During the past four decades, the incidence of esophageal adenocarcinoma (EAC) has increased markedly in Western populations. Recent reports have suggested that the rate of increase has slowed or ...plateaued.
Using data from cancer registries in Australia, the United States and Sweden, we examined incidence trends for esophageal and gastric cardia tumors between 1984 and 2008 using joinpoint analyses and age–period–cohort models.
EAC incidence continues to undergo statistically significant annual increases in Australia and the United States, although the rate of increase has slowed. Among men, incidence increased annually by 2.2% 95% confidence interval (CI) 1.5% to 2.9% between 1994 and 2008 in Australia and 1.5% (95% CI 0.2% to 2.8%) between 1998 and 2008 in the United States. EAC incidence among men remained unchanged in Sweden between 2001 and 2008 (P = 0.52). EAC incidence among women showed significant linear increases between 1984 and 2008. Age–period–cohort models suggested strong effects for both period and birth cohort on EAC incidence in Australia and the United States, and a strong period effect for Sweden.
EAC incidence continues to increase in Australia and the United States. The continued increases, even among more recent birth cohorts, suggest that EAC incidence will continue to rise during coming decades.
Summary
Background
Sunscreen use can prevent skin cancer, but there are concerns that it may increase the risk of vitamin D deficiency.
Objectives
We aimed to review the literature to investigate ...associations between sunscreen use and vitamin D3 or 25 hydroxyvitamin D 25(OH)D concentration.
Methods
We systematically reviewed the literature following the Meta‐analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. We identified manuscripts published in English between 1970 and 21 November 2017. Eligible studies were experimental using an artificial ultraviolet radiation (UVR) source, field trials or observational studies. The results of each of the experimental studies and field trials are described in detail. Two authors extracted information from observational studies, and applied quality scoring criteria that were developed specifically for this question. These have been synthesized qualitatively.
Results
We included four experimental studies, three field trials (two were randomized controlled trials) and 69 observational studies. In the experimental studies sunscreen use considerably abrogated the vitamin D3 or 25(OH)D production induced by exposure to artificially generated UVR. The randomized controlled field trials found no effect of daily sunscreen application, but the sunscreens used had moderate protection sun protection factor SPF) ~16. The observational studies mostly found no association or that self‐reported sunscreen use was associated with higher 25(OH)D concentration.
Conclusions
There is little evidence that sunscreen decreases 25(OH)D concentration when used in real‐life settings, suggesting that concerns about vitamin D should not negate skin cancer prevention advice. However, there have been no trials of the high‐SPF sunscreens that are now widely recommended.
What's already known about this topic?
Previous experimental studies suggest that sunscreen can block vitamin D production in the skin but use artificially generated ultraviolet radiation with a spectral output unlike that seen in terrestrial sunlight.
Nonsystematic reviews of observational studies suggest that use in real life does not cause vitamin D deficiency.
What does this study add?
This study systematically reviewed all experimental studies, field trials and observational studies for the first time.
While the experimental studies support the theoretical risk that sunscreen use may affect vitamin D, the weight of evidence from field trials and observational studies suggests that the risk is low.
We highlight the lack of adequate evidence regarding use of the very high sun protection factor sunscreens that are now recommended and widely used.
Linked Editorial: Wolf. Br J Dermatol 2019; 181:881–882.
Plain language summary available online
Objective: To review the evidence that childhood is a period of particular susceptibility to the carcinogenic effects of solar radiation. Methods: Studies were identified through searches of ...computerized bibliographic databases and article reference lists. Eligible studies were those that reported risks of melanoma associated with sun exposure during two or more age-periods. Results: The measurement of childhood sun exposure varied across studies, preventing formal meta-analysis for most measures. We found that the way in which sun exposure was measured led to strikingly different conclusions regarding the association between age-specific sun exposure and risk of melanoma. Ecological studies assessing ambient sun exposure consistently reported lower risks of melanoma among people who resided in a low ultraviolet (UV) environment in childhood compared with those who resided in a high UV environment. In contrast, case-control studies differed widely in their findings, and no consistent associations with childhood sun exposure were observed. Conclusions: Ecological studies provided better-quality evidence than case-control studies for examining the effects of exposure to sunlight during specific age periods. Exposure to high levels of sunlight in childhood is a strong determinant of melanoma risk, but sun exposure in adulthood also plays a role.
