title: Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: a cohort study.
abstract: BACKGROUND
  Few prospective studies have examined the relationship between sun exposure, other potential risk factors, and risk of different skin cancers [including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma] simultaneously.
  
  
  METHODS
  We evaluated the association between a number of potential risk factors and skin cancer risk in a cohort of 108,916 US women, the Nurses' Health Study II (1989-2009).
  
  
  RESULTS
  During 2.05 million years of follow-up, we identified 6,955, 880, and 779 diagnoses of BCC, SCC, and melanoma, respectively. Compared with participants in the lowest quintile of cumulative ultraviolet flux in adulthood, participants in the highest quintile had multivariable-adjusted relative risks (RR) of 2.35 (Ptrend < 0.0001) for BCC, 2.53 (Ptrend = 0.009) for SCC, and 0.68 (Ptrend = 0.38) for melanoma. In contrast, the RRs were 1.68 (95% CI, 1.55-1.82) for BCC, 1.68 (95% CI, 1.34-2.11) for SCC, and 1.80 (95% CI, 1.42-2.28) for melanoma for participants with ≥5 blistering sunburns when compared with participants without sunburn between ages 15 and 20 years. We found significant interactions between family history of melanoma, number of blistering sunburns between ages 15 and 20 years and BCC risk, and between sunburn reaction as a child/adolescent and SCC risk (all Pinteraction < 0.05).
  
  
  CONCLUSIONS
  In a cohort of U.S. women, we found that sun exposures in both early life and adulthood were predictive of BCC and SCC risks, whereas melanoma risk was predominantly associated with sun exposure in early life.
  
  
  CONCLUSIONS
  Our results may have potential implications for the prevention of skin cancers. Cancer Epidemiol Biomarkers Prev; 23(6); 1080-9. ©2014 AACR.
authors.affiliation: Authors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Shaowei
authors.initials: S
authors.lastname: Wu
authors.affiliation: Authors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Br
authors.forename: Jiali
authors.initials: J
authors.lastname: Han
authors.affiliation: Authors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Francine
authors.initials: F
authors.lastname: Laden
authors.affiliation: Authors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island abrar_qureshi@brown.edu.
authors.forename: Abrar A
authors.initials: AA
authors.lastname: Qureshi
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D012878:Skin Neoplasms / Q000209:etiology*; D014466:Ultraviolet Rays / Q000009:adverse effects*