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IJE Advance Access published online on August 30, 2006
International Journal of Epidemiology, doi:10.1093/ije/dyl197
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2006; all rights reserved.
Accepted August 2, 2006

Original paper

Risk factors for skin cancers: a nested case-control study within the Nurses' Health Study

Jiali Han 1 *, Graham A. Colditz 2, and David J. Hunter 3

1 Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA; The Program in Molecular and Genetic Epidemiology, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
2 Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
3 Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; The Program in Molecular and Genetic Epidemiology, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA

* To whom correspondence should be addressed.
Jiali Han, E-mail: jiali.han{at}channing.harvard.edu


  Abstract

Background Constitutional factors and sun exposure are associated with skin cancer risk. However, these relations are complex and differ according to skin cancer type.

Methods We examined the associations of constitutional risk factors and sun exposure with the risks of three types of skin cancer simultaneously and evaluated the interaction between constitutional susceptibility and sun exposure in a nested case-control study within the Nurses' Health Study [200 melanoma, 275 squamous cell carcinoma (SCC), and 283 basal cell carcinoma (BCC) cases, and 804 controls]. Information regarding skin cancer risk factors was obtained from the retrospective supplementary questionnaire.

Results Constitutional susceptibility was an independent risk factor for all three types of skin cancer. Sunlamp usage or tanning salon attendance was a risk factor for melanoma after adjusting for potential confounding variables (OR for ever vs never usage, 2.06, 95% CI 1.30-3.26). Higher sun exposure while wearing a bathing suit was an independent risk factor for all three types of skin cancer. We observed a significant interaction between constitutional susceptibility and sun exposure while wearing a bathing suit on melanoma risk (P, interaction, 0.03); women with the highest susceptibility and highest exposure had an OR of 8.37 (95% CI 3.07-22.84). This interaction was weaker and non-significant for SCC and BCC.

Conclusions These data largely confirm past studies on risk factors for skin cancer but provide evidence of difference on the strength of these risk factors for melanoma compared with SCC and BCC.

Keywords: constitutional susceptibility; sun exposure; skin cancer.
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