Summary
Individual studies have suggested that the association between occupational exposure to solar ultraviolet radiation (UVR) and the development of keratinocyte cancers (KCs) may only be valid ...in populations of European ancestry living in certain geographical regions. Comparative global data are scarce and so this review aimed to summarize current evidence on the association between occupational exposure to solar UVR and the development of KCs, with a specific focus on geographical location and skin colour. Ovid MEDLINE, PubMed, Embase and Web of Science were searched for potentially relevant records. Extracted data were summarized by study, country and region. We included one prospective cohort study and 18 case–control studies (n = 15 233) from 12 countries in regions where the majority of the population is white skinned (Americas, Europe and Oceania). Eighteen of the 19 studies reported effect estimates suggesting an increased risk of basal cell carcinoma (BCC) and/or squamous cell carcinoma (SCC) among outdoor workers. Only 11 studies found a significantly increased risk and many had imprecise estimates. There was a significantly increased risk of BCC and SCC in individual studies in North America, Latin America and the Caribbean, Western Europe and Southern Europe, but not across regions or countries. Overall, 95% of studies reported higher risks among outdoor workers, although the increases in risk were statistically significant in just over half of the studies. Well‐designed and sufficiently powered occupational case–control and cohort studies with adequate adjustment for confounding factors and other risk factors are required to provide more accurate risk estimates for occupational KC.
Background: Some melanomas form on sun-exposed body sites, whereas others do not. We previously proposed that melanomas at different body sites arise through different pathways that have different ...associations with melanocytic nevi and solar keratoses. We tested this hypothesis in a case–case comparative study of melanoma patients in Queensland, Australia. Methods: We randomly selected patients from among three prespecified groups reported to the population-based Queensland Cancer Registry: those with superficial spreading or nodular melanomas of the trunk (n = 154, the reference group), those with such melanomas of the head and neck (n = 77, the main comparison group), and those with lentigo maligna melanoma (LMM) (n = 75, the chronic sun-exposed group). Each participant completed a questionnaire, and a research nurse counted melanocytic nevi and solar keratoses. We calculated exposure odds ratios (ORs) and 95% confidence intervals (CIs) to quantify the association between factors of interest and each melanoma group. Results: Patients with head and neck melanomas, compared with patients with melanomas of the trunk, were statistically significantly less likely to have more than 60 nevi (OR = 0.34, 95% CI = 0.15 to 0.79) but were statistically significantly more likely to have more than 20 solar keratoses (OR = 3.61, 95% CI = 1.42 to 9.17) and also tended to have a past history of excised solar skin lesions (OR = 1.87, 95% CI = 0.89 to 3.92). Patients with LMM were also less likely than patients with truncal melanomas to have more than 60 nevi (OR = 0.32, 95% CI = 0.14 to 0.75) and tended toward more solar keratoses (OR = 2.14, 95% CI = 0.88 to 5.16). Conclusions: Prevalences of nevi and solar keratoses differ markedly between patients with head and neck melanomas or LMM and patients with melanomas of the trunk. Cutaneous melanomas may arise through two pathways, one associated with melanocyte proliferation and the other with chronic exposure to sunlight.
Highlights • There is a need for usable instruments to assess sun exposure habits. • Validation of the SEPI instrument for sun habits was done in Australia and Sweden. • The SEPI is a stable ...instrument with with an overall acceptable validity and reliability. • The SEPI was found applicable in both the investigated UVR environments.
Alcohol intake is a strong and well established risk factor for oesophageal squamous cell carcinoma (OSCC), but the association with oesophageal adenocarcinoma (OA) or adjacent tumours of the ...oesophagogastric junction (OGJA), remains unclear. Therefore, the association of alcohol intake with OSCC, OA, and OGJA was determined in nine case-control studies and two cohort studies of the Barrett's Esophagus and Esophageal Adenocarcinoma Consortium (BEACON).
Information was collected on alcohol intake, age, sex, education, body mass index, gastro-oesophageal reflux, and tobacco smoking from each study. Along with 10,854 controls, 1821 OA, and 1837 OGJA, seven studies also collected OSCC cases (n=1016). Study specific ORs and 95% CIs were calculated from multivariate adjusted logistic regression models for alcohol intake in categories compared to non-drinkers. Summary risk estimates were obtained by random effects models. Results No increase was observed in the risk of OA or OGJA for increasing levels of any of the alcohol intake measures examined. ORs for the highest frequency category (≥ 7 drinks per day) were 0.97 (95% CI 0.68 to 1.36) for OA and 0.77 (95% CI = 0.54 to 1.10) for OGJA. Suggestive findings linked moderate intake (eg, 0.5 to <1 drink per day) to decreased risk of OA (OR 0.63, 95% CI 0.41 to 0.99) and OGJA (OR 0.78, 95% CI 0.62 to 0.99). In contrast, alcohol intake was strongly associated with increased risk of OSCC (OR for ≥ 7 drinks per day 9.62, 95% CI 4.26 to 21.71).
