | 45 | 28 | 2.3 | 1.0, 5.2 | |||||||||
p for trend = 0.41 | p for trend = 0.02 |
Cases and controls were matched on age.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), hair color (refer to the categories in table 2), number of blistering sunburns at ages 10–17 years (continuous), ability to tan (refer to the categories in table 2), total energy intake, and lifetime ethanol intake (continuous) by conditional logistic regression.
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Retinol from foods (RE) | ||||||||||||||||||
≤1,103 | 54 | 57 | 1.0 | ≤1,011 | 37 | 37 | 1.0 | |||||||||||
1,104–2,084 | 57 | 55 | 1.1 | 0.6, 2.1 | 1,012–1,820 | 37 | 38 | 1.0 | 0.4, 2.5 | |||||||||
≥2,085 | 56 | 55 | 1.1 | 0.5, 2.5 | ≥1,821 | 33 | 40 | 0.9 | 0.4, 2.7 | |||||||||
p for trend = 0.78 | p for trend = 0.95 | |||||||||||||||||
Retinol from supplements (IU) | ||||||||||||||||||
0 | 116 | 111 | 1.0 | ≤0 | 48 | 51 | 1.0 | |||||||||||
1–5,000 | 33 | 34 | 0.9 | 0.5, 1.7 | 1–5,000 | 30 | 41 | 0.7 | 0.3, 1.4 | |||||||||
≥5,001 | 18 | 22 | 0.6 | 0.3, 1.4 | ≥5,001 | 33 | 19 | 1.8 | 0.8, 4.2 | |||||||||
p for trend = 0.30 | p for trend = 0.14 | |||||||||||||||||
Vitamin C from foods (mg) | ||||||||||||||||||
≤113 | 58 | 54 | 1.0 | ≤114 | 34 | 40 | 1.0 | |||||||||||
114–177 | 56 | 55 | 0.8 | 0.4, 1.5 | 115–182 | 33 | 42 | 0.8 | 0.4, 1.8 | |||||||||
≥178 | 53 | 58 | 0.9 | 0.5, 1.6 | ≥183 | 44 | 29 | 1.7 | 0.8, 3.7 | |||||||||
p for trend = 0.73 | p for trend = 0.12 | |||||||||||||||||
Vitamin C from supplements (mg) | ||||||||||||||||||
0 | 91 | 96 | 1.0 | 0–58 | 40 | 47 | 1.0 | |||||||||||
1–350 | 35 | 39 | 0.9 | 0.5, 1.8 | 59–447 | 29 | 35 | 0.8 | 0.4, 1.6 | |||||||||
≥351 | 41 | 32 | 1.4 | 0.8, 2.7 | ≥448 | 42 | 31 | 1.8 | 0.8, 3.8 | |||||||||
p for trend = 0.23 | p for trend = 0.08 | |||||||||||||||||
Alpha-tocopherol from foods (mg) | ||||||||||||||||||
≤8 | 56 | 56 | 1.0 | ≤7 | 37 | 37 | 1.0 | |||||||||||
9–12 | 55 | 56 | 0.9 | 0.5, 1.8 | 8–10 | 34 | 41 | 0.7 | 0.3, 1.5 | |||||||||
≥13 | 56 | 55 | 1.0 | 0.4, 2.3 | ≥11 | 40 | 33 | 1.0 | 0.4, 2.8 | |||||||||
p for trend = 0.91 | p for trend = 0.96 | |||||||||||||||||
Vitamin E from supplements (IU) | ||||||||||||||||||
0 | 100 | 102 | 1.0 | 0 | 46 | 52 | 1.0 | |||||||||||
1–30 | 33 | 38 | 0.8 | 0.4, 1.5 | 1–30 | 27 | 42 | 0.6 | 0.3, 1.3 | |||||||||
≥31 | 34 | 27 | 1.4 | 0.7, 2.8 | ≥31 | 38 | 17 | 2.4 | 1.1, 5.2 | |||||||||
p for trend = 0.27 | p for trend = 0.004 | |||||||||||||||||
Alpha-carotene from foods (μg) | ||||||||||||||||||
≤388 | 54 | 58 | 1.0 | ≤396 | 34 | 40 | 1.0 | |||||||||||
389–942 | 57 | 54 | 1.4 | 0.7, 2.6 | 397–858 | 40 | 35 | 1.7 | 0.8, 3.7 | |||||||||
≥943 | 56 | 55 | 1.2 | 0.6, 2.3 | ≥859 | 37 | 36 | 1.7 | 0.7, 3.8 | |||||||||
p for trend = 0.72 | p for trend = 0.34 | |||||||||||||||||
Beta-carotene from foods (μg) | ||||||||||||||||||
≤2,122 | 53 | 58 | 1.0 | ≤2,116 | 34 | 40 | 1.0 | |||||||||||
2,123–4,146 | 60 | 52 | 1.3 | 0.7, 2.5 | 2,117–4,223 | 42 | 33 | 1.3 | 0.6, 2.9 | |||||||||
≥4,147 | 54 | 57 | 1.0 | 0.5, 2.0 | ≥4,224 | 35 | 38 | 1.1 | 0.4, 2.5 | |||||||||
p for trend = 0.90 | p for trend = 0.99 | |||||||||||||||||
Lutein from foods (μg) | ||||||||||||||||||
≤1,184 | 51 | 61 | 1.0 | ≤1,241 | 34 | 39 | 1.0 | |||||||||||
1,185–1,992 | 62 | 49 | 1.8 | 1.0, 3.5 | 1,242–2,068 | 41 | 35 | 1.3 | 0.6, 2.8 | |||||||||
≥1,993 | 54 | 57 | 1.1 | 0.6, 2.3 | ≥2,069 | 36 | 37 | 1.3 | 0.5, 3.0 | |||||||||
p for trend = 0.97 | p for trend = 0.65 | |||||||||||||||||
Lycopene from foods (μg) | ||||||||||||||||||
≤1,612 | 58 | 54 | 1.0 | ≤1,359 | 43 | 31 | 1.0 | |||||||||||
1,613–3,298 | 53 | 58 | 0.7 | 0.4, 1.3 | 1,360–2,525 | 34 | 41 | 0.5 | 0.2, 1.2 | |||||||||
≥3,299 | 56 | 55 | 0.7 | 0.4, 1.4 | ≥2,526 | 34 | 39 | 0.5 | (0.2–1.2) | |||||||||
p for trend = 0.48 | p for trend = 0.23 | |||||||||||||||||
Beta-cryptoxanthin from foods (μg) | ||||||||||||||||||
≤65 | 48 | 64 | 1.0 | ≤65 | 31 | 43 | 1.0 | |||||||||||
66–217 | 62 | 49 | 1.9 | 1.0, 3.5 | 66–223 | 35 | 40 | 0.9 | 0.4, 1.9 | |||||||||
≥218 | 57 | 54 | 1.3 | 0.8, 2.8 | ≥224 | 45 | 28 | 2.3 | 1.0, 5.2 | |||||||||
