Cancer Causes & Control

, Volume 22, Issue 6, pp 885–897 | Cite as

Early-life sun exposure and risk of melanoma before age 40 years

  • Anne E. Cust
  • Mark A. Jenkins
  • Chris Goumas
  • Bruce K. Armstrong
  • Helen Schmid
  • Joanne F. Aitken
  • Graham G. Giles
  • Richard F. Kefford
  • John L. Hopper
  • Graham J. Mann
Original paper

Abstract

Objective

To examine associations between early-life sun exposure and risk of invasive cutaneous melanoma diagnosed between ages 18 and 39 years.

Methods

Data were analysed from 606 cases and 481 controls from the Australian Melanoma Family Study, a population-based, case–control-family study. Self- and parent-reported sun exposure was collected by interview. Odds ratios (OR) were estimated using unconditional logistic regression, adjusted for potential confounders.

Results

Self-reported childhood total sun exposure was not associated with melanoma overall, but was positively associated with melanoma diagnosed at 18–29 years of age (OR for highest vs. lowest quartile: 3.21, 95% confidence intervals (CI) 1.38–7.44; Ptrend 0.02; Pinteraction by age group 0.09). Analyses restricted to participants whose self-reported sun exposure was concordant with that recalled by their parents gave an OR for the highest versus lowest tertile of childhood total sun exposure of 2.28 (95% CI 1.03–5.04; Ptrend 0.05), and for any versus no severe childhood sunburn of 2.36 (95% CI 1.05–5.31). The association of self-reported severe sunburn with melanoma was evident only in people who tended to tan rather than burn and in people who had few nevi.

Conclusion

The association of early-life sun exposure with early-onset melanoma is influenced by host factors.

Keywords

Melanoma Sun exposure Early-onset Sunburn 

Abbreviations

UV

Ultraviolet

Notes

Acknowledgments

We gratefully acknowledge all of the participants, the work and dedication of the research coordinators, interviewers, examiners and data management staff, including Judith Maskiell, Jackie Arbuckle, Steven Columbus, Michaela Lang, Helen Rodais, Caroline Ellis (Centre for MEGA Epidemiology, School of Population Health, University of Melbourne, Melbourne, Australia); Elizabeth A Holland, Chantelle Agha-Hamilton, Carol El Hayek, Lynne Morgan, Joanne Roland, Emma Tyler, Jodi Barton, Caroline Watts and Lesley Porter (Westmead Institute of Cancer Research, University of Sydney at Westmead Millennium Institute and Melanoma Institute Australia, Sydney, Australia); Jodie Jetann, Megan Ferguson, Michelle Hillcoat, Kellie Holland, Pamela Saunders, Joan Roberts and Sheree Tait (Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, Brisbane, Australia); Anil Kurien, Clare Patterson, Caroline Thoo, Sally de Zwaan, Angelo Sklavos, Shobhan Manoharan, Jenny Cahill and Sarah Brennand (skin examiners). This work was supported by the National Health and Medical Research Council of Australia (NHMRC) (project grants 566946, 107359, 211172 and program grant number 402761 to GJM and RFK); the Cancer Council New South Wales (project grant 77/00, 06/10), the Cancer Council Victoria and the Cancer Council Queensland (project grant 371); and the US National Institutes of Health (via RO1 grant CA-83115-01A2 to the international Melanoma Genetics Consortium—GenoMEL). AEC is the recipient of a NHMRC public health postdoctoral fellowship (520018), a Cancer Institute NSW Early Career Development Fellowship (10/ECF/2-06) and a Victorian Cancer Agency Early Career Seed Grant (ECSG07_010). BKA’s research is supported by a University of Sydney Medical Foundation Program Grant and JLH is an Australia Fellow of the NHMRC.

