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Cancer Causes & Control
Published in: Cancer Causes & Control 5/2021

01-05-2021 | Lymphoma | Review article

Sunlight exposure in association with risk of lymphoid malignancy: a meta-analysis of observational studies

Authors: Hong-Bae Kim, Jung-Ha Kim

Published in: Cancer Causes & Control | Issue 5/2021

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Abstract

Purpose

Several observational studies have shown contradictory results regarding the association between sunlight exposure and the risk of malignant lymphoma. Thus, we aimed to systematically determine the association between sunlight exposure and lymphoid malignancy risk through a meta-analysis.

Methods

A thorough search of four electronic databases (PubMed, Embase, Web of Science, and Scopus) was performed to identify eligible studies until 13 August 2020. A random-effects model was used to calculate risk estimates of sunlight exposure. The main outcome measure was the risk of lymphoid malignancy subtypes with odds ratios (ORs) and 95% confidence intervals (CIs) according to various forms of solar ultraviolet radiation.

Results

In total, 17 case–control studies and 9 cohort studies including 216,285 non-Hodgkin lymphoma (NHL) and 23,017 Hodgkin’s lymphoma (HL) patients were included in the final analysis. Personal sunlight exposure was significantly associated with a decreased risk of HL (OR 0.77; 95% CI 0.68–0.87) and NHL (OR 0.81; 95% CI 0.71–0.92), including all subtypes except T-cell lymphoma. Ambient sunlight exposure at residence was associated with a reduced risk of HL (OR 0.88; 95% CI 0.81–0.95) and all NHL subtypes (OR 0.84; 95% CI 0.73–0.96), except for chronic lymphocytic leukemia/small lymphocytic lymphoma. As the number of sunburns and sunbaths increased, the risk of NHL tended to decrease.