p for trend = 0.41 | p for trend = 0.02 |
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Retinol from foods (RE) | ||||||||||||||||||
≤1,103 | 54 | 57 | 1.0 | ≤1,011 | 37 | 37 | 1.0 | |||||||||||
1,104–2,084 | 57 | 55 | 1.1 | 0.6, 2.1 | 1,012–1,820 | 37 | 38 | 1.0 | 0.4, 2.5 | |||||||||
≥2,085 | 56 | 55 | 1.1 | 0.5, 2.5 | ≥1,821 | 33 | 40 | 0.9 | 0.4, 2.7 | |||||||||
p for trend = 0.78 | p for trend = 0.95 | |||||||||||||||||
Retinol from supplements (IU) | ||||||||||||||||||
0 | 116 | 111 | 1.0 | ≤0 | 48 | 51 | 1.0 | |||||||||||
1–5,000 | 33 | 34 | 0.9 | 0.5, 1.7 | 1–5,000 | 30 | 41 | 0.7 | 0.3, 1.4 | |||||||||
≥5,001 | 18 | 22 | 0.6 | 0.3, 1.4 | ≥5,001 | 33 | 19 | 1.8 | 0.8, 4.2 | |||||||||
p for trend = 0.30 | p for trend = 0.14 | |||||||||||||||||
Vitamin C from foods (mg) | ||||||||||||||||||
≤113 | 58 | 54 | 1.0 | ≤114 | 34 | 40 | 1.0 | |||||||||||
114–177 | 56 | 55 | 0.8 | 0.4, 1.5 | 115–182 | 33 | 42 | 0.8 | 0.4, 1.8 | |||||||||
≥178 | 53 | 58 | 0.9 | 0.5, 1.6 | ≥183 | 44 | 29 | 1.7 | 0.8, 3.7 | |||||||||
p for trend = 0.73 | p for trend = 0.12 | |||||||||||||||||
Vitamin C from supplements (mg) | ||||||||||||||||||
0 | 91 | 96 | 1.0 | 0–58 | 40 | 47 | 1.0 | |||||||||||
1–350 | 35 | 39 | 0.9 | 0.5, 1.8 | 59–447 | 29 | 35 | 0.8 | 0.4, 1.6 | |||||||||
≥351 | 41 | 32 | 1.4 | 0.8, 2.7 | ≥448 | 42 | 31 | 1.8 | 0.8, 3.8 | |||||||||
p for trend = 0.23 | p for trend = 0.08 | |||||||||||||||||
Alpha-tocopherol from foods (mg) | ||||||||||||||||||
≤8 | 56 | 56 | 1.0 | ≤7 | 37 | 37 | 1.0 | |||||||||||
9–12 | 55 | 56 | 0.9 | 0.5, 1.8 | 8–10 | 34 | 41 | 0.7 | 0.3, 1.5 | |||||||||
≥13 | 56 | 55 | 1.0 | 0.4, 2.3 | ≥11 | 40 | 33 | 1.0 | 0.4, 2.8 | |||||||||
p for trend = 0.91 | p for trend = 0.96 | |||||||||||||||||
Vitamin E from supplements (IU) | ||||||||||||||||||
0 | 100 | 102 | 1.0 | 0 | 46 | 52 | 1.0 | |||||||||||
1–30 | 33 | 38 | 0.8 | 0.4, 1.5 | 1–30 | 27 | 42 | 0.6 | 0.3, 1.3 | |||||||||
≥31 | 34 | 27 | 1.4 | 0.7, 2.8 | ≥31 | 38 | 17 | 2.4 | 1.1, 5.2 | |||||||||
p for trend = 0.27 | p for trend = 0.004 | |||||||||||||||||
Alpha-carotene from foods (μg) | ||||||||||||||||||
≤388 | 54 | 58 | 1.0 | ≤396 | 34 | 40 | 1.0 | |||||||||||
389–942 | 57 | 54 | 1.4 | 0.7, 2.6 | 397–858 | 40 | 35 | 1.7 | 0.8, 3.7 | |||||||||
≥943 | 56 | 55 | 1.2 | 0.6, 2.3 | ≥859 | 37 | 36 | 1.7 | 0.7, 3.8 | |||||||||
p for trend = 0.72 | p for trend = 0.34 | |||||||||||||||||
Beta-carotene from foods (μg) | ||||||||||||||||||
≤2,122 | 53 | 58 | 1.0 | ≤2,116 | 34 | 40 | 1.0 | |||||||||||
2,123–4,146 | 60 | 52 | 1.3 | 0.7, 2.5 | 2,117–4,223 | 42 | 33 | 1.3 | 0.6, 2.9 | |||||||||
≥4,147 | 54 | 57 | 1.0 | 0.5, 2.0 | ≥4,224 | 35 | 38 | 1.1 | 0.4, 2.5 | |||||||||
p for trend = 0.90 | p for trend = 0.99 | |||||||||||||||||
Lutein from foods (μg) | ||||||||||||||||||
≤1,184 | 51 | 61 | 1.0 | ≤1,241 | 34 | 39 | 1.0 | |||||||||||
1,185–1,992 | 62 | 49 | 1.8 | 1.0, 3.5 | 1,242–2,068 | 41 | 35 | 1.3 | 0.6, 2.8 | |||||||||
≥1,993 | 54 | 57 | 1.1 | 0.6, 2.3 | ≥2,069 | 36 | 37 | 1.3 | 0.5, 3.0 | |||||||||
p for trend = 0.97 | p for trend = 0.65 | |||||||||||||||||
Lycopene from foods (μg) | ||||||||||||||||||
≤1,612 | 58 | 54 | 1.0 | ≤1,359 | 43 | 31 | 1.0 | |||||||||||
1,613–3,298 | 53 | 58 | 0.7 | 0.4, 1.3 | 1,360–2,525 | 34 | 41 | 0.5 | 0.2, 1.2 | |||||||||
≥3,299 | 56 | 55 | 0.7 | 0.4, 1.4 | ≥2,526 | 34 | 39 | 0.5 | (0.2–1.2) | |||||||||
p for trend = 0.48 | p for trend = 0.23 | |||||||||||||||||
Beta-cryptoxanthin from foods (μg) | ||||||||||||||||||
≤65 | 48 | 64 | 1.0 | ≤65 | 31 | 43 | 1.0 | |||||||||||
66–217 | 62 | 49 | 1.9 | 1.0, 3.5 | 66–223 | 35 | 40 | 0.9 | 0.4, 1.9 | |||||||||
≥218 | 57 | 54 | 1.3 | 0.8, 2.8 | ≥224 | 45 | 28 | 2.3 | 1.0, 5.2 | |||||||||
p for trend = 0.41 | p for trend = 0.02 |
Cases and controls were matched on age.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), hair color (refer to the categories in table 2), number of blistering sunburns at ages 10–17 years (continuous), ability to tan (refer to the categories in table 2), total energy intake, and lifetime ethanol intake (continuous) by conditional logistic regression.
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Plasma vitamin C (mg/dl) | ||||||||||||||||||
≤0.92 | 52 | 52 | 1.0 | ≤1.08 | 26 | 43 | 1.0 | |||||||||||
0.93–1.19 | 55 | 48 | 1.3 | 0.7, 2.3 | 1.09–1.36 | 36 | 33 | 1.6 | 0.8, 3.3 | |||||||||
≥1.20 | 47 | 54 | 0.9 | 0.5, 1.7 | ≥1.37 | 40 | 28 | 2.2 | 1.1, 4.6 | |||||||||
p for trend = 0.77 | p for trend = 0.04 | |||||||||||||||||
Plasma alpha-tocopherol/cholesterol | ||||||||||||||||||
≤53 | 42 | 60 | 1.0 | ≤52 | 33 | 36 | 1.0 | |||||||||||
54–71 | 54 | 48 | 1.8 | 1.0, 3.3 | 53–69 | 29 | 38 | 0.7 | 0.3, 1.6 | |||||||||
≥72 | 58 | 45 | 2.2 | 1.2, 4.0 | ≥70 | 40 | 29 | 1.6 | 0.7, 3.3 | |||||||||
p for trend = 0.02 | p for trend = 0.15 | |||||||||||||||||
Plasma alpha-carotene (ng/ml) | ||||||||||||||||||
≤34 | 43 | 61 | 1.0 | ≤42 | 31 | 38 | 1.0 | |||||||||||
35–62 | 50 | 47 | 1.4 | 0.8, 2.6 | 43–82 | 35 | 33 | 1.1 | 0.5, 2.2 | |||||||||
≥63 | 58 | 41 | 2.3 | 1.3, 4.3 | ≥83 | 36 | 32 | 1.1 | 0.5, 2.3 | |||||||||
p for trend = 0.007 | p for trend = 0.82 | |||||||||||||||||
Plasma beta-carotene (ng/ml) | ||||||||||||||||||
≤109 | 40 | 62 | 1.0 | ≤158 | 28 | 41 | 1.0 | |||||||||||
110–227 | 58 | 44 | 2.1 | 1.2, 3.9 | 159–324 | 35 | 33 | 1.2 | 0.6, 2.5 | |||||||||
≥228 | 55 | 46 | 2.1 | 1.1, 3.9 | ≥325 | 39 | 29 | 1.9 | 0.9, 3.9 | |||||||||
p for trend = 0.05 | p for trend = 0.09 | |||||||||||||||||
Plasma lycopene (ng/ml) | ||||||||||||||||||
≤194 | 50 | 54 | 1.0 | ≤192 | 37 | 32 | 1.0 | |||||||||||
195–319 | 49 | 52 | 1.0 | 0.5, 1.8 | 193–305 | 31 | 38 | 0.6 | 0.3, 1.3 | |||||||||
≥320 | 55 | 47 | 1.4 | 0.7, 2.5 | ≥306 | 34 | 34 | 0.9 | 0.4, 1.8 | |||||||||
p for trend = 0.30 | p for trend = 0.80 | |||||||||||||||||
Plasma lutein (ng/ml) | ||||||||||||||||||
≤223 | 45 | 58 | 1.0 | ≤216 | 30 | 39 | 1.0 | |||||||||||
224–321 | 54 | 48 | 1.5 | 0.8, 2.6 | 217–332 | 36 | 33 | 1.2 | 0.6, 2.5 | |||||||||
≥322 | 55 | 47 | 1.7 | 0.9, 3.1 | ≥333 | 36 | 32 | 1.3 | 0.6, 2.8 | |||||||||
p for trend = 0.08 | p for trend = 0.46 | |||||||||||||||||
Plasma beta-cryptoxanthin (ng/ml) | ||||||||||||||||||
≤92 | 44 | 58 | 1.0 | ≤109 | 29 | 40 | 1.0 | |||||||||||
93–173 | 53 | 50 | 1.5 | 0.8, 2.8 | 110–219 | 33 | 36 | 1.1 | 0.5, 2.3 | |||||||||
≥174 | 57 | 44 | 2.1 | 1.1, 3.9 | ≥220 | 40 | 28 | 1.8 | 0.8, 4.0 | |||||||||
p for trend = 0.03 | p for trend = 0.12 | |||||||||||||||||
Plasma selenium (μg/ml) | ||||||||||||||||||
≤0.12 | 54 | 49 | 1.0 | ≤0.11 | 41 | 31 | 1.0 | |||||||||||
0.13 | 47 | 62 | 0.7 | 0.4, 1.2 | 0.12–0.13 | 30 | 40 | 0.6 | 0.3, 1.2 | |||||||||
≥0.14 | 53 | 43 | 1.2 | 0.7, 2.2 | ≥0.14 | 31 | 33 | 0.8 | 0.4, 1.6 | |||||||||
p for trend = 0.53 | p for trend = 0.49 | |||||||||||||||||
Erythrocyte selenium (μg)‡ | ||||||||||||||||||
≤0.12 | 56 | 47 | 1.0 | ≤0.12 | 35 | 34 | 1.0 | |||||||||||
0.13–0.14 | 52 | 49 | 1.0 | 0.6, 1.8 | 0.13 | 33 | 35 | 0.9 | 0.4, 19 | |||||||||
≥0.15 | 56 | 57 | 0.8 | 0.4, 14 | ≥0.14 | 33 | 35 | 1.0 | 0.5, 2.0 | |||||||||
p for trend = 0.40 | p for trend = 0.90 | |||||||||||||||||
Toenail selenium (μg/g)§ | ||||||||||||||||||
≤0.86 | 46 | 49 | 1.0 | ≤0.8 | 36 | 28 | 1.0 | |||||||||||
0.87–0.99 | 48 | 46 | 1.3 | 0.7, 2.4 | 0.9–1.1 | 24 | 37 | 0.5 | 0.2, 1.1 | |||||||||
≥1.0 | 45 | 49 | 0.9 | 0.5, 1.6 | ≥1.2 | 36 | 26 | 1.0 | 0.4, 2.1 | |||||||||
p for trend = 0.61 | p for trend = 0.99 |
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Plasma vitamin C (mg/dl) | ||||||||||||||||||
≤0.92 | 52 | 52 | 1.0 | ≤1.08 | 26 | 43 | 1.0 | |||||||||||
0.93–1.19 | 55 | 48 | 1.3 | 0.7, 2.3 | 1.09–1.36 | 36 | 33 | 1.6 | 0.8, 3.3 | |||||||||
≥1.20 | 47 | 54 | 0.9 | 0.5, 1.7 | ≥1.37 | 40 | 28 | 2.2 | 1.1, 4.6 | |||||||||
