TY - JOUR
T1 - Citrus intake and risk of skin cancer in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC)
AU - Mahamat-Saleh, Yahya
AU - Cervenka, Iris
AU - Al-Rahmoun, Marie
AU - Mancini, Francesca R.
AU - Severi, Gianluca
AU - Ghiasvand, Reza
AU - Veierod, Marit B.
AU - Caini, Saverio
AU - Palli, Domenico
AU - Botteri, Edoardo
AU - Sacerdote, Carlotta
AU - Ricceri, Fulvio
AU - Trichopoulou, Antonia
AU - Peppa, Eleni
AU - La Vecchia, Carlo
AU - Overvad, Kim
AU - Dahm, Christina C.
AU - Olsen, Anja
AU - Tjønneland, Anne
AU - Perez-Cornago, Aurora
AU - Jakszyn, Paula
AU - Grioni, Sara
AU - Schulze, Matthias B.
AU - Skeie, Guri
AU - Lasheras, Cristina
AU - Colorado-Yohar, Sandra
AU - Rodríguez-Barranco, Miguel
AU - Kühn, Tilman
AU - Katzke, Verena A.
AU - Amiano, Pilar
AU - Tumino, Rosario
AU - Panico, Salvatore
AU - Ezponda, Ana
AU - Sonestedt, Emily
AU - Scalbert, Augustin
AU - Weiderpass, Elisabete
AU - Boutron-Ruault, Marie Christine
AU - Kvaskoff, Marina
N1 - Funding Information:
Yahya Mahamat-Saleh was supported by a research scholarship from the Paris Ile-de-France region. The coordination of EPIC is financially supported by the European Commission (DG-SANCO); and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); the French National Institute of Health and Medical Research (Inserm), the Mutuelle Générale de l’Education Nationale, the Gustave Roussy Institute, and the French League against Cancer (France); Deutsche Krebshilfe, Deutsches Krebsforschungszentrum (DKFZ); and Federal Ministry of Education and Research (Germany); Stavros Niarchos Foundation; the Hellenic Health Foundation; and Ministry of Health and Social Solidarity (Greece); Italian Association for Research on Cancer (AIRC); National Research Council; and AIRE-ONLUS Ragusa, AVIS Ragusa, Sicilian Government (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS); Netherlands Cancer Registry (NKR); LK Research Funds; Dutch Prevention Funds; Dutch ZON (Zorg Onderzoek Nederland); World Cancer Research Fund (WCRF); the National Institute for Public Health and the Environment (RIVM) and Statistics Netherlands (the Netherlands); European Research Council (ERC) (Grant Number ERC-2009-AdG 232997) and Nordforsk; and Nordic Center of Excellence Programme on Food, Nutrition and Health (Norway); Health Research Fund (FIS); Regional Governments of Andalucía, Asturias, Basque Country, Murcia (No. 6236) and Navarra; and ISCIII RETIC (RD06/0020) and the Catalan Institute of Oncology (Spain); Swedish Cancer Society; Swedish Scientific Council; and Regional Government of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C570/A16491 and C8221/A19170 for EPIC-Oxford); Medical Research Council (1000143 to EPIC-Norfolk, MR/M012190/1 to EPIC-Oxford); Stroke Association; British Heart Foundation; Department of Health; Food Standards Agency; and Wellcome Trust (UK). Reza Ghiasvand was supported by a grant (Project 6823329) from the Norwegian Cancer Society. Acknowledgements
Funding Information:
We thank all study participants for their cooperation and all interviewers who participated in the fieldwork studies in each EPIC center. We also thank Bertrand Hemon at IARC for his valuable work and technical support with the EPIC database. IARC disclaimer: Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization.
Publisher Copyright:
© 2020, Springer Nature B.V.