Conclusion

While there was an observed protective effect both from case–control and prospective studies, substantial heterogeneity was found in the current study. Thus, more evidence is required to confirm that promoting sunlight exposure can prevent the development of lymphoid neoplasia.
Appendix
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Literature
1.
Allemani C, Matsuda T, Di Carlo V et al (2018) Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet 391:1023–1075PubMedPubMedCentralCrossRef
2.
American Cancer Society (2010) Cancer facts & figures 2010. American Cancer Society, Atlanta, p 68
3.
Morton LM, Slager SL, Cerhan JR et al (2014) Etiologic heterogeneity among non-Hodgkin lymphoma subtypes: the InterLymph Non-Hodgkin Lymphoma subtypes project. J Natl Cancer Inst Monogr 2014:130–144PubMedPubMedCentralCrossRef
4.
Hidayat K, Li HJ, Shi BM (2018) Anthropometric factors and non-Hodgkin’s lymphoma risk: systematic review and meta-analysis of prospective studies. Crit Rev Oncol Hematol 129:113–123PubMedCrossRef
5.
Cartwright RA, Watkins G (2004) Epidemiology of Hodgkin’s disease: a review. Hematol Oncol 22:11–26PubMedCrossRef
6.
International Agency for Research on Cancer (1992) IARC monographs on the evaluation of carcinogenic risks to humans. Solar and ultraviolet radiation, vol 55. International Agency for Research on Cancer, Lyon, pp 1–316
7.
Frisch M, Hjalgrim H, Olsen JH, Melbye M (1996) Risk for subsequent cancer after diagnosis of basal-cell carcinoma. A population based, epidemiologic study. Ann Intern Med 125:815–821PubMedCrossRef
8.
Levi F, Randimbison L, Te VC, La Vecchia C (1996) Non-Hodgkin’s lymphomas, chronic lymphocytic leukaemias and skin cancers. Br J Cancer 74:1847–1850PubMedPubMedCentralCrossRef
9.
Krilaviciute A, Vincerzevskiene I, Smailyte G (2016) Basal cell skin cancer and the risk of second primary cancers: a cancer registry-based study in Lithuania. Ann Epidemiol 26:511–514PubMedCrossRef
10.
Cooper KD, Oberhelman L, Hamilton T et al (1992) UV exposure reduces immunization rates and promotes tolerance to epicutaneous antigens in humans: relationship to dose, CD1a-DR+ epidermal macrophage induction, and Langerhans cell depletion. Proc Natl Acad Sci USA 89:8497–8501PubMedPubMedCentralCrossRef
11.
Opelz G, Henderson R (1993) Incidence of non-Hodgkin lymphoma in kidney and heart transplant recipients. Lancet 342:1514–1516PubMedCrossRef
12.
Kasiske BL, Snyder JJ, Gilbertson DT, Wang C (2004) Cancer after kidney transplantation in the United States. Am J Transplant 4:905–913PubMedCrossRef
13.
Kinlen LJ (1992) Immunosuppressive therapy and acquired immunological disorders. Cancer Res 52:5474s–5476sPubMed
14.
McMichael AJ, Giles GG (1996) Have increases in solar ultraviolet exposure contributed to the rise in incidence of non-Hodgkin’s lymphoma? Br J Cancer 73:945–950PubMedPubMedCentralCrossRef
15.
Hartge P, Devesa SS, Grauman D, Fears TR, Fraumeni JF Jr (1996) Non Hodgkin’s lymphoma and sunlight. J Natl Cancer Inst 88:298–300PubMedCrossRef
16.
17.
van Leeuwen MT, Turner JJ, Falster MO (2013) Latitude gradients for lymphoid neoplasm subtypes in Australia support an association with ultraviolet radiation exposure. Int J Cancer 133:944–951PubMedCrossRef
18.
Kricker A, Armstrong BK, Hughes AM, Interlymph Consortium et al (2008) Personal sun exposure and risk of non Hodgkin lymphoma: a pooled analysis from the Interlymph Consortium. Int J Cancer 122:144–154PubMedCrossRef
19.
20.
21.
Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of Observational Studies in Epidemiology (MOOSE) Group. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 283:2008–2012PubMedCrossRef
22.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097PubMedPubMedCentralCrossRef
23.
Musselman JR, Spector LG (2011) Childhood cancer incidence in relation to sunlight exposure. Br J Cancer 104:214–220PubMedCrossRef
24.
25.
26.
Higgins JP, Altman DG, Gøtzsche PC, Cochrane Statistical Methods Group et al (2011) The cochrane collaboration’s tool for assessing risk of bias in randomized trials. BMJ 343:d5928PubMedPubMedCentralCrossRef
27.
Borenstein M, Hedges LV, Higgins JP, Rothstein HR (2010) A basic introduction to fixed effect and random effects models for meta-analysis. Res Synth Methods 1:97–111PubMedCrossRef
28.
Davey EM, Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634CrossRef
29.
Hughes AM, Armstrong BK, Vajdic CM et al (2004) Sun exposure may protect against non-Hodgkin lymphoma: a case-control study. Int J Cancer 112:865–871PubMedCrossRef
30.