p for trend = 0.77 | p for trend = 0.04 | |||||||||||||||||
Plasma alpha-tocopherol/cholesterol | ||||||||||||||||||
≤53 | 42 | 60 | 1.0 | ≤52 | 33 | 36 | 1.0 | |||||||||||
54–71 | 54 | 48 | 1.8 | 1.0, 3.3 | 53–69 | 29 | 38 | 0.7 | 0.3, 1.6 | |||||||||
≥72 | 58 | 45 | 2.2 | 1.2, 4.0 | ≥70 | 40 | 29 | 1.6 | 0.7, 3.3 | |||||||||
p for trend = 0.02 | p for trend = 0.15 | |||||||||||||||||
Plasma alpha-carotene (ng/ml) | ||||||||||||||||||
≤34 | 43 | 61 | 1.0 | ≤42 | 31 | 38 | 1.0 | |||||||||||
35–62 | 50 | 47 | 1.4 | 0.8, 2.6 | 43–82 | 35 | 33 | 1.1 | 0.5, 2.2 | |||||||||
≥63 | 58 | 41 | 2.3 | 1.3, 4.3 | ≥83 | 36 | 32 | 1.1 | 0.5, 2.3 | |||||||||
p for trend = 0.007 | p for trend = 0.82 | |||||||||||||||||
Plasma beta-carotene (ng/ml) | ||||||||||||||||||
≤109 | 40 | 62 | 1.0 | ≤158 | 28 | 41 | 1.0 | |||||||||||
110–227 | 58 | 44 | 2.1 | 1.2, 3.9 | 159–324 | 35 | 33 | 1.2 | 0.6, 2.5 | |||||||||
≥228 | 55 | 46 | 2.1 | 1.1, 3.9 | ≥325 | 39 | 29 | 1.9 | 0.9, 3.9 | |||||||||
p for trend = 0.05 | p for trend = 0.09 | |||||||||||||||||
Plasma lycopene (ng/ml) | ||||||||||||||||||
≤194 | 50 | 54 | 1.0 | ≤192 | 37 | 32 | 1.0 | |||||||||||
195–319 | 49 | 52 | 1.0 | 0.5, 1.8 | 193–305 | 31 | 38 | 0.6 | 0.3, 1.3 | |||||||||
≥320 | 55 | 47 | 1.4 | 0.7, 2.5 | ≥306 | 34 | 34 | 0.9 | 0.4, 1.8 | |||||||||
p for trend = 0.30 | p for trend = 0.80 | |||||||||||||||||
Plasma lutein (ng/ml) | ||||||||||||||||||
≤223 | 45 | 58 | 1.0 | ≤216 | 30 | 39 | 1.0 | |||||||||||
224–321 | 54 | 48 | 1.5 | 0.8, 2.6 | 217–332 | 36 | 33 | 1.2 | 0.6, 2.5 | |||||||||
≥322 | 55 | 47 | 1.7 | 0.9, 3.1 | ≥333 | 36 | 32 | 1.3 | 0.6, 2.8 | |||||||||
p for trend = 0.08 | p for trend = 0.46 | |||||||||||||||||
Plasma beta-cryptoxanthin (ng/ml) | ||||||||||||||||||
≤92 | 44 | 58 | 1.0 | ≤109 | 29 | 40 | 1.0 | |||||||||||
93–173 | 53 | 50 | 1.5 | 0.8, 2.8 | 110–219 | 33 | 36 | 1.1 | 0.5, 2.3 | |||||||||
≥174 | 57 | 44 | 2.1 | 1.1, 3.9 | ≥220 | 40 | 28 | 1.8 | 0.8, 4.0 | |||||||||
p for trend = 0.03 | p for trend = 0.12 | |||||||||||||||||
Plasma selenium (μg/ml) | ||||||||||||||||||
≤0.12 | 54 | 49 | 1.0 | ≤0.11 | 41 | 31 | 1.0 | |||||||||||
0.13 | 47 | 62 | 0.7 | 0.4, 1.2 | 0.12–0.13 | 30 | 40 | 0.6 | 0.3, 1.2 | |||||||||
≥0.14 | 53 | 43 | 1.2 | 0.7, 2.2 | ≥0.14 | 31 | 33 | 0.8 | 0.4, 1.6 | |||||||||
p for trend = 0.53 | p for trend = 0.49 | |||||||||||||||||
Erythrocyte selenium (μg)‡ | ||||||||||||||||||
≤0.12 | 56 | 47 | 1.0 | ≤0.12 | 35 | 34 | 1.0 | |||||||||||
0.13–0.14 | 52 | 49 | 1.0 | 0.6, 1.8 | 0.13 | 33 | 35 | 0.9 | 0.4, 19 | |||||||||
≥0.15 | 56 | 57 | 0.8 | 0.4, 14 | ≥0.14 | 33 | 35 | 1.0 | 0.5, 2.0 | |||||||||
p for trend = 0.40 | p for trend = 0.90 | |||||||||||||||||
Toenail selenium (μg/g)§ | ||||||||||||||||||
≤0.86 | 46 | 49 | 1.0 | ≤0.8 | 36 | 28 | 1.0 | |||||||||||
0.87–0.99 | 48 | 46 | 1.3 | 0.7, 2.4 | 0.9–1.1 | 24 | 37 | 0.5 | 0.2, 1.1 | |||||||||
≥1.0 | 45 | 49 | 0.9 | 0.5, 1.6 | ≥1.2 | 36 | 26 | 1.0 | 0.4, 2.1 | |||||||||
p for trend = 0.61 | p for trend = 0.99 |
Total numbers of subjects vary because of missing data.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), hair color (refer to the categories in table 2), number of blistering sunburns at ages 10–17 years (continuous), ability to tan (refer to the categories in table 2), and lifetime ethanol intake by unconditional logistic regression.
The data for erythrocyte selenium were normalized for 1 ml of whole blood and were also normalized for the hematocrit. Refer to the Materials and Methods section of the text for more information.
The models for toenail selenium were additionally adjusted for recent use of selenium-containing shampoo (yes vs. no).
