Season of birth and other perinatal risk factors for melanoma.
BACKGROUND
Ultraviolet radiation (UVR) exposure is the main risk factor for cutaneous malignant melanoma (CMM), but its specific effect in infancy is unknown. We examined whether season of birth, a proxy for solar UVR exposure in the first few months of life, is associated with CMM in childhood through young adulthood.


METHODS
National cohort study of 3,571,574 persons born in Sweden in 1973-2008, followed up for CMM incidence through 2009 (maximum age 37 years) to examine season of birth and other perinatal factors.


RESULTS
There were 1595 CMM cases in 63.9 million person-years of follow-up. We found a sinusoidal pattern in CMM risk by season of birth (P=0.006), with peak risk corresponding to birthdates in spring (March-May). Adjusted odds ratios for CMM by season of birth were 1.21 [95% confidence interval (CI), 1.05-1.39; P=0.008] for spring, 1.07 (95% CI, 0.92-1.24; P=0.40) for summer and 1.12 (95% CI, 0.96-1.29; P=0.14) for winter, relative to fall. Spring birth was associated with superficial spreading subtype of CMM (P=0.02), whereas there was no seasonal association with nodular subtype (P=0.26). Other CMM risk factors included family history of CMM in a sibling (>6-fold) or parent (>3-fold), female gender, high fetal growth and high paternal education level.


CONCLUSIONS
In this large cohort study, persons born in spring had increased risk of CMM in childhood through young adulthood, suggesting that the first few months of life may be a critical period of UVR susceptibility. Sun avoidance in early infancy may play an important role in the prevention of CMM in high-risk populations.
Department of Medicine, Stanford University, Stanford, CA, USA, Center for Primary Health Care Research, Lund University, Malmö, Sweden, Stanford Prevention Research Center, Stanford University, Stanford, CA, USA and Department of Health Research and Policy, Stanford University, Stanford, CA, USA kccrump@stanford.edu.
Casey
C
Crump
Department of Medicine, Stanford University, Stanford, CA, USA, Center for Primary Health Care Research, Lund University, Malmö, Sweden, Stanford Prevention Research Center, Stanford University, Stanford, CA, USA and Department of Health Research and Policy, Stanford University, Stanford, CA, USADepartment of Medicine, Stanford University, Stanford, CA, USA, Center for Primary Health Care Research, Lund University, Malmö, Sweden, Stanford Prevention Research Center, Stanford University, Stanford, CA, USA and Department of Health Research and Policy, Stanford University, Stanford, CA, USA.
Kristina
K
Sundquist
Department of Medicine, Stanford University, Stanford, CA, USA, Center for Primary Health Care Research, Lund University, Malmö, Sweden, Stanford Prevention Research Center, Stanford University, Stanford, CA, USA and Department of Health Research and Policy, Stanford University, Stanford, CA, USA.
Weiva
W
Sieh
Department of Medicine, Stanford University, Stanford, CA, USA, Center for Primary Health Care Research, Lund University, Malmö, Sweden, Stanford Prevention Research Center, Stanford University, Stanford, CA, USA and Department of Health Research and Policy, Stanford University, Stanford, CA, USA.
Marilyn A
MA
Winkleby
Department of Medicine, Stanford University, Stanford, CA, USA, Center for Primary Health Care Research, Lund University, Malmö, Sweden, Stanford Prevention Research Center, Stanford University, Stanford, CA, USA and Department of Health Research and Policy, Stanford University, Stanford, CA, USADepartment of Medicine, Stanford University, Stanford, CA, USA, Center for Primary Health Care Research, Lund University, Malmö, Sweden, Stanford Prevention Research Center, Stanford University, Stanford, CA, USA and Department of Health Research and Policy, Stanford University, Stanford, CA, USA.
Jan
J
Sundquist
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008545:Melanoma / Q000453:epidemiology*; D012307:Risk Factors; D012621:Seasons; D012737:Sex Factors; D012878:Skin Neoplasms / Q000453:epidemiology*; D012959:Socioeconomic Factors; D013472:Sunlight; D013548:Sweden / Q000453:epidemiology; D014466:Ultraviolet Rays / Q000009:adverse effects; D000096142:Cutaneous Malignant Melanoma
fetal development; melanoma; risk factors; seasons