References

  1. 1.
    Australian Institute of Health and Welfare (AIHW) & Australasian Association of Cancer Registries (AACR) (2008) Cancer in Australia: an overview, 2008. AIHW, CanberraGoogle Scholar
  2. 2.
    Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59(4):225–249PubMedCrossRefGoogle Scholar
  3. 3.
    Thompson JF, Scolyer RA, Kefford RF (2009) Cutaneous melanoma in the era of molecular profiling. Lancet 374(9687):362–365PubMedCrossRefGoogle Scholar
  4. 4.
    International Agency for Research on Cancer (IARC) World Health Organization (WHO) (1992) Volume 55—Solar and ultraviolet radiation. IARC, WHO, LyonGoogle Scholar
  5. 5.
    Whiteman DC, Whiteman CA, Green AC (2001) Childhood sun exposure as a risk factor for melanoma: a systematic review of epidemiologic studies. Cancer Causes Control 12(1):69–82PubMedCrossRefGoogle Scholar
  6. 6.
    Autier P, Boyle P (2008) Artificial ultraviolet sources and skin cancers: rationale for restricting access to sunbed use before 18 years of age. Nat Clin Pract Oncol 5(4):178–179PubMedCrossRefGoogle Scholar
  7. 7.
    Autier P, Dore JF (1998) Influence of sun exposures during childhood and during adulthood on melanoma risk. EPIMEL and EORTC Melanoma Cooperative Group. European Organisation for Research and Treatment of Cancer. Int J Cancer 77(4):533–537PubMedCrossRefGoogle Scholar
  8. 8.
    Gilchrest BA, Eller MS, Geller AC, Yaar M (1999) The pathogenesis of melanoma induced by ultraviolet radiation. N Engl J Med 340(17):1341–1348PubMedCrossRefGoogle Scholar
  9. 9.
    Holman CD, Armstrong BK, Heenan PJ (1983) A theory of the etiology and pathogenesis of human cutaneous malignant melanoma. J Natl Cancer Inst 71(4):651–656PubMedGoogle Scholar
  10. 10.
    Kricker A, Vajdic CM, Armstrong BK (2005) Reliability and validity of a telephone questionnaire for estimating lifetime personal sun exposure in epidemiologic studies. Cancer Epidemiol Biomarkers Prev 14(10):2427–2432PubMedCrossRefGoogle Scholar
  11. 11.
    Rogers C, Kvaskoff M, DiSipio T et al (2009) Prevalence and determinants of sunburn in Queensland. Health Promot J Austr 20(2):102–106PubMedGoogle Scholar
  12. 12.
    Horner MJ, Ries LAG, Krapcho M et al. (2009) SEER cancer statistics review, 1975–2006. National Cancer Institute, Bethesda, http://seer.cancer.gov/csr/1975_2006/
  13. 13.
    Australian Institute of Health, Welfare (AIHW) (2009) ACIM (Australian Cancer Incidence and Mortality) books. AIHW, Canberra, http://www.aihw.gov.au/acim-books/
  14. 14.
    Oliveria SA, Saraiya M, Geller AC, Heneghan MK, Jorgensen C (2006) Sun exposure and risk of melanoma. Arch Dis Child 91(2):131–138PubMedCrossRefGoogle Scholar
  15. 15.
    Gandini S, Sera F, Cattaruzza MS et al (2005) Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer 41(1):45–60PubMedCrossRefGoogle Scholar
  16. 16.
    Whiteman DC, Stickley M, Watt P, Hughes MC, Davis MB, Green AC (2006) Anatomic site, sun exposure, and risk of cutaneous melanoma. J Clin Oncol 24(19):3172–3177PubMedCrossRefGoogle Scholar
  17. 17.
    Holman CD, Armstrong BK, Heenan PJ (1986) Relationship of cutaneous malignant melanoma to individual sunlight-exposure habits. J Natl Cancer Inst 76(3):403–414PubMedGoogle Scholar
  18. 18.
    Whiteman DC, Valery P, McWhirter W, Green AC (1997) Risk factors for childhood melanoma in Queensland, Australia. Int J Cancer 70(1):26–31PubMedCrossRefGoogle Scholar
