Abstract
BackgroundBasal cell carcinoma of the skin (BCC) is the most common cancer in populations of European ancestry. Although consistently linked with basal cell carcinoma of the skin in case-control studies, few prospective cohort studies have evaluated the shape of the exposure-response of basal cell carcinoma associated with cumulative radiant solar ultraviolet exposure (UVR).MethodsWe followed 63,912 white cancer-free US radiologic technologists from entry (1983–1998) to exit (2003–2005) with known ultraviolet irradiance at up to 5 residential locations. Using generalized-additive and relative risk models we analyzed the exposure-response of basal cell carcinomas associated with ambient cumulative ultraviolet radiant exposure using ground-based National Solar Radiation database Average Daily Total Global data and satellite-based National Aeronautics and Space Administration Total Ozone Mapping Spectrometer data.ResultsThere were 2151 technologists with an incident primary basal cell carcinoma. Risk of basal cell carcinoma rose with increasing cumulative ultraviolet radiation exposure using both measures, such that 1 MJ cm− 2 increased basal cell carcinoma risk by 8.48 (95% CI 5.22, 11.09, p < 0.001) and by 10.15 (95% CI 6.67, 13.10, p < 0.001) per 10,000 persons per year using the Average Daily Total Global and Total Ozone Mapping Spectrometer ultraviolet data, respectively; relative risk was likewise elevated. There was some evidence of upward curvature in the cumulative ultraviolet exposure response using both exposure measures with a greater increase in risk of basal cell carcinoma at higher levels of ultraviolet radiation exposure, but less evidence for curvature in relative risk. There are indications of substantial variation of relative risk with time after exposure and age at exposure, so that risk is highest for the period 10–14 years after ultraviolet radiation exposure and for those exposed under the age of 25.ConclusionsWe observed increases in risk of basal cell carcinoma and a similar exposure-response for ground-based and satellite ultraviolet radiation measures. Our observations suggest that interventions should concentrate on persons with higher levels of ultraviolet radiation exposure.
Highlights
Basal cell carcinoma of the skin (BCC) is the most common cancer in populations of European ancestry
Overview of US radiologic technologists (USRT) study The USRT cohort consists of 146,022 radiologic technologists living in the United States and its territories who were certified by the American Registry of Radiologic Technologists (ARRT) for at least 2 years between 1926 and 1982
Study population and follow-up In the current study we evaluated the 63,912 white technologists who completed a baseline questionnaire and the third questionnaire and did not report any specific cancer or an unknown type of cancer diagnosed prior to their baseline questionnaire, and who had sufficiently complete residential history that they could be linked to two separate databases of ultraviolet radiation (UVR) irradiance estimates (AVGLO, Total Ozone Mapping Spectrometer (TOMS)) by calendar time period and location
Summary
Basal cell carcinoma of the skin (BCC) is the most common cancer in populations of European ancestry. Consistently linked with basal cell carcinoma of the skin in case-control studies, few prospective cohort studies have evaluated the shape of the exposure-response of basal cell carcinoma associated with cumulative radiant solar ultraviolet exposure (UVR). Exposure to solar ultraviolet radiation (UVR), and ultraviolet B (UVB) radiation, is the primary risk factor for basal cell carcinoma (BCC) [1], the most common cancer in populations of European ancestry. Information on BCC is usually not uniformly collected by many US or other population-based cancer registries so that quantitative information on risk in relation to many suspected etiologically relevant factors is scarce [3, 4]. In several cohorts [5,6,7], UVR has been assessed using Robertson-Berger (RB) ground-based meters over the lifetime. The exposure metric used was limited to average UVR over a lifetime
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