Risk factors for skin cancers: a nested case-control study within the Nurses' Health Study.
BACKGROUND
Constitutional factors and sun exposure are associated with skin cancer risk. However, these relations are complex and differ according to skin cancer type.


METHODS
We examined the associations of constitutional risk factors and sun exposure with the risks of three types of skin cancer simultaneously and evaluated the interaction between constitutional susceptibility and sun exposure in a nested case-control study within the Nurses' Health Study [200 melanoma, 275 squamous cell carcinoma (SCC), and 283 basal cell carcinoma (BCC) cases, and 804 controls]. Information regarding skin cancer risk factors was obtained from the retrospective supplementary questionnaire.


RESULTS
Constitutional susceptibility was an independent risk factor for all three types of skin cancer. Sunlamp usage or tanning salon attendance was a risk factor for melanoma after adjusting for potential confounding variables (OR for ever vs never usage, 2.06, 95% CI 1.30-3.26). Higher sun exposure while wearing a bathing suit was an independent risk factor for all three types of skin cancer. We observed a significant interaction between constitutional susceptibility and sun exposure while wearing a bathing suit on melanoma risk (P, interaction, 0.03); women with the highest susceptibility and highest exposure had an OR of 8.37 (95% CI 3.07-22.84). This interaction was weaker and non-significant for SCC and BCC.


CONCLUSIONS
These data largely confirm past studies on risk factors for skin cancer but provide evidence of difference on the strength of these risk factors for melanoma compared with SCC and BCC.
Han
Jiali
J
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA. jiali.han@channing.harvard.edu
Colditz
Graham A
GA
Hunter
David J
DJ
D000328:Adult; D000368:Aged; D015982:Bias; D002280:Basal Cell Carcinoma / Q000453:epidemiology / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000209:etiology; D016022:Case-Control Studies; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology; D006801:Humans; D008545:Melanoma / Q000453:epidemiology / Q000209:etiology; D011939:Mental Recall; D008875:Middle Aged; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D012880:Skin Pigmentation / Q000235:genetics; D013471:Sunburn / Q000150:complications / Q000453:epidemiology; D013472:Sunlight / Q000009:adverse effects