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      Residential Radon Exposure and Skin Cancer Incidence in a Prospective Danish Cohort

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          Abstract

          Background

          Although exposure to UV radiation is the major risk factor for skin cancer, theoretical models suggest that radon exposure can contribute to risk, and this is supported by ecological studies. We sought to confirm or refute an association between long-term exposure to residential radon and the risk for malignant melanoma (MM) and non-melanoma skin cancer (NMSC) using a prospective cohort design and long-term residential radon exposure.

          Methods

          During 1993–1997, we recruited 57,053 Danish persons and collected baseline information. We traced and geocoded all residential addresses of the cohort members and calculated radon concentrations at each address lived in from 1 January 1971 until censor date. Cox proportional hazards models were used to estimate incidence rate-ratios (IRR) and confidence intervals (CI) for the risk associated with radon exposure for NMSC and MM, and effect modification was assessed.

          Results

          Over a mean follow-up of 13.6 years of 51,445 subjects, there were 3,243 cases of basal cell carcinoma (BCC), 317 cases of squamous cell carcinoma (SCC) and 329 cases of MM. The adjusted IRRs per 100 Bq/m 3 increase in residential radon levels for BCC, SCC and MM were 1.14 (95% CI: 1.03, 1.27), 0.90 (95% CI: 0.70, 1.37) and 1.08 (95% CI: 0.77, 1.50), respectively. The association between radon exposure and BCC was stronger among those with higher socio-economic status and those living in apartments at enrollment.

          Conclusion and Impact

          Long-term residential radon exposure may contribute to development of basal cell carcinoma of the skin. We cannot exclude confounding from sunlight and cannot conclude on causality, as the relationship was stronger amongst persons living in apartments and non-existent amongst those living in single detached homes.

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          Most cited references 32

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          The Danish Civil Registration System.

          The Danish Civil Registration System (CRS) was established in 1968, and all persons alive and living in Denmark were registered for administrative use. CRS includes individual information on the unique personal identification number, name, gender, date of birth, place of birth, citizenship, identity of parents and continuously updated information on vital status, place of residence and spouses. Since 1968, CRS has recorded current and historical information on all persons living in Denmark. Among persons born in Denmark in 1960 or later it contains complete information on maternal identity. For women born in Denmark in April 1935 or later it contains complete information on all their children. CRS contains complete information on immigrations and emigrations from 1969 onwards, permanent residence in a Danish municipality from 1971 onwards, and full address in Denmark from 1977 onwards. CRS in connection with other registers and biobanks will continue to provide the basis for significant knowledge relevant to the aetiological understanding and possible prevention of human diseases.
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            The Danish Cancer Registry.

            The Danish Cancer Registry was founded in 1942. The Cancer Registry contains data on the incidence of cancer in the Danish population since 1943. Validity of the Cancer Registry is secured by the application of manual quality control routines in the daily production of the Cancer Registry, the application of the automated cancer logic, and the use of multiple notifications from different data sources, which also secures a high degree of completeness. In 2008 the Cancer Registry finished a process of modernisation where reporting became electronic through integration with the patient administrative systems and manual coding was partly replaced by an automatic coding logic.
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              Study design, exposure variables, and socioeconomic determinants of participation in Diet, Cancer and Health: a population-based prospective cohort study of 57,053 men and women in Denmark.

              Diet is considered an important aspect of lifestyle related to cancer development. To contribute further knowledge within this field a Danish prospective cohort study "Diet, Cancer and Health" has been initiated. The aims of this paper are to give a description of the study design, measurement procedures, and differences between participants and non-participants with special reference to socioeconomic characteristics. A total of 160,725 individuals 50-64 years of age living in Copenhagen or Aarhus were invited to participate. Information concerning diet and other lifestyle factors was obtained from 57,053 participants using questionnaires and interviews. Anthropometric measurements were taken and biological material collected. In addition, detailed (selected) socioeconomic information on all invited persons including 103,671 non-participants was obtained from statistical registers in Statistics Denmark. Differences were seen between participants and non-participants on a number of socioeconomic factors. The highest participation in relation to education was found among participants with higher education, with a significant tendency to be highest in the second highest level of higher education (3-4 years). Married people were more likely to participate than persons living alone or cohabiting. Results from the prospective cohort study "Diet, Cancer and Health" support the general assumption that lower socioeconomic groups are underrepresented in epidemiological studies.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                14 August 2015
                2015
                : 10
                : 8
                PONE-D-15-22829
                10.1371/journal.pone.0135642
                4537191
                26274607

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

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                Figures: 1, Tables: 3, Pages: 14
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                Funding
                This work was supported by Research Grants from Danish Cancer Society, Aase and Ejnar Danielsens, King Christian the 10th, A.P. Møller, The Hartmann Brothers, The Foundation of 1870, Snedker Jacobsen and hustru Astrid Jacobsen, Architect Holger Hjortenberg and hustru Dagmar Hjortenberg, Civil Engineer Frode V. Nyegaard and Simon Spies. These foundations had no role in the design of the study, interpretation of the results, or writing of the paper.
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                All relevant data are in the paper.

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