  19. 19.
    Anderson WF, Pfeiffer RM, Tucker MA, Rosenberg PS (2009) Divergent cancer pathways for early-onset and late-onset cutaneous malignant melanoma. Cancer 115(18):4176–4185PubMedCrossRefGoogle Scholar
  20. 20.
    Walter SD, King WD, Marrett LD (1999) Association of cutaneous malignant melanoma with intermittent exposure to ultraviolet radiation: results of a case–control study in Ontario, Canada. Int J Epidemiol 28(3):418–427PubMedCrossRefGoogle Scholar
  21. 21.
    Cust AE, Schmid H, Maskiell JA et al (2009) Population-based, case–control-family design to investigate genetic and environmental influences on melanoma risk: Australian melanoma family study. Am J Epidemiol 170(12):1541–1554PubMedCrossRefGoogle Scholar
  22. 22.
    Hopper JL, Chenevix-Trench G, Jolley DJ et al (1999) Design and analysis issues in a population-based, case–control-family study of the genetic epidemiology of breast cancer and the Co-operative Family Registry for Breast Cancer Studies (CFRBCS). J Natl Cancer Inst Monogr 26:95–100PubMedGoogle Scholar
  23. 23.
    Hopper JL, Bishop DT, Easton DF (2005) Population-based family studies in genetic epidemiology. Lancet 366(9494):1397–1406PubMedCrossRefGoogle Scholar
  24. 24.
    Australian Bureau of Statistics (2008) Australian demographic statistics, March 2008. ABS, CanberraGoogle Scholar
  25. 25.
    Australian Institute of Health, Welfare (AIHW), Australasian Association of Cancer Registries (AACR) (2007) Cancer in Australia: an overview, 2006. AIHW, CanberraGoogle Scholar
  26. 26.
    Lee-Taylor J, Madronich S (2007) Climatology of UV-A, UV-B, and erythemal radiation at the earth’s surface, 1979–2000. National Center for Atmospheric Research, BoulderGoogle Scholar
  27. 27.
    Kricker A, Armstrong BK, Goumas C et al (2007) Ambient UV, personal sun exposure and risk of multiple primary melanomas. Cancer Causes Control 18(3):295–304PubMedCrossRefGoogle Scholar
  28. 28.
    Bauer J, Garbe C (2003) Acquired melanocytic nevi as risk factor for melanoma development. A comprehensive review of epidemiological data. Pigment Cell Res 16(3):297–306PubMedCrossRefGoogle Scholar
  29. 29.
    Youl P, Aitken J, Hayward N et al (2002) Melanoma in adolescents: a case–control study of risk factors in Queensland, Australia. Int J Cancer 98(1):92–98PubMedCrossRefGoogle Scholar
  30. 30.
    Aitken JF, Green A, MacLennan R, Jackman L, Martin NG (1993) Comparability of surrogate and self-reported information on melanoma risk factors. Br J Cancer 67(5):1036–1041PubMedCrossRefGoogle Scholar
  31. 31.
    Chang YM, Barrett JH, Bishop DT et al (2009) Sun exposure and melanoma risk at different latitudes: a pooled analysis of 5700 cases and 7216 controls. Int J Epidemiol 38(3):814–830PubMedCrossRefGoogle Scholar
  32. 32.
    Dennis LK, Vanbeek MJ, Beane Freeman LE, Smith BJ, Dawson DV, Coughlin JA (2008) Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis. Ann Epidemiol 18(8):614–627PubMedCrossRefGoogle Scholar
  33. 33.
    Cust AE, Armstrong BK, Goumas C et al (2011) Sunbed use during adolescence and early adulthood is associated with increased risk of early-onset melanoma. Int J Cancer 128(10):2425–2435Google Scholar
  34. 34.
    Bulliard JL (2000) Site-specific risk of cutaneous malignant melanoma and pattern of sun exposure in New Zealand. Int J Cancer 85(5):627–632PubMedCrossRefGoogle Scholar
