Inverse association between melanoma and previous vaccinations against tuberculosis and smallpox: results of the FEBIM study.
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.
Pfahlberg
Annette
A
Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Germany.
Kölmel
Klaus F
KF
Grange
John M
JM
Mastrangelo
Giuseppe
G
Krone
Bernd
B
Botev
Ivan N
IN
Niin
Marianne
M
Seebacher
Claus
C
Lambert
Daniel
D
Shafir
Raphael
R
Schneider
Daniela
D
Kokoschka
Eva-Maria
EM
Kleeberg
Ulrich R
UR
Uter
Wolfgang
W
Gefeller
Olaf
O
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*
D001500:BCG Vaccine; D012900:Smallpox Vaccine