title: Incidence of nonmelanoma skin cancer in relation to ambient UV radiation in white populations, 1978-2012: empirical relationships.
abstract: OBJECTIVE
  Nonmelanoma skin cancers (NMSCs) are the most common cancers in fair-skinned populations. Their incidence continues to increase in many countries. Exposure to UV radiation (UVR) is the primary cause of NMSC, although the pattern of exposure that gives rise to different types of NMSC appears to vary.
  
  
  OBJECTIVE
  To examine dose-response relationships between ambient UVR levels and NMSC incidence at the population level.
  
  
  METHODS
  Peer-reviewed literature published from January 1, 1978, through December 31, 2012, that provided age- and sex-specific incidence of NMSC in white populations worldwide was systematically reviewed.
  
  
  METHODS
  Mean erythemally weighted daily ambient UVR levels for each study location were derived from satellite data.
  
  
  METHODS
  The incidence of NMSC in white populations worldwide as reported in population-based studies.
  
  
  RESULTS
  Forty eligible publications were included in the analysis. Analysis models that contained age group, sex, study year, mean daily UVR, and day-to-day variability of UVR explained most of the variability in NMSC incidence: 82% for basal cell carcinoma (BCC) and 85% for squamous cell carcinoma (SCC). Exclusion of studies in which imputation of age-specific incidence data from standardized rates was required improved the model fit to 85% for BCC and 88% for SCC. Higher mean daily UVR was associated with higher NMSC incidence rates; this was greater in men than women for BCC (70% vs 60%) but greater in women for SCC (99% vs 92%). Incidence rates for BCC and SCC were higher among those older than 60 years, but the increase with age was steeper for those younger than 60 years.
  
  
  CONCLUSIONS
  Our models highlight the etiologic differences between BCC and SCC and allow prediction of NMSC incidence for data-poor regions and under changing demographic and environmental conditions.
authors.affiliation: National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia2Centre for Research Excellence in Sun and Health, Brisbane, Australia.
authors.forename: Fan
authors.initials: F
authors.lastname: Xiang
authors.affiliation: National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia3Telethon Institute for Child Health Research, University of Western Australia, Perth.
authors.forename: Robyn
authors.initials: R
authors.lastname: Lucas
authors.affiliation: Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Simon
authors.initials: S
authors.lastname: Hales
authors.affiliation: QIMR Berghofer Medical Research Institute, Brisbane, Australia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Neale
mesh_terms: D000367:Age Factors; D002280:Basal Cell Carcinoma / Q000453:epidemiology* / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000209:etiology; D004307:Dose-Response Relationship, Radiation; D004781:Environmental Exposure / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D011832:Radiation Injuries / Q000453:epidemiology* / Q000209:etiology; D012737:Sex Factors; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000209:etiology; D014466:Ultraviolet Rays / Q000009:adverse effects*; D044465:White People