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Plasma vitamin C (mg/dl) | ||||||||||||||||||
≤0.92 | 52 | 52 | 1.0 | ≤1.08 | 26 | 43 | 1.0 | |||||||||||
0.93–1.19 | 55 | 48 | 1.3 | 0.7, 2.3 | 1.09–1.36 | 36 | 33 | 1.6 | 0.8, 3.3 | |||||||||
≥1.20 | 47 | 54 | 0.9 | 0.5, 1.7 | ≥1.37 | 40 | 28 | 2.2 | 1.1, 4.6 | |||||||||
p for trend = 0.77 | p for trend = 0.04 | |||||||||||||||||
Plasma alpha-tocopherol/cholesterol | ||||||||||||||||||
≤53 | 42 | 60 | 1.0 | ≤52 | 33 | 36 | 1.0 | |||||||||||
54–71 | 54 | 48 | 1.8 | 1.0, 3.3 | 53–69 | 29 | 38 | 0.7 | 0.3, 1.6 | |||||||||
≥72 | 58 | 45 | 2.2 | 1.2, 4.0 | ≥70 | 40 | 29 | 1.6 | 0.7, 3.3 | |||||||||
p for trend = 0.02 | p for trend = 0.15 | |||||||||||||||||
Plasma alpha-carotene (ng/ml) | ||||||||||||||||||
≤34 | 43 | 61 | 1.0 | ≤42 | 31 | 38 | 1.0 | |||||||||||
35–62 | 50 | 47 | 1.4 | 0.8, 2.6 | 43–82 | 35 | 33 | 1.1 | 0.5, 2.2 | |||||||||
≥63 | 58 | 41 | 2.3 | 1.3, 4.3 | ≥83 | 36 | 32 | 1.1 | 0.5, 2.3 | |||||||||
p for trend = 0.007 | p for trend = 0.82 | |||||||||||||||||
Plasma beta-carotene (ng/ml) | ||||||||||||||||||
≤109 | 40 | 62 | 1.0 | ≤158 | 28 | 41 | 1.0 | |||||||||||
110–227 | 58 | 44 | 2.1 | 1.2, 3.9 | 159–324 | 35 | 33 | 1.2 | 0.6, 2.5 | |||||||||
≥228 | 55 | 46 | 2.1 | 1.1, 3.9 | ≥325 | 39 | 29 | 1.9 | 0.9, 3.9 | |||||||||
p for trend = 0.05 | p for trend = 0.09 | |||||||||||||||||
Plasma lycopene (ng/ml) | ||||||||||||||||||
≤194 | 50 | 54 | 1.0 | ≤192 | 37 | 32 | 1.0 | |||||||||||
195–319 | 49 | 52 | 1.0 | 0.5, 1.8 | 193–305 | 31 | 38 | 0.6 | 0.3, 1.3 | |||||||||
≥320 | 55 | 47 | 1.4 | 0.7, 2.5 | ≥306 | 34 | 34 | 0.9 | 0.4, 1.8 | |||||||||
p for trend = 0.30 | p for trend = 0.80 | |||||||||||||||||
Plasma lutein (ng/ml) | ||||||||||||||||||
≤223 | 45 | 58 | 1.0 | ≤216 | 30 | 39 | 1.0 | |||||||||||
224–321 | 54 | 48 | 1.5 | 0.8, 2.6 | 217–332 | 36 | 33 | 1.2 | 0.6, 2.5 | |||||||||
≥322 | 55 | 47 | 1.7 | 0.9, 3.1 | ≥333 | 36 | 32 | 1.3 | 0.6, 2.8 | |||||||||
p for trend = 0.08 | p for trend = 0.46 | |||||||||||||||||
Plasma beta-cryptoxanthin (ng/ml) | ||||||||||||||||||
≤92 | 44 | 58 | 1.0 | ≤109 | 29 | 40 | 1.0 | |||||||||||
93–173 | 53 | 50 | 1.5 | 0.8, 2.8 | 110–219 | 33 | 36 | 1.1 | 0.5, 2.3 | |||||||||
≥174 | 57 | 44 | 2.1 | 1.1, 3.9 | ≥220 | 40 | 28 | 1.8 | 0.8, 4.0 | |||||||||
p for trend = 0.03 | p for trend = 0.12 | |||||||||||||||||
Plasma selenium (μg/ml) | ||||||||||||||||||
≤0.12 | 54 | 49 | 1.0 | ≤0.11 | 41 | 31 | 1.0 | |||||||||||
0.13 | 47 | 62 | 0.7 | 0.4, 1.2 | 0.12–0.13 | 30 | 40 | 0.6 | 0.3, 1.2 | |||||||||
≥0.14 | 53 | 43 | 1.2 | 0.7, 2.2 | ≥0.14 | 31 | 33 | 0.8 | 0.4, 1.6 | |||||||||
p for trend = 0.53 | p for trend = 0.49 | |||||||||||||||||
Erythrocyte selenium (μg)‡ | ||||||||||||||||||
≤0.12 | 56 | 47 | 1.0 | ≤0.12 | 35 | 34 | 1.0 | |||||||||||
0.13–0.14 | 52 | 49 | 1.0 | 0.6, 1.8 | 0.13 | 33 | 35 | 0.9 | 0.4, 19 | |||||||||
≥0.15 | 56 | 57 | 0.8 | 0.4, 14 | ≥0.14 | 33 | 35 | 1.0 | 0.5, 2.0 | |||||||||
p for trend = 0.40 | p for trend = 0.90 | |||||||||||||||||
Toenail selenium (μg/g)§ | ||||||||||||||||||
≤0.86 | 46 | 49 | 1.0 | ≤0.8 | 36 | 28 | 1.0 | |||||||||||
0.87–0.99 | 48 | 46 | 1.3 | 0.7, 2.4 | 0.9–1.1 | 24 | 37 | 0.5 | 0.2, 1.1 | |||||||||
≥1.0 | 45 | 49 | 0.9 | 0.5, 1.6 | ≥1.2 | 36 | 26 | 1.0 | 0.4, 2.1 | |||||||||
p for trend = 0.61 | p for trend = 0.99 |
Males . | . | . | . | . | Females . | . | . | . | . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | Value . | No. of cases . | No. of controls . | OR† . | 95% CI† . | |||||||||
Plasma vitamin C (mg/dl) | ||||||||||||||||||
≤0.92 | 52 | 52 | 1.0 | ≤1.08 | 26 | 43 | 1.0 | |||||||||||
0.93–1.19 | 55 | 48 | 1.3 | 0.7, 2.3 | 1.09–1.36 | 36 | 33 | 1.6 | 0.8, 3.3 | |||||||||
≥1.20 | 47 | 54 | 0.9 | 0.5, 1.7 | ≥1.37 | 40 | 28 | 2.2 | 1.1, 4.6 | |||||||||
p for trend = 0.77 | p for trend = 0.04 | |||||||||||||||||
Plasma alpha-tocopherol/cholesterol | ||||||||||||||||||
≤53 | 42 | 60 | 1.0 | ≤52 | 33 | 36 | 1.0 | |||||||||||
54–71 | 54 | 48 | 1.8 | 1.0, 3.3 | 53–69 | 29 | 38 | 0.7 | 0.3, 1.6 | |||||||||
≥72 | 58 | 45 | 2.2 | 1.2, 4.0 | ≥70 | 40 | 29 | 1.6 | 0.7, 3.3 | |||||||||
p for trend = 0.02 | p for trend = 0.15 | |||||||||||||||||
Plasma alpha-carotene (ng/ml) | ||||||||||||||||||
≤34 | 43 | 61 | 1.0 | ≤42 | 31 | 38 | 1.0 | |||||||||||
35–62 | 50 | 47 | 1.4 | 0.8, 2.6 | 43–82 | 35 | 33 | 1.1 | 0.5, 2.2 | |||||||||
≥63 | 58 | 41 | 2.3 | 1.3, 4.3 | ≥83 | 36 | 32 | 1.1 | 0.5, 2.3 | |||||||||
p for trend = 0.007 | p for trend = 0.82 | |||||||||||||||||
Plasma beta-carotene (ng/ml) | ||||||||||||||||||
≤109 | 40 | 62 | 1.0 | ≤158 | 28 | 41 | 1.0 | |||||||||||
110–227 | 58 | 44 | 2.1 | 1.2, 3.9 | 159–324 | 35 | 33 | 1.2 | 0.6, 2.5 | |||||||||
≥228 | 55 | 46 | 2.1 | 1.1, 3.9 | ≥325 | 39 | 29 | 1.9 | 0.9, 3.9 | |||||||||
p for trend = 0.05 | p for trend = 0.09 | |||||||||||||||||
Plasma lycopene (ng/ml) | ||||||||||||||||||
≤194 | 50 | 54 | 1.0 | ≤192 | 37 | 32 | 1.0 | |||||||||||
195–319 | 49 | 52 | 1.0 | 0.5, 1.8 | 193–305 | 31 | 38 | 0.6 | 0.3, 1.3 | |||||||||
≥320 | 55 | 47 | 1.4 | 0.7, 2.5 | ≥306 | 34 | 34 | 0.9 | 0.4, 1.8 | |||||||||