In contrast to OSCC, higher alcohol consumption was not associated with increased risk of either OA or OGJA. The apparent inverse association observed with moderate alcohol intake should be evaluated in future prospective studies.
Summary
Background
Lung transplant recipients are at high risk of skin cancer, but precise annual incidence rates of treated skin cancers per patient are unknown.
Objectives
To perform a prospective ...assessment of the total burden of histologically confirmed squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) and associated factors in lung transplant recipients.
Methods
A population‐based cohort of 125 Queensland lung transplant recipients aged 18 years and over, recruited between 2013 and 2015, were followed to the end of 2016. All underwent dermatological skin examinations at baseline and annually thereafter and patients self‐reported all interim treated skin cancers, which were verified against pathology databases. Standard skin cancer risk factors were obtained via questionnaire, and details of medications were acquired from hospital records.
Results
During a median follow‐up time of 1·7 years, 29 (23%) and 30 (24%) lung transplant recipients with a median duration of immunosuppression of 3·3 years developed SCC and BCC, respectively. The general population age‐standardized incidence rates of SCC and BCC were 201 and 171 per 1000 person‐years, respectively (based on first primary SCC or BCC during follow‐up); however, on accounting for multiple primary tumours, corresponding incidence rates were 447 and 281 per 1000 person‐years. Risk of multiple SCCs increased around sixfold in those aged ≥ 60 years and in those with previous skin cancer, and increased around threefold in those treated with the antifungal medication voriconazole. Multiple BCC risk rose threefold from age 60 years and tenfold for patients with previous skin cancer.
Conclusions
Lung transplant recipients have very high incidence of multiple primary skin cancers. Close surveillance and assiduous prevention measures are essential.
Linked Comment: Proby and Harwood. Br J Dermatol 2020; 183:416–417.
What is already known about this topic?
Lung transplant recipients are known to be especially prone to squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) owing to high‐dose immunosuppressants, but precise annual incidence rates and skin cancer multiplicity in this high‐risk group are unknown.
What does this study add?
We have quantified the burden of new skin cancers developed annually by lung transplant recipients in Queensland, Australia.
We found an extremely high histologically confirmed SCC tumour burden of 447 per 1000 person‐years, and a high BCC tumour burden of 281 per 1000 person‐years.
Multiplicity of SCCs and BCCs increased with age > 60 years and previous skin cancer.
Multiple SCCs also increased after treatment with the antifungal medication voriconazole.
Linked Comment: Proby and Harwood. Br J Dermatol 2020; 183:416–417.
Abstract Background Vitamin D, specifically serum 25(OH)D has been associated with mortality, cancer and multiple other health endpoints in observational studies, but there is a paucity of clinical ...trial evidence sufficient to determine the safety and effectiveness of population-wide supplementation. We have therefore launched the D-Health Trial, a randomized trial of vitamin D supplementation for prevention of mortality and cancer. Here we report the methods and describe the trial cohort. Methods The D-Health Trial is a randomized placebo-controlled trial, with planned intervention for 5 years and a further 5 years of passive follow-up through linkage with health and death registers. Participants aged 65–84 years were recruited from the general population of Australia. The intervention is monthly oral doses of 60,000 IU of cholecalciferol or matching placebo. The primary outcome is all-cause mortality. Secondary outcomes are total cancer incidence and colorectal cancer incidence. Results We recruited 21,315 participants to the trial between February 2014 and May 2015. The participants in the two arms of the trial were well-balanced at baseline. Comparison with Australian population statistics shows that the trial participants were less likely to report being in fair or poor health, to be current smokers or to have diabetes than the Australian population. However, the proportion overweight or with health conditions such as arthritis and angina was similar. Conclusions Observational data cannot be considered sufficient to support interventions delivered at a population level. Large-scale randomized trials such as the D-Health Trial are needed to inform public health policy and practice.
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