Smedby KE, Hjalgrim H, Melbye M et al (2005) Ultraviolet radiation exposure and risk of malignant lymphomas. J Natl Cancer Inst 97:199–209PubMedCrossRef
31.
Tavani A, Bosetti C, Franceschi S, Talamini R, Negri E, La Vecchia C (2006) Occupational exposure to ultraviolet radiation and risk of non-Hodgkin lymphoma. Eur J Cancer Prev 15:453–457PubMedCrossRef
32.
Hartge P, Lim U, Freedman DM et al (2006) Ultraviolet radiation, dietary vitamin D, and risk of non-Hodgkin lymphoma (United States). Cancer Causes Control 17:1045–1052PubMedCrossRef
33.
Petridou ET, Dikalioti SK, Skalkidou A, Andrie E, Dessypris N, Trichopoulos D, Childhood Hematology-Oncology Group (2007) Sun exposure, birth weight, and childhood lymphomas: a case control study in Greece. Cancer Causes Control 18:1031–1037PubMedCrossRef
34.
Soni LK, Hou L, Gapstur SM, Evens AM, Weisenburger DD, Chiu BC (2007) Sun exposure and non-Hodgkin lymphoma: a population-based, case-control study. Eur J Cancer 43:2388–2395PubMedCrossRef
35.
Weihkopf T, Becker N, Nieters A et al (2007) Sun exposure and malignant lymphoma: a population-based case-control study in Germany. Int J Cancer 120:2445–2451PubMedCrossRef
36.
Zhang Y, Holford TR, Leaderer B et al (2007) Ultraviolet radiation exposure and risk of non-Hodgkin’s lymphoma. Am J Epidemiol 165:1255–1264PubMedCrossRef
37.
Grandin L, Orsi L, Troussard X et al (2008) UV radiation exposure, skin type and lymphoid malignancies: results of a French case-control study. Cancer Causes Control 19:305–315PubMedCrossRef
38.
Boffetta P, van der Hel O, Kricker A et al (2008) Exposure to ultraviolet radiation and risk of malignant lymphoma and multiple myeloma–a multicentre European case-control study. Int J Epidemiol 37:1080–1094PubMedCrossRef
39.
Kane EV, Painter D, Roman E, Allan J, Law G, Lightfoot T (2010) Melanocortin 1 receptor (MC1R), pigmentary characteristics and sun exposure: findings from a case-control study of diffuse large B-cell and follicular lymphoma. Cancer Epidemiol 34:136–141PubMedCrossRef
40.
Kelly JL, Friedberg JW, Calvi LM, van Wijngaarden E, Fisher SG (2010) A case-control study of ultraviolet radiation exposure, vitamin D, and lymphoma risk in adults. Cancer Causes Control 21:1265–1275PubMedPubMedCentralCrossRef
41.
Wong KY, Tai BC, Chia SE et al (2012) Sun exposure and risk of lymphoid neoplasms in Singapore. Cancer Causes Control 23:1055–1064PubMedCrossRef
42.
Kelly JL, Drake MT, Fredericksen ZS et al (2012) Early life sun exposure, vitamin D-related gene variants, and risk of non-Hodgkin lymphoma. Cancer Causes Control 23:1017–1029PubMedPubMedCentralCrossRef
43.
Lombardi C, Heck JE, Cockburn M, Ritz B (2013) Solar UV radiation and cancer in young children. Cancer Epidemiol Biomark Prev 22:1118–1128CrossRef
44.
Coste A, Goujon S, Boniol M et al (2015) Residential exposure to solar ultraviolet radiation and incidence of childhood hematological malignancies in France. Cancer Causes Control 26:1339–1349PubMedCrossRef
45.
Wang SS, Luo J, Cozen W et al (2017) Sun sensitivity, indoor tanning and B-cell non-Hodgkin lymphoma risk among Caucasian women in Los Angeles County. Br J Haematol 177:153–156PubMedCrossRef
46.
Adami J, Gridley G, Nyrén O et al (1999) Sunlight and non-Hodgkin’s lymphoma: a population-based cohort study in Sweden. Int J Cancer 80:641–645PubMedCrossRef
47.
Håkansson N, Floderus B, Gustavsson P, Feychting M, Hallin N (2001) Occupational sunlight exposure and cancer incidence among Swedish construction workers. Epidemiology 12:552–557PubMedCrossRef
48.
Veierød MB, Smedby KE, Lund E, Adami HO, Weiderpass E (2010) Pigmentary characteristics, UV radiation exposure, and risk of non-Hodgkin lymphoma: a prospective study among Scandinavian women. Cancer Epidemiol Biomark Prev 19:1569–1576CrossRef
49.
Freedman DM, Kimlin MG, Hoffbeck RW, Alexander BH, Linet MS (2010) Multiple indicators of ambient and personal ultraviolet radiation exposure and risk of non-Hodgkin lymphoma (United States). J Photochem Photobiol B 101:321–325PubMedPubMedCentralCrossRef
50.
Chang ET, Canchola AJ, Cockburn M et al (2011) Adulthood residential ultraviolet radiation, sun sensitivity, dietary vitamin D, and risk of lymphoid malignancies in the California Teachers Study. Blood 118:1591–1599PubMedPubMedCentralCrossRef
51.
Bertrand KA, Chang ET, Abel GA et al (2011) Sunlight exposure, vitamin D, and risk of non-Hodgkin lymphoma in the Nurses’ Health Study. Cancer Causes Control 22:1731–1741PubMedPubMedCentralCrossRef
52.
53.
