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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 references25

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          Epidemiology of melanoma and nonmelanoma skin cancer--the role of sunlight.

          Melanoma and nonmelanoma skin cancer (NMSC) are now the most common types of cancer in white populations. Both tumor entities show an increasing incidence rate worldwide but a stable or decreasing mortality rate. The rising incidence rates of NMSC are probably caused by a combination of increased sun exposure or exposure to ultraviolet (UV) light, increased outdoor activities, changes in clothing style, increased longevity, ozone depletion, genetics and in some cases, immune suppression. A dose-dependent increase in the risk of squamous cell carcinoma (SCC) of the skin was found associated with exposure to Psoralen and UVA irradiation. An intensive UV exposure in childhood and adolescence was causative for the development of basal cell carcinoma (BCC) whereas for the aetiology of SCC a chronic UV exposure in the earlier decades was accused. Cutaneous malignant melanoma is the most rapidly increasing cancer in white populations. The frequency of its occurrence is closely associated with the constitutive colour of the skin and depends on the geographical zone. The highest incidence rates have been reported from Queensland, Australia with 56 new cases per year per 100,000 for men and 43 for women. Mortality rates of melanoma show a stabilisation in the USA, Australia and also in European countries. The tumor thickness is the most important prognostic factor in primary melanoma. There is an ongoing trend towards thin melanoma since the last two decades. Epidemiological studies have confirmed the hypothesis that the majority of all melanoma cases are caused, at least in part, by excessive exposure to sunlight. In contrast to squamous cell carcinoma, melanoma risk seems not to be associated with cumulative, but intermittent exposure to sunlight. Therefore campaigns for prevention and early detection are necessary.
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            The epidemiology of skin cancer.

            Melanoma and non-melanoma (basal and squamous cell carcinoma) skin cancer (NMSC) are now the most common types of cancer in the white populations and the incidence of skin cancer has reached epidemic proportions. According to recent population-based studies from Australia the incidence rate is over 2% for basal cell carcinoma in males and 1% for squamous cell carcinoma, and there are over 50 new cases of melanoma per 100 000.
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              Development of a semiquantitative food frequency questionnaire to assess food, energy and nutrient intake in Denmark.

              Foods to be included in a Danish self-administered semiquantitative food frequency questionnaire were identified from food tables developed, together with data collected, for the survey 'Dietary habits in Denmark, 1985'. The questionnaire was to be used in a prospective study on diet, cancer and health, and the aim was to rank individuals with regard to intake of 19 different nutrients considered of prime importance in human carcinogenesis. The questionnaire for the dietary survey included 247 foods and recipes. From stepwise multiple regression analyses with the intake of each of the 19 nutrients as the dependent variable and the intake of the 247 foods and recipes as independent variables, the foods in the models explaining 90% of the between-person variability were considered for the final questionnaire. All relevant analyses were performed for the study group as a whole, for men and women separately, and in each gender for subgroups of energy intake. Taken together, the models explaining 90% of the between-person variability identified a total of 74 foods or recipes, which were important predictors of the intake of one or more of the nutrients considered. A few foods were excluded and a few foods were added to the final questionnaire based on common biological background information, and on information on foods providing important amounts of given nutrients, but which failed to contribute to regression analyses. The 92 foods and recipes, which were included in the final questionnaire provided altogether 81% of the average total supply of the nutrients.(ABSTRACT TRUNCATED AT 250 WORDS)
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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
                : e0135642
                Affiliations
                [1 ]Research Center of Prevention and Heath, Center of Health, Capital region of Denmark, Glostrup Hospital, Glostrup, Denmark
                [2 ]Diet, Genes and Environment, Danish Cancer Society Research Centre, Copenhagen, Denmark
                [3 ]Department Public Health, Section of Environmental Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
                [4 ]Virus, Lifestyle and Genes, Danish Cancer Society Research Centre, Copenhagen, Denmark
                [5 ]Center for Nuclear Technologies, Technical University of Denmark, Roskilde, Denmark
                [6 ]National Institute of Radiation Protection, Herlev, Denmark
                [7 ]Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
                [8 ]Department of Environmental Science, Aarhus University, Aarhus, Denmark
                Ohio State University Medical Center, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: EVB SL. Performed the experiments: EVB. Analyzed the data: EVB SL ORN. Contributed reagents/materials/analysis tools: EVB. Wrote the paper: EVB CEA KU CP AT AJ SK SL ORN OH MS. Registered extraction of all skin cancer cases: AJ SK. Prediction and quality control of all exposure data: CEA KU. Collected data on cohort persons: AT.

                Article
                PONE-D-15-22829
                10.1371/journal.pone.0135642
                4537191
                26274607
                f3dd465b-5d76-4e30-b850-7127d1c85fd1
                Copyright @ 2015

                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

                History
                : 26 May 2015
                : 23 July 2015
                Page count
                Figures: 1, Tables: 3, Pages: 14
                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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