Abstract
To investigate whether risk factors for keratinocyte carcinomas (KCs), namely pigmentary traits and sun exposure, are associated with risk of non‐Hodgkin's lymphomas (NHL) and chronic lymphocytic leukemia (CLL). E3N is a prospective cohort of French women aged 40–65 years at inclusion in 1990. Cancer data were collected at baseline and updated every 2–3 years. Hazard Ratios (HRs) and 95% confidence intervals (CIs) for associations between pigmentary traits and sun exposure, and risk of CLL/NHL were estimated using Cox models. With a median follow‐up of 24 years, 622 incident cases of CLL/NHL were ascertained among the 92,097 included women. The presence of nevi was associated with CLL/NHL risk: HR for “many or very many nevi” relative to “no nevi”: 1.56 [1.15; 2.11]. Such association with number of nevi appears to be mostly limited to risk of CLL: HR for “many or very many nevi”: 3.00 [1.38; 6.52]; versus 1.32 [0.94; 1.84] for NHL. Women whose skin was highly sensitive to sunburn also had a higher risk of CLL: HR = 1.96 [1.21; 3.18], while no increase in risk of NHL was observed. Skin or hair color, number of freckles, and average daily ultraviolet (UV) dose during spring and summer in location of residence at birth or at inclusion (kJ/m2) were not associated with CLL/NHL risk. Some pigmentary traits (presence of nevi and skin sensitivity), but not sun exposure, were associated with CLL/NHL. These observations suggest that CLL may share some constitutional risk factors with keratinocyte cancers.
Highlights
Chronic lymphocytic leukemia (CLL) and non-Hodgkin's lymphoma (NHL) are among the most common hematologic cancers
To study the association between keratinocyte carcinomas (KCs) risk factors and CLL/NHL risk, we excluded from the original study population (n = 98,995) women with any cancer diagnosed before inclusion (n = 4,848) and women lost to follow-up after they answered the inclusion questionnaire (n = 2,050)
The presence of nevi was associated with CLL/NHL risk: Hazard Ratios (HRs) for nevi frequency compared to no nevi was 1.42 [1.04;
Summary
Chronic lymphocytic leukemia (CLL) and non-Hodgkin's lymphoma (NHL) are among the most common hematologic cancers. Main risk factors include exposure to pesticides, being a farmer, chronic viral infections with Human Immunodeficiency Virus (HIV) or hepatitis B or C viruses, and autoimmune diseases.[1] Genome-Wide Association Studies (GWAS) have identified several polymorphisms that modulate the risk of CLL and NHL.[2,3] Keratinocyte carcinomas (basal-cell carcinoma (BCC) and squamous-cell carcinoma (SCC)) are the most common cancers worldwide, and their incidence has been increasing for several decades. Several risk factors have been well established for these cancers, such as chronic exposure to ultraviolet (UV) radiation, a fair pigmentation, presence of nevi, and a family history of keratinocyte carcinomas.[4,5] The incidence of keratinocytes carcinomas (KCs) is increased in patients with immune deficiency, especially after organ transplantation.[6] Genetic predisposition factors have been identified in several studies, including genome-wide association studies.[7,8]. Unlike KCs, for which the incidence increases with sun exposure, the incidence of CLL and NHL appears to be inversely associated with sun exposure,[15] some studies have published conflicting results.[16,17] We investigated whether KCs risk factors, namely pigmentary traits and sun exposure, were associated with CLL/NHL risk in the French E3 N prospective cohort
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