Sun exposure and risk of lymphoid neoplasms in Singapore

Wong, Yin Kwan; Tai, Bee–Choo; Chia, Sin-Eng; Kuperan, Ponnudurai; Lee, Khai-Mun; Lim, Soon-Thye; Loong, Susan; Mow, Benjamin; Ng, Siok-Bian; Tan, Leonard; Tan, Soo‐Yong; Tan, Siong San; Tao, Miriam; Wong, Andrew Barnabas; Wong, Gee-Chuan; Seow, Adeline

doi:10.1007/s10552-012-9974-1

Cited by 17 publications

(24 citation statements)

References 37 publications

(55 reference statements)

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“…Prior research in this area has been scant, and the 3 largest previously published studies were included in this pooled analysis. 11,13,14 Among other studies, neither a case-control study in Singapore involving 74 cases and 829 controls 16 nor a prospective cohort study in California female teachers that included 38 HL cases 15 observed a significant association between UVR exposure and HL. A Greek study of 71 childhood HL cases (mostly patients age 10 to 14 years) and 164 controls also found no association of UVR exposure with HL risk.…”

Section: Discussionmentioning

confidence: 93%

“…The Singapore study, which used a questionnaire adapted from the Epilymph study, reported that having an outdoor occupation (OR, 0.76; 95% CI, 0. 39 16 The Californian study reported a nonsignificant inverse association of HL risk with minimum average annual UVR near one's residence (relative risk, 0.86; 95% CI, 0.46 to 1.62), but not with median or maximum average annual UVR. 15 In the Greek study, a nonsignificant inverse association (OR, 0.83; 95% CI, 0.58 to 1.19) was detected with 15 days or more spent annually at seaside resorts.…”

Section: Discussionmentioning

confidence: 99%

“…7,9 Ultraviolet radiation (UVR) exposure has been associated with HL risk, albeit inconsistently and based on only a few studies. [11][12][13][14][15][16] A large population-based case-control study in Sweden and Denmark detected an inverse association between risk of HL and sunbathing or There is an Inside Blood commentary on this article in this issue.…”

Section: Introductionmentioning

confidence: 99%

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Exposure to UV radiation and risk of Hodgkin lymphoma: a pooled analysis

Monnereau

Glaser

Schupp

et al. 2013

Blood

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• Our pooled analysis found an inverse association between several measures of UVR exposure and Hodgkin lymphoma. • Significant UVR-related inverse associations of EBV-positive HL with a doseresponse relationship support etiologic heterogeneity in HL.Ultraviolet radiation (UVR) exposure has been inversely associated with Hodgkin lymphoma (HL) risk, but only inconsistently, only in a few studies, and without attention to HL heterogeneity. We conducted a pooled analysis of HL risk focusing on type and timing of UVR exposure and on disease subtypes by age, histology, and tumor-cell Epstein-Barr virus (EBV) status. Four case-control studies contributed 1320 HL cases and 6381 controls. We estimated lifetime, adulthood, and childhood UVR exposure and history of sunburn and sunlamp use. We used 2-stage estimation with mixed-effects models and weighted pooled effect estimates by inverse marginal variances. We observed statistically significant inverse associations with HL risk for UVR exposures during childhood and adulthood, sunburn history, and sunlamp use, but we found no significant doseresponse relationships. Risks were significant only for EBV-positive HL (pooled odds ratio, 0.56; 95% confidence interval, 0.35 to 0.91 for the highest overall UVR exposure category), with a significant linear trend for overall exposure (P 5 .03). Pooled relative risk estimates were not heterogeneous across studies. Increased UVR exposure may protect against HL, particularly EBV-positive HL. Plausible mechanisms involving UVR induction of regulatory T cells or the cellular DNA damage response suggest opportunities for new prevention targets. (Blood. 2013;122(20):3492-3499)

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exposure to UV radiation and risk of Hodgkin lymphoma: a pooled analysis

Monnereau

Glaser

Schupp

et al. 2013

Blood

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“…In Singapore, skin cancer is the sixth commonest cancer in males and the seventh commonest cancer in females, while non‐melanoma skin cancer is the twelfth commonest cancer in Malaysia . Despite these statistics, only 4.0% of respondents in a Singapore study used sun protection during childhood and 9.1% in adulthood, while 22% of children used sunscreen at school and <3% used sunglasses while outdoors . Among women in Malaysia, majority (74.8%) of respondents from urban areas did not use sunscreen, while this figure increased to 89.4% among those from rural areas .…”

