title: Cumulative ultraviolet radiation flux in adulthood and risk of incident skin cancers in women.
abstract: BACKGROUND
  Solar ultraviolet (UV) exposure estimated based on residential history has been used as a sun exposure indicator in previous case-control and descriptive studies. However, the associations of cumulative UV exposure based on residential history with different skin cancers, including melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC), have not been evaluated simultaneously in prospective studies.
  
  
  METHODS
  We conducted a cohort study among 108,578 women in the Nurses' Health Study (1976-2006) to evaluate the relative risks of skin cancers with cumulative UV flux based on residential history in adulthood.
  
  
  RESULTS
  Risk of SCC and BCC was significantly lower for women in lower quintiles vs the highest quintile of cumulative UV flux (both P for trend <0.0001). The association between cumulative UV flux and risk of melanoma did not reach statistical significance. However, risk of melanoma appeared to be lower among women in lower quintiles vs the highest quintile of cumulative UV flux in lag analyses with 2-10 years between exposure and outcome. The multivariable-adjusted hazard ratios per 200 × 10(-4) Robertson-Berger units increase in cumulative UV flux were 0.979 (95% confidence interval (CI): 0.933, 1.028) for melanoma, 1.072 (95% CI: 1.041, 1.103) for SCC, and 1.043 (95% CI: 1.034, 1.052) for BCC.
  
  
  CONCLUSIONS
  Associations with cumulative UV exposure in adulthood among women differed for melanoma, SCC, and BCC, suggesting a potential variable role of UV radiation in adulthood in the carcinogenesis of the three major skin cancers.
authors.affiliation: Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, 45 Francis Street, 221L, Boston, MA 02115, USA.
authors.forename: S
authors.initials: S
authors.lastname: Wu
authors.affiliation: 1] Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, 45 Francis Street, 221L, Boston, MA 02115, USA [2] Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA [3] Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, IN 46202, USA [4] Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: J
authors.initials: J
authors.lastname: Han
authors.affiliation: Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, 45 Francis Street, 221L, Boston, MA 02115, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Vleugels
authors.affiliation: Maryland Institute of Applied Environmental Health, College Park, College Park, MD 20742, USA.
authors.forename: R
authors.initials: R
authors.lastname: Puett
authors.affiliation: 1] Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA [2] Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA [3] Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: F
authors.initials: F
authors.lastname: Laden
authors.affiliation: 1] Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA [2] Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Hunter
authors.affiliation: 1] Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, 45 Francis Street, 221L, Boston, MA 02115, USA [2] Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Qureshi
mesh_terms: D000328:Adult; D002280:Basal Cell Carcinoma / Q000453:epidemiology / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D004781:Environmental Exposure / Q000009:adverse effects / Q000032:analysis* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008545:Melanoma / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D014466:Ultraviolet Rays / Q000009:adverse effects*