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American Journal of Epidemiology Advance Access originally published online on April 17, 2008
American Journal of Epidemiology 2008 167(12):1421-1429; doi:10.1093/aje/kwn077
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Are Patients with Skin Cancer at Lower Risk of Developing Colorectal or Breast Cancer?

I. Soerjomataram1,2, W. J. Louwman2, V. E. P. P. Lemmens2, J. W. W. Coebergh1,2 and E. de Vries1,2

1 Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
2 Comprehensive Cancer Centre South, Eindhoven, the Netherlands

Correspondence to Isabelle Soerjomataram, Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands (e-mail: i.soerjomataram{at}erasmusmc.nl).

Received for publication September 25, 2007. Accepted for publication March 11, 2008.

Ultraviolet exposure may reduce the risk of colorectal and breast cancer as the result of rising vitamin D levels. Because skin cancer is positively related to sun exposure, the authors hypothesized a lower incidence of breast and colorectal cancer after skin cancer diagnosis. They analyzed the incidence of colorectal and breast cancer diagnosed from 1972 to 2002 among 26,916 Netherlands skin cancer patients (4,089 squamous cell carcinoma (SCC), 19,319 basal cell carcinoma (BCC), and 3,508 cutaneous malignant melanoma (CMM)). Standardized incidence ratios were calculated. A markedly decreased risk of colorectal cancer was found for subgroups supposedly associated with the highest accumulated sun exposure: men (standardized incidence ratio (SIR) = 0.83, 95% confidence interval (CI): 0.71, 0.97); patients with SCC (SIR = 0.64, 95% CI: 0.43, 0.93); older patients at SCC diagnosis (SIR = 0.59, 95% CI: 0.37, 0.88); and patients with a SCC or BCC lesion on the head and neck area (SIR = 0.59, 95% CI: 0.36, 0.92 for SCC and SIR = 0.78, 95% CI: 0.63, 0.97 for BCC). Patients with CMM exhibited an increased risk of breast cancer, especially advanced breast cancer (SIR = 2.20, 95% CI: 1.10, 3.94) and older patients at CMM diagnosis (SIR = 1.87, 95% CI: 1.14, 2.89). Study results suggest a beneficial effect of continuous sun exposure against colorectal cancer. The higher risk of breast cancer among CMM patients may be related to socioeconomic class, both being more common in the affluent group.

breast neoplasms; colorectal neoplasms; risk; skin neoplasms; vitamin D

Abbreviations: BCC, basal cell carcinoma; CI, confidence interval; CMM, cutaneous malignant melanoma; SCC, squamous cell carcinoma; SIR, standardized incidence ratio


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