© 2005 Oxford University Press
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Ultraviolet Radiation Exposure and Risk of Malignant Lymphomas
Affiliations of authors: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (KES, AT, JA, HOA); Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (HH, MM, KR, LM); Department of Hematology, Odense University Hospital, Odense, Denmark (LM); Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden (JA); Department of Hematology, Rigshospitalet, Copenhagen, Denmark (MH); Department of Pathology, Karolinska Institutet and University Hospital, Stockholm, Sweden (APM); Department of Medicine, Hillerød Hospital, Hillerød, Denmark (BAJ); Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden (GR); Department of Medicine, Viborg Hospital, Viborg, Denmark (BBP); Department of Pathology, Akademiska Hospital, Uppsala, Sweden (CS); Department of Pathology and Oncology, Karolinska University Hospital, Stockholm, and Department of Oncology, Radiology and Clinical Immunology, Akademiska Hospital, Uppsala, Sweden (BG); Department of Epidemiology, Harvard University, Boston, MA (HOA)
Correspondence to: Karin Ekström Smedby, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77 Stockholm, Sweden (e-mail: karin.ekstrom{at}meb.ki.se).
Background: The incidence of malignant lymphomas has been increasing rapidly, but the causes of these malignancies remain poorly understood. One hypothesis holds that exposure to ultraviolet (UV) radiation increases lymphoma risk. We tested this hypothesis in a population-based case–control study in Denmark and Sweden. Methods: A total of 3740 patients diagnosed between October 1, 1999, and August 30, 2002, with incident malignant lymphomas, including non-Hodgkin lymphoma, chronic lymphocytic leukemia, and Hodgkin lymphoma, and 3187 population controls provided detailed information on history of UV exposure and skin cancer and information on other possible risk factors for lymphomas. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by logistic regression. Statistical tests were two-sided. Results: Multivariable-adjusted analyses revealed consistent, statistically significant negative associations between various measures of UV light exposure and risk of non-Hodgkin lymphoma. A high frequency of sun bathing and sunburns at age 20 years and 5–10 years before the interview and sun vacations abroad were associated with 30%–40% reduced risks of non-Hodgkin lymphoma (e.g., for sunbathing four times a week or more at age 20 versus never sunbathing, OR = 0.7, 95% CI = 0.6 to 0.9; for two or more sunburns a year at age 20 versus no sunburns, OR = 0.6, 95% CI = 0.5 to 0.8). These inverse associations increased in strength with increasing levels of exposure (all Ptrend
.01). Similar, albeit weaker, associations were observed for Hodgkin lymphoma. There were no clear differences among non-Hodgkin lymphoma subtypes, although associations were stronger for B-cell than for T-cell lymphomas. A history of skin cancer was associated with a doubling in risks of both non-Hodgkin and Hodgkin lymphoma. Conclusions: A history of high UV exposure was associated with reduced risk of non-Hodgkin lymphoma. The positive association between skin cancer and malignant lymphomas is, therefore, unlikely to be mediated by UV exposure.
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