p for trend = 0.30 | p for trend = 0.80 | |||||||||||||||||
Plasma lutein (ng/ml) | ||||||||||||||||||
≤223 | 45 | 58 | 1.0 | ≤216 | 30 | 39 | 1.0 | |||||||||||
224–321 | 54 | 48 | 1.5 | 0.8, 2.6 | 217–332 | 36 | 33 | 1.2 | 0.6, 2.5 | |||||||||
≥322 | 55 | 47 | 1.7 | 0.9, 3.1 | ≥333 | 36 | 32 | 1.3 | 0.6, 2.8 | |||||||||
p for trend = 0.08 | p for trend = 0.46 | |||||||||||||||||
Plasma beta-cryptoxanthin (ng/ml) | ||||||||||||||||||
≤92 | 44 | 58 | 1.0 | ≤109 | 29 | 40 | 1.0 | |||||||||||
93–173 | 53 | 50 | 1.5 | 0.8, 2.8 | 110–219 | 33 | 36 | 1.1 | 0.5, 2.3 | |||||||||
≥174 | 57 | 44 | 2.1 | 1.1, 3.9 | ≥220 | 40 | 28 | 1.8 | 0.8, 4.0 | |||||||||
p for trend = 0.03 | p for trend = 0.12 | |||||||||||||||||
Plasma selenium (μg/ml) | ||||||||||||||||||
≤0.12 | 54 | 49 | 1.0 | ≤0.11 | 41 | 31 | 1.0 | |||||||||||
0.13 | 47 | 62 | 0.7 | 0.4, 1.2 | 0.12–0.13 | 30 | 40 | 0.6 | 0.3, 1.2 | |||||||||
≥0.14 | 53 | 43 | 1.2 | 0.7, 2.2 | ≥0.14 | 31 | 33 | 0.8 | 0.4, 1.6 | |||||||||
p for trend = 0.53 | p for trend = 0.49 | |||||||||||||||||
Erythrocyte selenium (μg)‡ | ||||||||||||||||||
≤0.12 | 56 | 47 | 1.0 | ≤0.12 | 35 | 34 | 1.0 | |||||||||||
0.13–0.14 | 52 | 49 | 1.0 | 0.6, 1.8 | 0.13 | 33 | 35 | 0.9 | 0.4, 19 | |||||||||
≥0.15 | 56 | 57 | 0.8 | 0.4, 14 | ≥0.14 | 33 | 35 | 1.0 | 0.5, 2.0 | |||||||||
p for trend = 0.40 | p for trend = 0.90 | |||||||||||||||||
Toenail selenium (μg/g)§ | ||||||||||||||||||
≤0.86 | 46 | 49 | 1.0 | ≤0.8 | 36 | 28 | 1.0 | |||||||||||
0.87–0.99 | 48 | 46 | 1.3 | 0.7, 2.4 | 0.9–1.1 | 24 | 37 | 0.5 | 0.2, 1.1 | |||||||||
≥1.0 | 45 | 49 | 0.9 | 0.5, 1.6 | ≥1.2 | 36 | 26 | 1.0 | 0.4, 2.1 | |||||||||
p for trend = 0.61 | p for trend = 0.99 |
Total numbers of subjects vary because of missing data.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), hair color (refer to the categories in table 2), number of blistering sunburns at ages 10–17 years (continuous), ability to tan (refer to the categories in table 2), and lifetime ethanol intake by unconditional logistic regression.
The data for erythrocyte selenium were normalized for 1 ml of whole blood and were also normalized for the hematocrit. Refer to the Materials and Methods section of the text for more information.
The models for toenail selenium were additionally adjusted for recent use of selenium-containing shampoo (yes vs. no).
Odds ratios were also examined for food intake (data not shown). No association with melanoma risk was found for total vegetables, total fruits, tomatoes, carrots, broccoli, red meat, processed meats, fish, and coffee. Further adjustment for total number of moles did not materially change the odds ratios shown in tables 5–8.
Because animal data had suggested the possibility of a modifying effect for fat intake (22), we explored the interactions of PUFA intake, successively, with alcohol and levels of blood antioxidants after combining data for both sexes to optimize the sample size (table 9). Suggestions of an interaction were found for alcohol and toenail selenium. The increased risk of melanoma associated with lifetime ethanol intake was present only at low levels of PUFA intake (p for interaction = 0.04). Moreover, a decreased risk of melanoma was observed with toenail selenium at low levels of PUFA intake; however, at high levels of PUFA intake, no association was observed with toenail selenium (p for interaction = 0.07).
Median PUFA intake (g) . | Lifetime ethanol intake (g) . | . | . | . | . | . | . | . | Toenail selenium (μg/g) . | . | . | . | . | . | . | . | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | ≤55,138† . | . | . | . | >55,138 . | . | . | . | ≤0.96‡ . | . | . | . | >0.96 . | . | . | . | ||||||||||||||
. | No. of cases . | No. of controls . | OR§ . | 95% CI§ . | No. of cases . | No. of controls . | OR§ . | 95% CI§ . | No. of cases . | No. of controls . | OR¶ . | 95% CI¶ . | No. of cases . | No. of controls . | OR¶ . | 95% CI¶ . | ||||||||||||||
≤22.9 | 65 | 82 | 1.0 | 75 | 56 | 1.8 | 1.1, 3.0 | 87 | 72 | 1.0 | 53 | 66 | 0.6 | 0.3, 1.0 | ||||||||||||||||
>22.9 | 61 | 70 | 1.1 | 0.7, 1.8 | 77 | 70 | 1.2 | 0.7, 2.0 | 76 | 86 | 0.7 | 0.4, 1.2 | 62 | 54 | 0.8 | 0.5, 1.4 | ||||||||||||||
p = 0.04# | p = 0.07# |
Median PUFA intake (g) . | Lifetime ethanol intake (g) . | . | . | . | . | . | . | . | Toenail selenium (μg/g) . | . | . | . | . | . | . | . | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | ≤55,138† . | . | . | . | >55,138 . | . | . | . | ≤0.96‡ . | . | . | . | >0.96 . | . | . | . | ||||||||||||||
. | No. of cases . | No. of controls . | OR§ . | 95% CI§ . | No. of cases . | No. of controls . | OR§ . | 95% CI§ . | No. of cases . | No. of controls . | OR¶ . | 95% CI¶ . | No. of cases . | No. of controls . | OR¶ . | 95% CI¶ . | ||||||||||||||
≤22.9 | 65 | 82 | 1.0 | 75 | 56 | 1.8 | 1.1, 3.0 | 87 | 72 | 1.0 | 53 | 66 | 0.6 | 0.3, 1.0 | ||||||||||||||||
>22.9 | 61 | 70 | 1.1 | 0.7, 1.8 | 77 | 70 | 1.2 | 0.7, 2.0 | 76 | 86 | 0.7 | 0.4, 1.2 | 62 | 54 | 0.8 | 0.5, 1.4 | ||||||||||||||
p = 0.04# | p = 0.07# |
PUFA, polyunsaturated fat.
