title: Ultraviolet Radiation Exposure and the Incidence of Oral, Pharyngeal and Cervical Cancer and Melanoma: An Analysis of the SEER Data.
abstract: BACKGROUND
  Based on the hypothesis that ultraviolet radiation (UVR) exposure can cause DNA damage that may activate dormant viruses such as human papilloma virus, a recent ecological study, which estimated state-level UVR exposure, reported positive correlations between annual UVR exposure and the incidence of oral, pharyngeal, and cervical cancer in 16 U.S. states using the International Agency for Research on Cancer (IARC) data. The purpose of the current study was to further investigate whether the annual UVR level, estimated on a county level, is associated with incidence rates of such cancers using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 18 data. If UVR exposure is associated with incidence of these cancer types, we would expect to see a similar or stronger association with melanoma because UVR exposure is a well-demonstrated risk factor for this disease. Thus, we also included melanoma in the study.
  
  
  METHODS
  The study subjects were White and Black individuals with oral, pharyngeal, cervical cancer or melanoma diagnosed between 1973 and 2011 from the SEER 18 data. UVR was estimated at the county level and grouped into high-, medium- and low-exposure levels. Age-adjusted incidence rates of cancer were calculated and compared among the UVR exposure groups. The comparisons were also stratified by sex and race.
  
  
  RESULTS
  There was an inverse association between UVR exposure and incidence of oral, pharyngeal, and cervical cancer. The inverse association was also observed for melanoma. When stratified by race and sex, the inverse associations remained except for melanoma among Blacks.
  
  
  CONCLUSIONS
  In contrast to a previous study, our study found that there were inverse associations between UVR exposure and the incidence of oral, pharyngeal, and cervical cancer, as well as of melanoma. Our findings are in agreement with several other published studies reporting no positive correlation between UVR exposure and the incidence rates of oral, pharyngeal, and cervical cancer and melanoma.
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, U.S.A.
authors.forename: Spencer
authors.initials: S
authors.lastname: Adams
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, U.S.A.
authors.forename: Jie
authors.initials: J
authors.lastname: Lin
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, U.S.A.
authors.forename: Derek
authors.initials: D
authors.lastname: Brown
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, U.S.A. Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, U.S.A.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Shriver
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, U.S.A. Department of Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda, MD, U.S.A. kzhu@murthacancercenter.org.
authors.forename: Kangmin
authors.initials: K
authors.lastname: Zhu
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000532:radiotherapy*; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy*; D000069079:Radiation Exposure / Q000032:analysis*; D018426:SEER Program; D014466:Ultraviolet Rays; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*
keywords: Cancer incidence; SEER; cervical cancer; melanoma; oral cancer; pharyngeal cancer; ultraviolet radiation exposure