  35. 35.
    Platz A, Egyhazi S, Ringborg U, Hansson J (2008) Human cutaneous melanoma; a review of NRAS and BRAF mutation frequencies in relation to histogenetic subclass and body site. Mol Oncol 1(4):395–405PubMedCrossRefGoogle Scholar
  36. 36.
    McPherson M, Elwood M, English DR, Baade PD, Youl PH, Aitken JF (2006) Presentation and detection of invasive melanoma in a high-risk population. J Am Acad Dermatol 54(5):783–792PubMedCrossRefGoogle Scholar
  37. 37.
    Armstrong BK (2004) How sun exposure causes skin cancer: an epidemiological perspective. In: Hill D, Elwood JM, English DR (eds) Prevention of skin cancer. Kluwer, DordrechtGoogle Scholar
  38. 38.
    White E, Kirkpatrick CS, Lee JA (1994) Case–control study of malignant melanoma in Washington State. I. Constitutional factors and sun exposure. Am J Epidemiol 139(9):857–868PubMedGoogle Scholar
  39. 39.
    Weinstock MA, Colditz GA, Willett WC et al (1991) Melanoma and the sun: the effect of swimsuits and a “healthy” tan on the risk of nonfamilial malignant melanoma in women. Am J Epidemiol 134(5):462–470PubMedGoogle Scholar
  40. 40.
    Solomon CC, White E, Kristal AR, Vaughan T (2004) Melanoma and lifetime UV radiation. Cancer Causes Control 15(9):893–902PubMedCrossRefGoogle Scholar
  41. 41.
    Whiteman DC (2010) Testing the divergent pathway hypothesis for melanoma: recent findings and future challenges. Expert Rev Anticancer Ther 10(5):615–618PubMedCrossRefGoogle Scholar
  42. 42.
    Fears TR, Bird CC, Guerry DP et al (2002) Average midrange ultraviolet radiation flux and time outdoors predict melanoma risk. Cancer Res 62(14):3992–3996PubMedGoogle Scholar
  43. 43.
    Kricker A, Armstrong BK, Goumas C et al (2010) MC1R genotype may modify the effect of sun exposure on melanoma risk in the GEM study. Cancer Causes Control 21(12):2137–2147Google Scholar
  44. 44.
    Armstrong BK, Kricker A (2001) The epidemiology of UV induced skin cancer. J Photochem Photobiol B 63(1–3):8–18PubMedCrossRefGoogle Scholar
  45. 45.
    Egan KM (2009) Vitamin D and melanoma. Ann Epidemiol 19(7):455–461PubMedCrossRefGoogle Scholar
  46. 46.
    English DR, Armstrong BK, Kricker A (1998) Reproducibility of reported measurements of sun exposure in a case–control study. Cancer Epidemiol Biomarkers Prev 7(10):857–863PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Anne E. Cust
    • 1
    • 2
  • Mark A. Jenkins
    • 1
  • Chris Goumas
    • 2
  • Bruce K. Armstrong
    • 2
  • Helen Schmid
    • 3
  • Joanne F. Aitken
    • 4
  • Graham G. Giles
    • 1
    • 5
  • Richard F. Kefford
    • 3
  • John L. Hopper
    • 1
  • Graham J. Mann
    • 3
  1. 1.Centre for Molecular, Environmental, Genetic and Analytic (MEGA) Epidemiology, Melbourne School of Population HealthUniversity of MelbourneMelbourneAustralia
  2. 2.Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, Sydney Medical SchoolThe University of SydneySydneyAustralia
  3. 3.Westmead Institute for Cancer Research, Millennium Institute and Melanoma Institute AustraliaUniversity of Sydney at WestmeadSydneyAustralia
  4. 4.Viertel Centre for Research in Cancer ControlCancer Council QueenslandBrisbaneAustralia
  5. 5.Cancer Epidemiology CentreCancer Council VictoriaMelbourneAustralia

Personalised recommendations