title: Female Estrogen-Related Factors and Incidence of Basal Cell Carcinoma in a Nationwide US Cohort.
abstract: OBJECTIVE
  UV radiation exposure is the primary risk factor for basal cell carcinoma (BCC), the most common human malignancy. Although the photosensitizing properties of estrogens have been recognized for decades, few studies have examined the relationship between reproductive factors or exogenous estrogen use and BCC.
  
  
  METHODS
  Using data from the US Radiologic Technologists Study, a large, nationwide, prospective cohort, we assessed the relationship between reproductive factors, exogenous estrogen use, and first primary BCC while accounting for sun exposure, personal sun sensitivity, and lifestyle factors for geographically dispersed women exposed to a wide range of ambient UV radiation.
  
  
  RESULTS
  Elevated risk of BCC was associated with late age at natural menopause (hazard ratio [HR] for ≥ 55 years v 50 to 54 years, 1.50; 95% CI, 1.04 to 2.17) and any use of menopausal hormone therapy (MHT; HR, 1.16; 95% CI, 1.03 to 1.30; P for trend for duration = .001). BCC risk was most increased among women reporting natural menopause who used MHT for 10 or more years versus women who never used MHT (HR, 1.97; 95% CI, 1.35 to 2.87). Risk of BCC was not associated with age at menarche, parity, age at first birth, infertility, use of diethylstilbestrol by participant's mother, age at hysterectomy, or use of oral contraceptives.
  
  
  CONCLUSIONS
  These analyses confirm a previous finding of increased risk of BCC associated with MHT. Novel findings of increased BCC risk associated with MHT in women experiencing natural menopause and for late age at natural menopause warrant further investigation. Users of MHT may constitute an additional high-risk group in need of more frequent skin cancer screening.
authors.affiliation: Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN. cahoonek@mail.nih.gov.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Cahoon
authors.affiliation: Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Cari M
authors.initials: CM
authors.lastname: Kitahara
authors.affiliation: Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Estelle
authors.initials: E
authors.lastname: Ntowe
authors.affiliation: Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Bowen
authors.affiliation: Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Michele M
authors.initials: MM
authors.lastname: Doody
authors.affiliation: Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Alexander
authors.affiliation: Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Terrence
authors.initials: T
authors.lastname: Lee
authors.affiliation: Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Little
authors.affiliation: Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Martha S
authors.initials: MS
authors.lastname: Linet
authors.affiliation: Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: D Michal
authors.initials: DM
authors.lastname: Freedman
mesh_terms: D000293:Adolescent; D000328:Adult; D002280:Basal Cell Carcinoma / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D002648:Child; D003276:Contraceptives, Oral / Q000009:adverse effects*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D017584:Reproductive History; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D014466:Ultraviolet Rays / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral