Cancer Causes & Control

, Volume 27, Issue 6, pp 817–823 | Cite as

Impact of residential UV exposure in childhood versus adulthood on skin cancer risk in Caucasian, postmenopausal women in the Women’s Health Initiative

  • Katherine J. Ransohoff
  • Mina S. Ally
  • Marcia L. Stefanick
  • Elizabeth Keiser
  • Katrina Spaunhurst
  • Kristopher Kapphahn
  • Sherry Pagoto
  • Catherine Messina
  • Haley Hedlin
  • JoAnn E. Manson
  • Jean Y. Tang
Brief report



Sun exposure is a major risk factor for skin cancer; however, the relative contribution of ultraviolet (UV) exposure during childhood versus adulthood on skin cancer risk remains unclear.


Our goal was to determine the impact of residential UV, measured by AVerage daily total GLObal solar radiation (AVGLO), exposure during childhood (birth, 15 years) versus adulthood (35, 50 years, and present) on incident non-melanoma skin cancer (NMSC) and malignant melanoma (MM) in postmenopausal women.


Women were followed with yearly surveys throughout the duration of their participation in the Women’s Health Initiative Observational study, a multicenter study from 1993 to 2005. A total of 56,557 women had data on all observations and were included in the baseline characteristics. The main exposure, residential UV (as measured by AVGLO), was measured by geographic residence during childhood and adulthood. Outcome was risk of incident NMSC and MM.


Over 11.9 years (median follow-up), there were 9,195 (16.3 %) cases of NMSC and 518 (0.92 %) cases of MM. Compared with the reference group (women with low childhood and low adulthood UV), women with low childhood and high adulthood UV had a 21 % increased risk of NMSC (odds ratio 1.21, 95 % confidence interval 1.12, 1.31). Women with high childhood and high adulthood UV had a 19 % increased risk of NMSC (odds ratio 1.19, 95 % confidence interval 1.11, 1.27). Surprisingly, women with high childhood UV and low adulthood UV did not have a significant increase in NMSC risk compared with the reference group (odds ratio 1.08, 95 % confidence interval 0.91, 1.28) in multivariable models. Residential UV exposure in childhood or adulthood was not associated with increased melanoma risk.


This study reveals an increase in NMSC risk associated with adulthood residential UV exposure, with no effect for childhood UV exposure.


Sun exposure Ultraviolet radiation Skin cancer Basal cell carcinoma Squamous cell carcinoma Malignant melanoma Women’s Health Initiative 



AVerage daily total GLObal solar radiation


Non-melanoma skin cancer


Basal cell carcinoma


Squamous cell carcinoma


Malignant melanoma




Women’s Health Initiative



This study was supported in part by the Women’s Health Initiative program, which is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, and United States Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C.

Author’s contributions

Dr(s) Tang and Hedlin had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Ally and Stefanick were involved in study concept and design. Ransohoff, Ally, Stefanick, Hedlin, Kapphahn, and Tang were involved in acquisition, analysis, and interpretation of data. Ally, Ransohoff, and Tang drafted the manuscript. Ransohoff, Ally, Tang, Stefanick, Hedlin, Kapphahn, Keiser, Spaunhurst, Pagoto, Messina, and Manson were involved in critical revision of the manuscript for important intellectual content. Hedlin and Kapphahn were involved in statistical analysis. Tang obtained funding. Stefanick and Tang were involved in administrative, technical, or material support. Tang and Stefanick were involved in study supervision.

Compliance with ethical standards

Conflict of interest



  1. 1.
    Qureshi AA, Laden F, Colditz GA, Hunter DJ (2008) Geographic variation and risk of skin cancer in US women. Differences between melanoma, squamous cell carcinoma, and basal cell carcinoma. Arch Intern Med 168:501–507CrossRefPubMedGoogle Scholar
  2. 2.
    Wei-Passanese EX, Han J, Lin W, Li T, Laden F, Qureshi AA (2012) Geographical variation in residence and risk of multiple nonmelanoma skin cancers in US women and men. Photochem Photobiol 88:483–489CrossRefPubMedGoogle Scholar
  3. 3.
    Suzuki T, Ueda M, Ogata K, Horikoshi T, Munakata N, Ichihashi M (1996) Doses of solar ultraviolet radiation correlate with skin cancer rates in Japan. Kobe J Med Sci 42:375–388PubMedGoogle Scholar
  4. 4.
    Kennedy C, Bajdik CD, Willemze R, De Gruijl FR, Bouwes Bavinck JN (2003) The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol 120:1087–1093CrossRefPubMedGoogle Scholar
  5. 5.
    English DR, Armstrong BK, Kricker A (1998) Reproducibility of reported measurements of sun exposure in a case–control study. Cancer Epidemiol Biomark Prev 7:857–863Google Scholar
  6. 6.
    English DR, Armstrong BK, Kricker A, Winter MG, Heenan PJ, Randell PL (1998) Case–control study of sun exposure and squamous cell carcinoma of the skin. Int J Cancer 77:347–353CrossRefPubMedGoogle Scholar
  7. 7.
    Iannacone MR, Wang W, Stockwell HG et al (2012) Patterns and timing of sunlight exposure and risk of basal cell and squamous cell carcinomas of the skin—a case–control study. BMC Cancer 12:417CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Tatalovich Z, Wilson JP, Mack T, Yan Y, Cockburn M (2006) The objective assessment of lifetime cumulative ultraviolet exposure for determining melanoma risk. J Photochem Photobiol B 85:198–204CrossRefPubMedGoogle Scholar
  9. 9.
    Richards TB, Johnson CJ, Tatalovich Z et al (2011) Association between cutaneous melanoma incidence rates among white U.S. residents and county-level estimates of solar ultraviolet exposure. J Am Acad Dermatol 65:S50–S57CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Leiter U, Garbe C (2008) Epidemiology of melanoma and nonmelanoma skin cancer—the role of sunlight. Adv Exp Med Biol 624:89–103CrossRefPubMedGoogle Scholar
  11. 11.
    Xiang F, Lucas R, Hales S, Neale R (2014) Incidence of nonmelanoma skin cancer in relation to ambient UV radiation in white populations, 1978–2012: empirical relationships. JAMA Dermatol 150(10):1063–71CrossRefPubMedGoogle Scholar
  12. 12.
    Moan J, Grigalavicius M, Baturaite Z, Dahlback A, Juzeniene A (2015) The relationship between UV exposure and incidence of skin cancer. Photodermatol Photoimmunol Photomed 31:26–35CrossRefPubMedGoogle Scholar
  13. 13.
    The Women’s Health Initiative Study Group (1998) Design of the Women’s Health Initiative clinical trial and observational study. Control Clin Trials 19:61–109CrossRefGoogle Scholar
  14. 14.
    Hays J, Hunt JR, Hubbell FA et al (2003) The Women’s Health Initiative recruitment methods and results. Ann Epidemiol 13:S18–S77CrossRefPubMedGoogle Scholar
  15. 15.
    Ming ME, Levy RM, Hoffstad OJ, Filip J, Gimotty PA, Margolis DJ (2004) Validity of patient self-reported history of skin cancer. Arch Dermatol 140:730–735CrossRefPubMedGoogle Scholar
  16. 16.
    Hunter DJ, Colditz GA, Stampfer MJ, Rosner B, Willett WC, Speizer FE (1990) Risk factors for basal cell carcinoma in a prospective cohort of women. Ann Epidemiol 1:13–23CrossRefPubMedGoogle Scholar
  17. 17.
    Wu S, Han J, Vleugels RA et al (2014) Cumulative ultraviolet radiation flux in adulthood and risk of incident skin cancers in women. Br J Cancer 110:1855–1861CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Song F, Qureshi AA, Giovannucci EL et al (2013) Risk of a second primary cancer after non-melanoma skin cancer in white men and women: a prospective cohort study. PLoS Med 10:e1001433CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Rosenberg CA, Khandekar J, Greenland P, Rodabough RJ, McTiernan A (2006) Cutaneous melanoma in postmenopausal women after nonmelanoma skin carcinoma: the Women’s Health Initiative Observational Study. Cancer 106:654–663CrossRefPubMedGoogle Scholar
