Papers

Evidence of an association between non-Hodgkin's lymphoma and skin cancer

^a Department of Cancer Epidemiology, University Hospital, S-751 85 Uppsala, Sweden, ^b Danish Epidemiology Science Centre, Statens Seruminstitut, DK-2300, Copenhagen S, Denmark, ^c Department of Oncology, University Hospital, Uppsala, Sweden

Correspondence to: Ms Adami.

Abstract

Objective: To investigate a possible link between exposure to ultraviolet light and the almost epidemic increase in non-Hodgkin's lymphoma worldwide. Because ultraviolet light is known to cause skin cancers, the association between non-Hodgkin's lymphoma and skin cancer was studied.
Design: Secondary occurrence of either malignant melanoma or squamous cell skin cancer in cohorts of patients with a first diagnosis of either non-Hodgkin's lymphoma or chronic lymphocytic leukaemia, and vice versa, were studied. Expected numbers of subsequent cancers were calculated by sex, age, and period specific national incidence rates multiplied by the person years under observation in the cohorts.
Setting: Denmark (1943-89) and Sweden (1958-89).
Subjects: Four population based cohorts identified in the nationwide cancer registries (34641 people with non-Hodgkin's lymphoma, 17400 with chronic lymphocytic leukaemia, 34989 with malignant melanoma, 25980 with squamous cell skin cancer). A total of 562085 person years were accrued for the analysis.
Main outcome measures: The ratios of observed to expected cancers (the standardised incidence ratio) served as a measure of the relative risk.
Results: The relative risk for developing squamous cell skin cancer was 5.5 (95% confidence interval 4.6 to 6.6) among patients with non-Hodgkin's lymphoma and 8.6 (7.2 to 10.3) among patients with chronic lymphocytic leukaemia. The relative risks remained high over more than 15 years of follow up. Relative risks for malignant melanoma were 2.4 (1.8 to 3.2) for patients with non-Hodgkin's lymphoma and 3.1 (2.1 to 4.4) for patients with chronic lymphocytic leukaemia. After squamous cell skin cancer had been diagnosed there was a twofold excess risk for non-Hodgkin's lymphoma and chronic lymphocytic leukaemia. By contrast, in each of the cohorts the general cancer risks excluding skin and lymphoproliferative malignancies were close to the expected.
Conclusions: The occurrence of non-Hodgkin's lymphoma and skin cancer are strongly associated; this supports the hypothesis that the secular increase in exposure to ultraviolet light may have contributed to the increasing incidence of non-Hodgkin's lymphoma in recent decades

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Non-Hodgkin's lymphoma and skin cancer

Peter Sasieni and Veronique Bataille
BMJ 1995 311: 749. [Extract] [Full Text]

Pathogenesis is multifactorial

Robert Gniadecki
BMJ 1995 311: 749-750. [Extract] [Full Text]

Association may be iatrogenic

Mark Vickers
BMJ 1995 311: 750. [Extract] [Full Text]

American data refute ultraviolet hypothesis

Robert Newton
BMJ 1995 311: 750. [Extract] [Full Text]

This article has been cited by other articles:

