title: Geography of non-melanoma skin cancer and ecological associations with environmental risk factors in England.
abstract: BACKGROUND
  This study investigates the geography of non-melanoma skin cancer (NMSC) in England, and ecological associations with three widespread environmental hazards: radon, arsenic and ultraviolet radiation from the sun.
  
  
  METHODS
  Age-/sex-standardised registration rates of NMSC were mapped for local authority (LA) areas (n=326), along with geographical data on bright sunshine, household radon and arsenic. Associations between NMSC and environmental variables, adjusted for socio-economic confounders, were investigated.
  
  
  RESULTS
  There was a substantial geographical variation in NMSC rates across English local authorities and between cancer registration regions. Forty percent of variance in rates was at registry region level and 60% at LA level. No association was observed between environmental arsenic and NMSC rates. Rates were associated with area-mean bright sunshine hours. An association with area-mean radon concentration was suggested, although the strength of statistical evidence was sensitive to model specification.
  
  
  CONCLUSIONS
  The significant geographical variation across England in NMSC registration rate is likely to be partly, but not wholly, explained by registry differences. Findings tentatively support suggestions that environmental radon may be a risk factor for NMSC. Although NMSC is rarely fatal, it has significant implications for individuals and health services, and further research into NMSC geographical and environmental risk factors is warranted.
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, Royal Cornwall Hospital, Truro TR1 3HD, UK. b.w.wheeler@exeter.ac.uk
authors.forename: B W
authors.initials: BW
authors.lastname: Wheeler
authors.forename: G
authors.initials: G
authors.lastname: Kothencz
authors.forename: A S
authors.initials: AS
authors.lastname: Pollard
mesh_terms: D001151:Arsenic / Q000633:toxicity; D004739:England / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects*; D005843:Geography; D006801:Humans; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology*; D011886:Radon / Q000633:toxicity; D012307:Risk Factors; D012878:Skin Neoplasms / Q000139:chemically induced / Q000453:epidemiology* / Q000209:etiology; D012959:Socioeconomic Factors; D013472:Sunlight / Q000009:adverse effects; D014466:Ultraviolet Rays / Q000009:adverse effects
chemical_list: D001151:Arsenic; D011886:Radon