  20. 20.
    Gamba CA, Swetter SM, Stefanick ML et al (2013) Aspirin is associated with lower melanoma risk among postmenopausal Caucasian women. Cancer 119:1562–1569CrossRefPubMedGoogle Scholar
  21. 21.
    Grau MV, Baron JA, Langholz B et al (2006) Effect of NSAIDs on the recurrence of nonmelanoma skin cancer. Int J Cancer 119:682–686CrossRefPubMedGoogle Scholar
  22. 22.
    Caini S, Boniol M, Tosti G et al (2014) Vitamin D and melanoma and non-melanoma skin cancer risk and prognosis: a comprehensive review and meta-analysis. Eur J Cancer 50:2649–2658CrossRefPubMedGoogle Scholar
  23. 23.
    Armstrong BK, Kricker A (2001) The epidemiology of UV induced skin cancer. J Photochem Photobiol B 63:8–18CrossRefPubMedGoogle Scholar
  24. 24.
    Scotto J, Fears TR, Fraumeni JF (1983) Incidence of non-melanoma skin cancer in the United States. Bethesda, MD: U.S. Dept. of Health and Human Services, National Institutes of Health. NIH Publication no. 83-2433Google Scholar
  25. 25.
    Stern RS, Weinstein MC, Baker SG (1986) Risk reduction for nonmelanoma skin cancer with childhood sunscreen use. Arch Dermatol 122:537–545CrossRefPubMedGoogle Scholar
  26. 26.
    van der Pols JC, Williams GM, Pandeya N, Logan V, Green AC (2006) Prolonged prevention of squamous cell carcinoma of the skin by regular sunscreen use. Cancer Epidemiol Biomark Prev 15:2546–2548CrossRefGoogle Scholar
  27. 27.
    Green AC, Williams GM, Logan V, Strutton GM (2011) Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol 29:257–263CrossRefPubMedGoogle Scholar
  28. 28.
    Fears TR, Bird CC, Dt G et al (2002) Average midrange ultraviolet radiation flux and time outdoors predict melanoma risk. Cancer Res 62:3992–3996PubMedGoogle Scholar
  29. 29.
    Kricker A, Armstrong BK, English DR (1994) Sun exposure and non-melanocytic skin cancer. Cancer Causes Control 5:367–392CrossRefPubMedGoogle Scholar
  30. 30.
    Gandini S, Sera F, Cattaruzza MS et al (2005) Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer 41:45–60CrossRefPubMedGoogle Scholar
  31. 31.
    Mack TM, Floderus B (1991) Malignant melanoma risk by nativity, place of residence at diagnosis, and age at migration. Cancer Causes Control 2:401–411CrossRefPubMedGoogle Scholar
  32. 32.
    Zanetti R, Franceschi S, Rosso S, Colonna S, Bidoli E (1992) Cutaneous melanoma and sunburns in childhood in a southern European population. Eur J Cancer 28A:1172–1176CrossRefPubMedGoogle Scholar
  33. 33.
    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 18:614–627CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Katherine J. Ransohoff
    • 1
  • Mina S. Ally
    • 1
  • Marcia L. Stefanick
    • 2
  • Elizabeth Keiser
    • 3
  • Katrina Spaunhurst
    • 4
  • Kristopher Kapphahn
    • 5
  • Sherry Pagoto
    • 6
  • Catherine Messina
    • 7
  • Haley Hedlin
    • 5
  • JoAnn E. Manson
    • 8
  • Jean Y. Tang
    • 1
  1. 1.Department of DermatologyStanford University School of MedicineRedwood CityUSA
  2. 2.Department of Medicine, Stanford Prevention Research CenterStanford University School of MedicineStanfordUSA
  3. 3.UCSD School of MedicineLa JollaUSA
  4. 4.Department of DermatologyCase Western ReserveClevelandUSA
  5. 5.Department of Medicine, Quantitative Sciences UnitStanford University School of MedicineStanfordUSA
  6. 6.Department of MedicineUniversity of Massachusetts Medical SchoolBostonUSA
  7. 7.Department of Preventive MedicineStony Brook University School of MedicineStony BrookUSA
  8. 8.Department of MedicineBrigham and Women’sBostonUSA

Personalised recommendations