Median lifetime ethanol intake: drinks/week × weeks.
Median toenail selenium.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), hair color (refer to the categories in table 2), number of blistering sunburns at ages 10–17 years (continuous), and ability to tan (refer to the categories in table 2) by conditional logistic regression.
Odds ratios and 95% confidence intervals were adjusted for age (continuous), sex, height (continuous), education (high school or less vs. more than high school), hair color (refer to the categories in table 2), number of blistering sunburns at ages 10–17 years (continuous), ability to tan (refer to the categories in table 2), lifetime ethanol intake (continuous), and recent use of selenium-containing shampoo (yes vs. no) by unconditional logistic regression.
p for interaction test.
Median PUFA intake (g) . | Lifetime ethanol intake (g) . | . | . | . | . | . | . | . | Toenail selenium (μg/g) . | . | . | . | . | . | . | . | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | ≤55,138† . | . | . | . | >55,138 . | . | . | . | ≤0.96‡ . | . | . | . | >0.96 . | . | . | . | ||||||||||||||
. | No. of cases . | No. of controls . | OR§ . | 95% CI§ . | No. of cases . | No. of controls . | OR§ . | 95% CI§ . | No. of cases . | No. of controls . | OR¶ . | 95% CI¶ . | No. of cases . | No. of controls . | OR¶ . | 95% CI¶ . | ||||||||||||||
≤22.9 | 65 | 82 | 1.0 | 75 | 56 | 1.8 | 1.1, 3.0 | 87 | 72 | 1.0 | 53 | 66 | 0.6 | 0.3, 1.0 | ||||||||||||||||
>22.9 | 61 | 70 | 1.1 | 0.7, 1.8 | 77 | 70 | 1.2 | 0.7, 2.0 | 76 | 86 | 0.7 | 0.4, 1.2 | 62 | 54 | 0.8 | 0.5, 1.4 | ||||||||||||||
p = 0.04# | p = 0.07# |
Median PUFA intake (g) . | Lifetime ethanol intake (g) . | . | . | . | . | . | . | . | Toenail selenium (μg/g) . | . | . | . | . | . | . | . | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
. | ≤55,138† . | . | . | . | >55,138 . | . | . | . | ≤0.96‡ . | . | . | . | >0.96 . | . | . | . | ||||||||||||||
. | No. of cases . | No. of controls . | OR§ . | 95% CI§ . | No. of cases . | No. of controls . | OR§ . | 95% CI§ . | No. of cases . | No. of controls . | OR¶ . | 95% CI¶ . | No. of cases . | No. of controls . | OR¶ . | 95% CI¶ . | ||||||||||||||
≤22.9 | 65 | 82 | 1.0 | 75 | 56 | 1.8 | 1.1, 3.0 | 87 | 72 | 1.0 | 53 | 66 | 0.6 | 0.3, 1.0 | ||||||||||||||||
>22.9 | 61 | 70 | 1.1 | 0.7, 1.8 | 77 | 70 | 1.2 | 0.7, 2.0 | 76 | 86 | 0.7 | 0.4, 1.2 | 62 | 54 | 0.8 | 0.5, 1.4 | ||||||||||||||
p = 0.04# | p = 0.07# |
PUFA, polyunsaturated fat.
Median lifetime ethanol intake: drinks/week × weeks.
Median toenail selenium.
Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for height (continuous), education (high school or less vs. more than high school), hair color (refer to the categories in table 2), number of blistering sunburns at ages 10–17 years (continuous), and ability to tan (refer to the categories in table 2) by conditional logistic regression.
Odds ratios and 95% confidence intervals were adjusted for age (continuous), sex, height (continuous), education (high school or less vs. more than high school), hair color (refer to the categories in table 2), number of blistering sunburns at ages 10–17 years (continuous), ability to tan (refer to the categories in table 2), lifetime ethanol intake (continuous), and recent use of selenium-containing shampoo (yes vs. no) by unconditional logistic regression.
p for interaction test.
DISCUSSION
In this population-based case-control study of Caucasians in Hawaii, we found that height, Celtic and English ancestries, fair complexion, freckling, propensity to sunburn, inability to tan, number of moles, longer years of Hawaii residence, increasing hours of sun exposure, and family history of skin cancer all increased risk of melanoma. These findings agree with the well-established roles of constitutional susceptibility and intense sun exposure in the etiology of this cancer. The associations found with migration to Hawaii before age 20 years and number of blistering sunburns during adolescence also add to the evidence for the critical role played by sun exposure during childhood. The association with height, although less well understood, is also consistent with previous findings (39) and may reflect the increased surface area exposed to the sun (although estimates of body surface area did not better characterize risk in our study) or an unrecognized difference in lifestyle.
With regard to diet and melanoma, we had hypothesized direct associations with alcohol consumption and PUFA intake, and an inverse association with dietary antioxidants (13). However, in our data, only alcohol was found to be clearly associated with risk. This association was first reported in an analysis of the Third National Cancer Survey (30) and was reproduced in most (26, 27, 30–32) but not all (25, 29) subsequent studies. Mechanisms for this association remain unclear, although a pituitary-mediated pathway has been proposed (30).
Dietary retinoids and antioxidants have been shown to protect against UV carcinogenesis in in vitro and animal experimental studies (13–15). Thus, we expected them to be inversely related to risk. Not only did we observe no inverse association with micronutrients but in fact we also found evidence for direct associations between melanoma and plasma levels of alpha-tocopherol, alpha-carotene, and beta-cryptoxanthin for males and plasma vitamin C for females. Consistent with our results, dietary and plasma retinol has not been found to be associated with melanoma in past studies (24–26), although the Nurses' Health Studies I and II recently reported an inverse association between melanoma and retinol from foods and supplements (28). Past epidemiologic studies have also provided no evidence (40, 41), or only weak evidence, for an association of melanoma with carotenoids and tocopherols (25, 26, 27). Consistent with the direct association between plasma vitamin C and melanoma risk for women observed in our data, the Nurses' Health Studies I and II also reported an increased risk associated with vitamin C intake from food sources, especially for higher risk sun-sensitive women (28).