Section: Introductionmentioning

confidence: 97%

Analysis of Internet searches using Google Trends to measure interest in sun protection and skin cancer in selected South‐East Asian populations

Kwan

Yong

Robinson

2019

Photoderm Photoimm Photomed

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Background Analysis of Internet search trends has been performed to evaluate interest in sun protection, artificial tanning, and skin cancers among the public, particularly in Western countries. This observational study aimed to investigate the relative popularity of search terms relating to sun protection, sunburn, skin cancers, and tanning used in Google Trends® in three South‐East Asian countries (Malaysia, Singapore, and Indonesia). Methods The relevant search terms were queried using the Google Trends® in each location and worldwide. The search volume indices were compared between locations and over a time period from January 1, 2004, to January 31, 2019. Correlations between “sunblock” and “sunburn” as well as “sunblock” and search terms relating to skin cancers (“skin cancer,” “melanoma,” “basal cell carcinoma,” and “squamous cell carcinoma”) were evaluated. Results The favored search term relating to sun protection in this region was “sunblock” despite the term itself being a misnomer. The relative popularity of searches for “sunblock” also showed an increase over time and was generally higher compared with interest in sunburn, skin cancers, and artificial tanning practices. Positive correlations were noted between “sunblock” and “sunburn” in Malaysia and “sunblock” and “melanoma” in Singapore. Conclusion Insights into search trends may assist public health promotion to raise awareness regarding sun protection and skin cancers in the region by targeting commonly used terms for each geographical location.

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“…Diffuse large B‐cell lymphoma is the most common NHL subtype in both Chinese and Western populations, accounting for at least 30% of cases, whereas in Asia the proportions of T‐cell lymphomas are higher compared to Western countries (e.g. ~13‐18% in Shanghai and ~11% in Singapore compared to ~7% in the U.S.) . It is therefore likely that our findings reflect at least in part associations with DLBCL given that this is the predominant expected subtype in our study.…”

Section: Discussionmentioning

confidence: 68%

Prediagnostic blood levels of organochlorines and risk of non‐Hodgkin lymphoma in three prospective cohorts in China and Singapore

Bassig

Shu

Sjödin

et al. 2019

Intl Journal of Cancer

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Specific organochlorines (OCs) have been associated with non‐Hodgkin lymphoma (NHL) with varying degrees of evidence. These associations have not been evaluated in Asia, where the high exposure and historical environmental contamination of certain OC pesticides (e.g., dichlorodiphenyltrichloroethane [DDT], hexachlorocyclohexane [HCH]) are different from Western populations. We evaluated NHL risk and prediagnostic blood levels of OC pesticides/metabolites and polychlorinated biphenyl congeners in a case–control study of 167 NHL cases and 167 controls nested within three prospective cohorts in Shanghai and Singapore. Conditional logistic regression was used to analyze lipid‐adjusted OC levels and NHL risk. Median levels of p,p′‐dichlorodiphenyldichloroethylene (p,p′‐DDE), the primary DDT metabolite, and β‐HCH were up to 12 and 65 times higher, respectively, in samples from the Asian cohorts compared to several cohorts in the United States and Norway. An increased risk of NHL was observed among those with higher β‐HCH levels both overall (3rd vs. 1st tertile OR = 1.8, 95%CI = 1.0–3.2; ptrend = 0.049) and after excluding cases diagnosed within 2 years of blood collection (3rd vs. 1st tertile OR = 2.0, 95%CI = 1.1–3.9; ptrend = 0.03), and the association was highly consistent across the three cohorts. No significant associations were observed for other OCs, including p,p′‐DDE. Our findings provide support for an association between β‐HCH blood levels and NHL risk. This is a concern because substantial quantities of persistent, toxic residues of HCH are present in the environment worldwide. Although there is some evidence that DDT is associated with NHL, our findings for p,p′‐DDE do not support an association.

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Sun exposure and risk of lymphoid neoplasms in Singapore

Abstract: Our findings support an inverse relationship between intermittent sun exposure and the risk of NHL. These findings are consistent with the growing evidence from various countries, but further studies, especially prospective studies, are needed in Asian populations.

Cited by 17 publications

References 37 publications

Exposure to UV radiation and risk of Hodgkin lymphoma: a pooled analysis

Exposure to UV radiation and risk of Hodgkin lymphoma: a pooled analysis

Analysis of Internet searches using Google Trends to measure interest in sun protection and skin cancer in selected South‐East Asian populations

Prediagnostic blood levels of organochlorines and risk of non‐Hodgkin lymphoma in three prospective cohorts in China and Singapore

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