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Citrus intake and risk of skin cancer in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC)

Mahamat-Saleh, Yahya ; Cervenka, Iris ; Al-Rahmoun, Marie ; Mancini, Francesca R. ; Severi, Gianluca ; Ghiasvand, Reza ; Veierod, Marit B. ; Caini, Saverio ; Palli, Domenico and Botteri, Edoardo , et al. (2020) In European Journal of Epidemiology 35(11). p.1057-1067
Abstract

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.... (More)

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.

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organization
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type
Contribution to journal
publication status
published
subject
keywords
Citrus, Cohort studies, Cutaneous melanoma, Epidemiology, Keratinocyte cancers
in
European Journal of Epidemiology
volume
35
issue
11
pages
11 pages
publisher
Springer
external identifiers
  • pmid:32710289
  • scopus:85088559805
ISSN
0393-2990
DOI
10.1007/s10654-020-00666-9
language
English
LU publication?
yes
id
a5cf8076-141e-47f6-921e-ade56347cb2e
date added to LUP
2020-08-06 13:03:34
date last changed
2021-06-24 01:33:48
@article{a5cf8076-141e-47f6-921e-ade56347cb2e,
  abstract     = {<p>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; P<sub>trend</sub> = 0.001), particularly with basal cell carcinoma (BCC) (HR = 1.11, 95% CI 1.02–1.20, P<sub>trend</sub> = 0.007) and squamous cell carcinoma (SCC) (HR = 1.23, 95% CI 1.04–1.47, P<sub>trend</sub> = 0.01). Citrus fruit intake was positively associated with skin cancer risk (HR = 1.08, 95% CI 1.01–1.16, P<sub>trend</sub> = 0.01), particularly with melanoma (HR = 1.23, 95% CI 1.02–1.48; P<sub>trend</sub> = 0.01), although with no heterogeneity across skin cancer types (P<sub>homogeneity</sub> = 0.21). Citrus juice was positively associated with skin cancer risk (P<sub>trend</sub> = 0.004), particularly with BCC (P<sub>trend</sub> = 0.008) and SCC (P<sub>trend</sub> = 0.004), but not with melanoma (P<sub>homogeneity</sub> = 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.</p>},
  author       = {Mahamat-Saleh, Yahya and Cervenka, Iris and Al-Rahmoun, Marie and Mancini, Francesca R. and Severi, Gianluca and Ghiasvand, Reza and Veierod, Marit B. and Caini, Saverio and Palli, Domenico and Botteri, Edoardo and Sacerdote, Carlotta and Ricceri, Fulvio and Trichopoulou, Antonia and Peppa, Eleni and La Vecchia, Carlo and Overvad, Kim and Dahm, Christina C. and Olsen, Anja and Tjønneland, Anne and Perez-Cornago, Aurora and Jakszyn, Paula and Grioni, Sara and Schulze, Matthias B. and Skeie, Guri and Lasheras, Cristina and Colorado-Yohar, Sandra and Rodríguez-Barranco, Miguel and Kühn, Tilman and Katzke, Verena A. and Amiano, Pilar and Tumino, Rosario and Panico, Salvatore and Ezponda, Ana and Sonestedt, Emily and Scalbert, Augustin and Weiderpass, Elisabete and Boutron-Ruault, Marie Christine and Kvaskoff, Marina},
  issn         = {0393-2990},
  language     = {eng},
  number       = {11},
  pages        = {1057--1067},
  publisher    = {Springer},
  series       = {European Journal of Epidemiology},
  title        = {Citrus intake and risk of skin cancer in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC)},
  url          = {http://dx.doi.org/10.1007/s10654-020-00666-9},
  doi          = {10.1007/s10654-020-00666-9},
  volume       = {35},
  year         = {2020},
}