• Toro, J. R., Blake, P. W., Bjorkholm, M., Kristinsson, S. Y., Wang, Z., Landgren, O. (2009). Prior history of non-melanoma skin cancer is associated with increased mortality in patients with chronic lymphocytic leukemia. haematol 94: 1460-1464 [Abstract] [Full text]  
• Hemminki, K., Lenner, P., Sundquist, J., Lorenzo Bermejo, J. (2008). Risk of Subsequent Solid Tumors After Non-Hodgkin's Lymphoma: Effect of Diagnostic Age and Time Since Diagnosis. JCO 26: 1850-1857 [Abstract] [Full text]  
• Zhang, Y., Holford, T. R., Leaderer, B., Boyle, P., Zhu, Y., Wang, R., Zou, K., Zhang, B., Wise, J. P. Sr, Qin, Q., Kilfoy, B., Han, J., Zheng, T. (2007). Ultraviolet Radiation Exposure and Risk of Non-Hodgkin's Lymphoma. Am J Epidemiol 165: 1255-1264 [Abstract] [Full text]  
• Armstrong, B. K., Kricker, A. (2007). Sun Exposure and Non-Hodgkin Lymphoma. Cancer Epidemiol. Biomarkers Prev. 16: 396-400 [Abstract] [Full text]  
• Hill, D. A., Wang, S. S., Cerhan, J. R., Davis, S., Cozen, W., Severson, R. K., Hartge, P., Wacholder, S., Yeager, M., Chanock, S. J., Rothman, N. (2006). Risk of non-Hodgkin lymphoma (NHL) in relation to germline variation in DNA repair and related genes. Blood 108: 3161-3167 [Abstract] [Full text]  
• van Balen, E, Font, R, Cavalle, N, Font, L, Garcia-Villanueva, M, Benavente, Y, Brennan, P, de Sanjose, S (2006). Exposure to non-arsenic pesticides is associated with lymphoma among farmers in Spain. Occup. Environ. Med. 63: 663-668 [Abstract] [Full text]  
• Ekstrom Smedby, K., Lindgren, C. M., Hjalgrim, H., Humphreys, K., Schollkopf, C., Chang, E. T., Roos, G., Ryder, L. P., Falk, K. I., Palmgren, J., Kere, J., Melbye, M., Glimelius, B., Adami, H.-O. (2006). Variation in DNA Repair Genes ERCC2, XRCC1, and XRCC3 and Risk of Follicular Lymphoma.. Cancer Epidemiol. Biomarkers Prev. 15: 258-265 [Abstract] [Full text]  
• Chang, E. T., Smedby, K. E., Hjalgrim, H., Porwit-MacDonald, A., Roos, G., Glimelius, B., Adami, H.-O. (2005). Family History of Hematopoietic Malignancy and Risk of Lymphoma. JNCI J Natl Cancer Inst 97: 1466-1474 [Abstract] [Full text]  
• Lens, M. B., Newton-Bishop, J. A. (2005). An association between cutaneous melanoma and non-Hodgkin's lymphoma: pooled analysis of published data with a review. Ann Oncol 16: 460-465 [Abstract] [Full text]  
• Smedby, K. E., Hjalgrim, H., Melbye, M., Torrang, A., Rostgaard, K., Munksgaard, L., Adami, J., Hansen, M., Porwit-MacDonald, A., Jensen, B. A., Roos, G., Pedersen, B. B., Sundstrom, C., Glimelius, B., Adami, H.-O. (2005). Ultraviolet Radiation Exposure and Risk of Malignant Lymphomas. JNCI J Natl Cancer Inst 97: 199-209 [Abstract] [Full text]  
• Zhang, Y., Holford, T. R., Leaderer, B., Boyle, P., Zahm, S. H., Owens, P. H., Morton, L. M., Zhang, B., Zou, K., Flynn, S., Tallini, G., Zheng, T. (2004). Blood Transfusion and Risk of Non-Hodgkin's Lymphoma in Connecticut Women. Am J Epidemiol 160: 325-330 [Abstract] [Full text]  
• Sorensen, H. T., Mellemkjaer, L., Nielsen, G. L., Baron, J. A., Olsen, J. H., Karagas, M. R. (2004). Skin Cancers and Non-Hodgkin Lymphoma Among Users of Systemic Glucocorticoids: A Population-Based Cohort Study. JNCI J Natl Cancer Inst 96: 709-711 [Abstract] [Full text]  