Although a PUFA-rich diet has been shown to promote UV carcinogenesis in mice, we failed to find a significant association between dietary lipids and melanoma. We are not aware of any previous studies that investigated the interaction between alcohol and fat intakes. Thus, our finding that the effect of alcohol was limited to subjects whose intake of PUFA was low is speculative at this stage and requires confirmation. We also found that PUFA modified the associations of toenail selenium with melanoma, with an inverse association being limited to those whose PUFA intake levels were low. This finding is consistent with the lack of inhibition of UV carcinogenesis by beta-carotene observed in mice when they are fed a high-fat diet (22).
This study has a number of strengths and limitations. Careful attention was given to assessing constitutional susceptibility factors and sun exposure behavior throughout life, which may potentially confound the association with diet. This point is critical since, in the past, suntan and, in more recent years, sun avoidance is likely to be correlated with health behaviors, including certain dietary patterns. Although we were unable to blind interviewers to the case-control status of the participants, careful training and the use of standardized instruments minimized the risk of interviewer bias. In addition, since diet has not been included in past public health messages regarding prevention of melanoma, it is unlikely that cases had changed their diet because of the diagnosis or that a differential recall bias may have plagued the responses of cases and controls. We acknowledge that a large number of comparisons were made in the analysis. Thus, our findings should be interpreted with caution and in light of past findings.
In summary, these data provide additional evidence for the association of constitutional susceptibility factors, intense sun exposure (particularly before the age of 20 years), and alcohol consumption with melanoma risk. They do not support a beneficial role for dietary antioxidants against this disease, with the possible exception of selenium for those whose PUFA intake is low.
Supported in part by grant P01 CA33619 and contract N01-PC67010 from the National Cancer Institute, US Department of Health and Human Services.
The authors thank Castle Medical Center, Kaiser Medical Center, Kuakini Medical Center, Pali Momi Hospital, Queen's Medical Center, Straub Clinic and Hospital, St. Francis Medical Center, Tripler Hospital, Wahiawa General Hospital, and the participating dermatologists on Oahu for their support of this study. They also thank Jean Sato, Paula Brick, Clara Richards, Heidi Iverson, and Lynne Yamanaka for their help with interviewing.
The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views or policies of these institutions.
Conflict of interest: none declared.
References
Solar and ultraviolet radiation. IARC monographs on the evaluation of carcinogenic risks to humans. Vol 55. Lyon, France: International Agency for Research on Cancer,
Pollock PM, Yu F, Qiu L, et al. Evidence for u.v. induction of CDKN2 mutations in melanoma cell lines.
Lassam NJ, From L, Kahn HJ. Overexpression of mutant p53 is a late event in the development of malignant melanoma.
Atillasoy ES, Seykora JT, Soballe PW, et al. UVB induces atypical melanocytic lesions and melanoma in human skin.
Holman CD, Armstrong BK. Cutaneous malignant melanoma and indicators of total accumulated exposure to the sun: an analysis separating histogenic types.
Khlat M, Vail A, Parkin M, et al. Mortality from melanoma in migrants to Australia: variation by age at arrival and duration of stay.
Mack TM, Floderus B. Malignant melanoma risk by nativity, place of residence at diagnosis, and age at migration.
Holman CD, Armstrong BK, Heenan PJ. Relationship of cutaneous malignant melanoma to individual sunlight exposure habits.
Elwood JM, Gallagher RP, Hill GB, et al. Cutaneous melanoma in relation to intermittent and constant sun exposure—The Western Canada Melanoma Study.
Osterlind A, Tucker MA, Stone BJ, et al. The Danish case-control study of cutaneous malignant melanoma II. Importance of UV-light exposure.
Lottan R, Giotta G, Nork E, et al. Characterizations of the inhibitory effects of retinoids on the in-vitro growth of two malignant murine melanomas.
Meyskens FL, Salmno SE. Inhibition of human melanoma colony formation by retinoids.
Epstein JH. Effects of beta-carotene on UV induced cancer formation in the hairless mouse skin.
Black HS, Chan JT, Brown GE. Effects of dietary constituents on ultraviolet light-mediated carcinogenesis.
Matthews-Roth MM. Antitumor activity of beta-carotene, cantaxanthin and phytoene.
Bram S, Froussard P, Guichard M. Vitamin C preferential toxicity for malignant melanoma cells.
Prasad KN, Edwards-Rasad J. Effects of tocopherol (vitamin E) acid succinate on morphological alterations and growth inhibition of melanoma cell in culture.
Black HS, Lenger WA, Phelps W, et al. Influence of dietary lipid upon ultraviolet-light induced carcinogenesis.
Matthews-Roth MM, Krinsky NI. Effect of dietary fat level on UV-B induced skin tumors, and anti-tumor action of beta-carotene.
Levine N, Meyskens FL. Topical vitamin A acid therapy for cutaneous metastatic melanoma.
Middleton B, Byers T, Marshall J, et al. Dietary vitamin A and cancer. A multisite case-control study.
Osterlind A, Tucker MA, Stone BJ, et al. The Danish case-control study of cutaneous malignant melanoma. IV. No association with nutritional factors, alcohol, smoking or hair dyes.
Stryker WS, Stampfer MJ, Stein EA, et al. Diet, plasma levels of beta-carotene and alpha-tocopherol, and risk of malignant melanoma.
Millen AE, Tucker MA, Hartge P, et al. Diet and melanoma in a case-control study.
Feskanich D, Willett WC, Hunter DJ, et al. Dietary intakes of vitamins A, C, and E and risk of melanoma in two cohorts of women.
Veierod MB, Thielle DS, Laake P. Diet and risk of cutaneous malignant melanoma: a prospective study of 50,757 Norwegian men and women.
Williams RR, Horm JW. Association of cancer sites with tobacco and alcohol consumption and socioeconomic status of patients: interview study from the Third National Cancer Survey.
Freedman DM, Sigurdson A, Doody MM, et al. Risk of melanoma in relation to smoking, alcohol intake, and other factors in a large occupational cohort.
Bain C, Green A, Siskind V, et al. Diet and melanoma. An exploratory case-control study.
Hankin JH, Wilkens LR, Kolonel LN, et al. Validation of a quantitative diet history method in Hawaii.
Hertzman C, Walter SD, From L, et al. Observer perception of skin color in a study of malignant melanoma.
US Department of Agriculture. Nutrient database for standard reference, release 10. Bethesda, MD: Human Nutrition Information Service, USDA,
Cooney RV, Franke AA, Hankin JH, et al Seasonal effects on intra-individual variations in plasma micronutrients and antioxidants.
McKown DM, Morris JS. Rapid measurement of selenium in biological samples using instrumental neutron activation analysis.
Willett W, Stampfer MJ. Total energy intake: implications for epidemiologic analyses.
Shors AR, Solomon C, McTiernan A, et al. Melanoma risk in relation to height, weight, and exercise (United States).
Breslow RA, Alberg AJ, Helzlsouer KJ, et al. Serological precursors of cancer: malignant melanoma, basal and squamous cell skin cancer, and prediagnostic levels of retinol, beta-carotene, lycopene, alpha-tocopherol, and selenium.