Abstract
BackgroundCutaneous melanoma (CM) is a cancer usually associated with high socio-economic level in the literature. Few studies have, however, assessed this relationship by gender and site or the association between CM and rurality.MethodsA major-sized historical occupational Swedish cohort comprising 2,992,166 workers was used to estimate relative risk of cutaneous melanoma, broken down by gender and anatomical site, for occupational sectors (as a proxy of socio-economic class) and rurality. To this end, Poisson models were fitted for each site in men and women, including occupational sector and town size, with adjustment for age, period of diagnosis and geographical area as possible confounding factors.ResultsWhite collar workers presented a marked increased of risk in men in all melanoma cases, as well as in trunk, upper and lower limbs. This pattern was less clear for women, in which some heterogeneity appeared, as low risks in lower socioeconomic sectors in trunk, or risk excesses in white collar workers in lower limbs did not achieve statistical significance. Males also showed significant differences in risk by rural/urban distribution, but in women this association was limited to CM of lower limb. Risk of CM of head/neck did not vary by occupational sector or town size, thus depicting a specific epidemiological profile, which proved common to both sexes.ConclusionWhile differences in risk between men and women could suggest greater homogeneity in UV-exposure behaviour among women, the uniform risk pattern in head and neck melanoma, present in both sexes, might support the coexistence of different aetiological pathways, related to anatomical site.
Highlights
Cutaneous melanoma (CM) is a cancer usually associated with high socio-economic level in the literature
Using a major-sized occupational Swedish historical cohort [21], comprising almost 3 million persons followed up from 1971 to 1989, we studied the relationship between occupational sector, rurality and melanoma incidence by site and sex, duly adjusted for age, period of diagnosis and latitude
Across follow-up, a total of 6187 cases of cutaneous melanoma were observed among men, with trunk accounting for 51%, head/neck and upper limbs for 12% each, and lower limbs for an additional 11%
Summary
Cutaneous melanoma (CM) is a cancer usually associated with high socio-economic level in the literature. Cutaneous melanoma (CM) is one of the neoplasms more usually associated with higher social class [1,2,3,4,5]. Sun-bed use [9] has been related to increased CM risk; and other lifestyle-related exposures in which social class might differ, such as occupation [10,11], tobacco or alcohol use [12], diet [13], or contraceptive use [14], have been studied as possible modifiers of melanoma risk, albeit with inconclusive results. Most studies on socio-economic level and melanoma have mainly focused on men, and anatomical site has not usually been addressed [4,15]. As reported [17,18,19,20], risk factors might conceivably differ by site, which would justify the interest in studying risk factors for each anatomical location separately
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