• Hu, S., Ma, F., Collado-Mesa, F., Kirsner, R. S. (2004). Ultraviolet Radiation and Incidence of Non-Hodgkin's Lymphoma among Hispanics in the United States. Cancer Epidemiol. Biomarkers Prev. 13: 59-64 [Abstract] [Full text]  
• MOLLER, P., WALLIN, H., HOLST, E., KNUDSEN, L. E. (2002). Sunlight-induced DNA damage in human mononuclear cells. FASEB J. 16: 45-53 [Abstract] [Full text]  
• Groves, F. D., Linet, M. S., Travis, L. B., Devesa, S. S. (2000). Cancer Surveillance Series: Non-Hodgkin's Lymphoma Incidence by Histologic Subtype in the United States From 1978 Through 1995. JNCI J Natl Cancer Inst 92: 1240-1251 [Abstract] [Full text]  
• Fritschi, L. (2000). Cancer in veterinarians. Occup. Environ. Med. 57: 289-297 [Abstract] [Full text]  
• Askling, J., Sorensen, P., Ekbom, A., Frisch, M., Melbye, M., Glimelius, B., Hjalgrim, H. (1999). Is History of Squamous-Cell Skin Cancer a Marker of Poor Prognosis in Patients with Cancer?. ANN INTERN MED 131: 655-659 [Abstract] [Full text]  
• Bentham, G., Wolfreys, A. M., Liu, Y., Cortopassi, G., Green, M. H.L., Arlett, C. F., Cole, J. (1999). Frequencies of hprt- mutations and bcl-2 translocations in circulating human lymphocytes are correlated with United Kingdom sunlight records. Mutagenesis 14: 527-532 [Abstract] [Full text]  
• Ness, A. R, Frankel, S. J, Gunnell, D. J, Smith, G. D. (1999). Are we really dying for a tan?. BMJ 319: 114-116 [Full text]  
• Bonnerup Jaeger, A., Gramkow, A., Hjalgrim, H., Melbye, M., Frisch, M. (1999). Bowen Disease and Risk of Subsequent Malignant Neoplasms: A Population-Based Cohort Study of 1147 Patients. Arch Dermatol 135: 790-793 [Abstract] [Full text]  
• Kahn, H. S., Tatham, L. M., Patel, A. V., Thun, M. J., Heath, C. W. Jr (1998). Increased Cancer Mortality Following a History of Nonmelanoma Skin Cancer. JAMA 280: 910-912 [Abstract] [Full text]  
• Freedman, D M., Zahm, S. H., Dosemeci, M. (1997). Residential and occupational exposure to sunlight and mortality from non-Hodgkin's lymphoma: composite (threefold) case-control study. BMJ 314: 1451-1451 [Abstract] [Full text]  
• Newton, R. (1997). Solar ultraviolet radiation is not a major cause of primary cutaneous non-Hodgkin's lymphoma. BMJ 314: 1483-1483 [Full text]  
• Nielsen, L. G., Frisch, M., Melbye, M. (1997). Cancer risk in a cohort of Danes working in Greenland. Scand J Public Health 25: 44-49 [Abstract]  
• Lear, J T, Tan, B B, Smith, A G, Fryer, A A, Strange, R C, Jones, P W (1996). Basal cell carcinoma may be linked to haematological malignancy. BMJ 313: 298a-299 [Full text]  
• Bentham, G. (1996). Association between incidence of non-Hodgkin's lymphoma and solar ultraviolet radiation in England and Wales. BMJ 312: 1128-1131 [Abstract] [Full text]  
• Vickers, M. (1995). Association may be iatrogenic. BMJ 311: 750-750 [Full text]  
• Sasieni, P., Bataille, V. (1995). Non-Hodgkin's lymphoma and skin cancer. BMJ 311: 749a-749 [Full text]  
• Gniadecki, R. (1995). Pathogenesis is multifactorial. BMJ 311: 749b-750 [Full text]  
• Newton, R. (1995). American data refute ultraviolet hypothesis. BMJ 311: 750a-750 [Full text]  
• Jiang, W., Ananthaswamy, H. N., Muller, H. K., Ouhtit, A., Bolshakov, S., Ullrich, S. E., El-Naggar, A. K., Kripke, M. L. (2001). UV irradiation augments lymphoid malignancies in mice with one functional copy of wild-type p53. Proc. Natl. Acad. Sci. USA 98: 9790-9795 [Abstract] [Full text]