Cahoon EK, Pfeiffer RM, Wheeler DC et al (2015) Relationship between ambient ultraviolet radiation and non-Hodgkin lymphoma subtypes: a U.S. population-based study of racial and ethnic groups. Int J Cancer 136:E432-441PubMedCrossRef
54.
Bowen EM, Pfeiffer RM, Linet MS et al (2016) Relationship between ambient ultraviolet radiation and Hodgkin lymphoma subtypes in the United States. Br J Cancer 114:826–831PubMedPubMedCentralCrossRef
55.
Grant WB (2003) Health benefits of solar UV-B radiation through the production of vitamin D: comment and response. Photochem Photobiol Sci 2:1307–1308 (discussion 1308–1310)PubMedCrossRef
56.
Hickish T, Cunningham D, Colston K et al (1993) The effect of 1,25-dihydroxyvitamin D3 on lymphoma cell lines and expression of vitamin D receptor in lymphoma. Br J Cancer 68:668–672PubMedPubMedCentralCrossRef
57.
Chen S, Sims GP, Chen XX, Gu YY, Chen S, Lipsky PE (2007) Modulatory effects of 1,25-dihydroxyvitamin D3 on human B cell differentiation. J Immunol 179:1634–1647PubMedCrossRef
58.
Sánchez-Hidalgo M, Lee M, de la Lastra CA, Guerrero JM, Packham G (2012) Melatonin inhibits cell proliferation and induces caspase activation and apoptosis in human malignant lymphoid cell lines. J Pineal Res 53:366–373PubMedCrossRef
59.
60.
Zhu Y, Zheng T (2008) Clock-cancer connection in non-Hodgkin’s lymphoma. Med Hypotheses 70:788–792PubMedCrossRef
61.
Lahti TA, Partonen T, Kyyrönen P, Kauppinen T, Pukkala E (2008) Night-time work predisposes to non-Hodgkin lymphoma. Int J Cancer 123:2148–2151PubMedCrossRef
62.
Hoffman AE, Zheng T, Stevens RG et al (2009) Clock-cancer connection in non Hodgkin’s lymphoma: a genetic association study and pathway analysis of the circadian gene cryptochrome 2. Cancer Res 69:3605–3613PubMedPubMedCentralCrossRef
63.
64.
Hussain SP, Trivers GE, Hofseth LJ et al (2004) Nitric oxide, a mediator of inflammation, suppresses tumorigenesis. Cancer Res 64:6849–6853PubMedCrossRef
65.
Huang J, Tatsumi T, Pizzoferrato E, Vujanovic N, Storkus WJ (2005) Nitric oxide sensitizes tumor cells to dendritic cell-mediated apoptosis, uptake, and cross-presentation. Cancer Res 65:8461–8470PubMedCrossRef
66.
van der Rhee H, Coebergh JW, de Vries E (2013) Is prevention of cancer by sun exposure more than just the effect of vitamin D? A systematic review of epidemiological studies. Eur J Cancer 49:1422–1436PubMedCrossRef
67.
Smolensky MH, Sackett-Lundeen LL, Portaluppi F (2015) Nocturnal light pollution and underexposure to daytime sunlight: Complementary mechanisms of circadian disruption and related diseases. Chronobiol Int 32:1029–1048PubMedCrossRef
68.
Vallèsa X, Alonsoa MH, López-Caleya JF et al (2018) Colorectal cancer, sun exposure and dietary vitamin D and calcium intake in the MCC-Spain study. Environ Int 12:428–434CrossRef
69.
Gandini S, Boniol M, Haukka J et al (2011) Meta-analysis of observational studies of serum 25-hydroxyvitamin D levels and colorectal, breast and prostate cancer and colorectal adenoma. Int J Cancer 128:1414–1424PubMedCrossRef
70.
Ma Y, Zhang P, Wang F, Lin Z, Qin H (2011) Association between vitamin D and risk of colorectal cancer: a systematic review of prospective studies. J Clin Oncol 29:3775–3782PubMedCrossRef
71.
Ragan KR, Buchanan Lunsford N, Thomas CC, Tai EW, Sussell A, Holman DM (2019) Skin cancer prevention behaviors among agricultural and construction workers in the United States, 2015. Prev Chronic Dis 16:E15PubMedPubMedCentralCrossRef
72.
Rombaldi AJ, Canabarro LK, Neutzling MB, Silva MCD (2017) Prevalence and factors associated with exposure to sunlight and sunscreen among physical education teachers in Pelotas, southern Brazil. An Bras Dermatol 92:785–792PubMedPubMedCentralCrossRef
73.
Downs N, Parisi A, Schouten P (2011) Basal and squamous cell carcinoma risks for golfers: an assessment of the influence of tee time for latitudes in the Northern and Southern hemispheres. J Photochem Photobiol B 105:98–105PubMedCrossRef
74.
Cockburn M, Hamilton A, Mack T (2001) Recall bias in self-reported melanoma risk factors. Am J Epidemiol 153:1021–1026PubMedCrossRef
75.
Matsuoka LY, Ide L, Wortsman J, MacLaughlin JA, Holick MF (1987) Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab 64:1165–1168PubMedCrossRef
Metadata
Title
Sunlight exposure in association with risk of lymphoid malignancy: a meta-analysis of observational studies
Authors
Hong-Bae Kim
Jung-Ha Kim
Publication date
01-05-2021
Publisher
Springer International Publishing
Published in
Cancer Causes & Control / Issue 5/2021
Print ISSN: 0957-5243
Electronic ISSN: 1573-7225
DOI
https://doi.org/10.1007/s10552-021-01404-6

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