title: Inverse association between melanoma and previous vaccinations against tuberculosis and smallpox: results of the FEBIM study.
abstract: Various forms of immunotherapy utilizing bacille Calmette-Guérin vaccine or vaccinia vaccine have been evaluated in clinical trials on melanoma patients. The effect of the "natural" application of these vaccinations, administered to provide protection against tuberculosis and smallpox, has, however, never been studied in epidemiologic investigations on risk factors for melanoma. In a case-control study comprising 11 institutions in seven countries we recruited 603 incident melanoma cases and 627 population controls frequency matched to the cases with respect to sex, age, and ethnic origin within each center to assess this relationship to obtain insights into the prevention of melanoma. Exposure information, incorporating also detailed ascertainment of potential confounding variables, was obtained in standardized personal interviews at the study subject's home. We found an inverse association between melanoma risk and previous bacille Calmette-Guérin vaccine/vaccinia vaccination depicted by an adjusted odds ratio of 0.44 (95% confidence interval: 0.26-0.72) for those vaccinated against tuberculosis and smallpox compared with subjects without a positive history of either vaccination. A variety of subgroup analyses showing a consistent pattern of results make it unlikely that the observed inverse association is a spurious finding. We conclude that bacille Calmette-Guérin vaccination and vaccinia vaccination may lower melanoma risk. Current immunologic theory of melanoma development provides a sound basis for understanding the biologic plausibility of the findings that have to be confirmed in future studies.
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Pfahlberg
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Kölmel
authors.forename: John M
authors.initials: JM
authors.lastname: Grange
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mastrangelo
authors.forename: Bernd
authors.initials: B
authors.lastname: Krone
authors.forename: Ivan N
authors.initials: IN
authors.lastname: Botev
authors.forename: Marianne
authors.initials: M
authors.lastname: Niin
authors.forename: Claus
authors.initials: C
authors.lastname: Seebacher
authors.forename: Daniel
authors.initials: D
authors.lastname: Lambert
authors.forename: Raphael
authors.initials: R
authors.lastname: Shafir
authors.forename: Daniela
authors.initials: D
authors.lastname: Schneider
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Kokoschka
authors.forename: Ulrich R
authors.initials: UR
authors.lastname: Kleeberg
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Uter
authors.forename: Olaf
authors.initials: O
authors.lastname: Gefeller
mesh_terms: D001500:BCG Vaccine / Q000008:administration & dosage*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000517:prevention & control; D008875:Middle Aged; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D012900:Smallpox Vaccine / Q000008:administration & dosage*
chemical_list: D001500:BCG Vaccine; D012900:Smallpox Vaccine