PY - 2020/11
Y1 - 2020/11
N2 - Citrus intake has been suggested to increase the risk of skin cancer. Although this relation is highly plausible biologically, epidemiologic evidence is lacking. We aimed to examine the potential association between citrus intake and skin cancer risk. EPIC is an ongoing multi-center prospective cohort initiated in 1992 and involving ~ 520,000 participants who have been followed-up in 23 centers from 10 European countries. Dietary data were collected at baseline using validated country-specific dietary questionnaires. We used Cox proportional hazards regression models to compute hazard ratios (HR) and 95% confidence intervals (CI). During a mean follow-up of 13.7 years, 8448 skin cancer cases were identified among 270,112 participants. We observed a positive linear dose–response relationship between total citrus intake and skin cancer risk (HR = 1.10, 95% CI 1.03–1.18 in the highest vs. lowest quartile; Ptrend = 0.001), particularly with basal cell carcinoma (BCC) (HR = 1.11, 95% CI 1.02–1.20, Ptrend = 0.007) and squamous cell carcinoma (SCC) (HR = 1.23, 95% CI 1.04–1.47, Ptrend = 0.01). Citrus fruit intake was positively associated with skin cancer risk (HR = 1.08, 95% CI 1.01–1.16, Ptrend = 0.01), particularly with melanoma (HR = 1.23, 95% CI 1.02–1.48; Ptrend = 0.01), although with no heterogeneity across skin cancer types (Phomogeneity = 0.21). Citrus juice was positively associated with skin cancer risk (Ptrend = 0.004), particularly with BCC (Ptrend = 0.008) and SCC (Ptrend = 0.004), but not with melanoma (Phomogeneity = 0.02). Our study suggests moderate positive linear dose–response relationships between citrus intake and skin cancer risk. Studies with available biomarker data and the ability to examine sun exposure behaviors are warranted to clarify these associations and examine the phototoxicity mechanisms of furocoumarin-rich foods.
AB - Citrus intake has been suggested to increase the risk of skin cancer. Although this relation is highly plausible biologically, epidemiologic evidence is lacking. We aimed to examine the potential association between citrus intake and skin cancer risk. EPIC is an ongoing multi-center prospective cohort initiated in 1992 and involving ~ 520,000 participants who have been followed-up in 23 centers from 10 European countries. Dietary data were collected at baseline using validated country-specific dietary questionnaires. We used Cox proportional hazards regression models to compute hazard ratios (HR) and 95% confidence intervals (CI). During a mean follow-up of 13.7 years, 8448 skin cancer cases were identified among 270,112 participants. We observed a positive linear dose–response relationship between total citrus intake and skin cancer risk (HR = 1.10, 95% CI 1.03–1.18 in the highest vs. lowest quartile; Ptrend = 0.001), particularly with basal cell carcinoma (BCC) (HR = 1.11, 95% CI 1.02–1.20, Ptrend = 0.007) and squamous cell carcinoma (SCC) (HR = 1.23, 95% CI 1.04–1.47, Ptrend = 0.01). Citrus fruit intake was positively associated with skin cancer risk (HR = 1.08, 95% CI 1.01–1.16, Ptrend = 0.01), particularly with melanoma (HR = 1.23, 95% CI 1.02–1.48; Ptrend = 0.01), although with no heterogeneity across skin cancer types (Phomogeneity = 0.21). Citrus juice was positively associated with skin cancer risk (Ptrend = 0.004), particularly with BCC (Ptrend = 0.008) and SCC (Ptrend = 0.004), but not with melanoma (Phomogeneity = 0.02). Our study suggests moderate positive linear dose–response relationships between citrus intake and skin cancer risk. Studies with available biomarker data and the ability to examine sun exposure behaviors are warranted to clarify these associations and examine the phototoxicity mechanisms of furocoumarin-rich foods.
KW - Citrus
KW - Cohort studies
KW - Cutaneous melanoma
KW - Epidemiology
KW - Keratinocyte cancers
UR - http://www.scopus.com/inward/record.url?scp=85088559805&partnerID=8YFLogxK
U2 - 10.1007/s10654-020-00666-9
DO - 10.1007/s10654-020-00666-9
M3 - Article
C2 - 32710289
AN - SCOPUS:85088559805
SN - 0393-2990
VL - 35
SP - 1057
EP - 1067
JO - European Journal of Epidemiology
JF - European Journal of Epidemiology
IS - 11
ER -
