Swimming and the risk of cutaneous melanoma.
Recreational exposure to the sun may not explain fully current trends in melanoma incidence. The hypothesis was examined whether carcinogens in water play a role in the development of cutaneous melanoma. In a case-control study, 128 melanoma patients and 168 patients with other types of malignancy completed a detailed questionnaire on aquatic leisure time activities. All relative risk estimates were adjusted for age, gender, educational level, pigmentation characteristics, and exposure to sun habits. Regular swimming during the summer months in swimming pools and in open waters such as rivers and seas before the age of 15 years, was associated with odds ratios of 2.20 (95% confidence interval (CI), 1.05-4.62) and 2.41 (95% CI, 1.04-5.58), respectively, compared with no swimming at all or swimming in relatively unpolluted waters, such as lakes and fens. Melanoma patients learned to swim at a younger age; compared with those who never learned to swim or who learned to swim after the age of 12 years, the odds ratio was 1.87 (95% CI, 0.91-3.78) for those who learned to swim at ages 9-12 years, and 2.22 (95% CI, 1.16-4.26) for those who learned to swim before 9 years of age. Compared with persons who had no swimming certificates, an odds ratio of 1.25 (95% CI, 0.71-2.23) was found for persons with one or two certificates, and an odds ratio of 2.96 (95% CI, 1.25-6.96) for persons with three or more certificates. The positive association between a history of swimming and melanoma risk suggests that carcinogenic agents in water, possibly chlorination by products, play a role in melanoma aetiology.
Department of Medical Informatics and Epidemiology, University of Nijmegen, The Netherlands.
P J
PJ
Nelemans
F H
FH
Rampen
H
H
Groenendal
L A
LA
Kiemeney
D J
DJ
Ruiter
A L
AL
Verbeek
D000293:Adolescent; D000328:Adult; D000368:Aged; D002274:Carcinogens, Environmental / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002713:Chlorine / Q000009:adverse effects; D003043:Cocarcinogenesis; D015897:Comorbidity; D005260:Female; D005618:Fresh Water; D006370:Heliotherapy / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008545:Melanoma / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D009381:Neoplasms, Radiation-Induced / Q000209:etiology; D009426:Netherlands / Q000453:epidemiology; D009508:Nevus, Pigmented / Q000453:epidemiology; D016017:Odds Ratio; D012306:Risk; D012307:Risk Factors; D012621:Seasons; D012878:Skin Neoplasms / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D012880:Skin Pigmentation; D013472:Sunlight / Q000009:adverse effects; D013550:Swimming; D013551:Swimming Pools; D014873:Water Pollutants / Q000009:adverse effects*
D002274:Carcinogens, Environmental; D014873:Water Pollutants; D002713:Chlorine