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Cancer Epidemiol Biomarkers Prev. 2019 Sep;28(9):1534-1543. doi: 10.1158/1055-9965.EPI-19-0214. Epub 2019 Jun 19.

A Prospective Study of Toenail Trace Element Levels and Risk of Skin Cancer.

Matthews NH1,2,3, Koh M1, Li WQ1,4, Li T1,5, Willett WC5,6,7, Stampfer MJ5,6,7, Christiani DC8,9, Morris JS10, Qureshi AA1,4,5,11, Cho E12,4,5.

Author information

1
Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island.
2
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
3
Department of Medicine, Signature Healthcare Brockton Hospital, Brockton, Massachusetts.
4
Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.
5
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
6
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
7
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
8
Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
9
Pulmonary and Critical Care Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
10
Research Reactor Center, University of Missouri-Columbia and Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri.
11
Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island.
12
Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island. eunyoung_cho@brown.edu.

Abstract

BACKGROUND:

Few epidemiologic studies have investigated trace element exposure and skin cancer risk.

METHODS:

Toenail levels of mercury, selenium, chromium, iron, and zinc were measured from 6,708 women in the Nurses' Health Study (1984-2012) and 3,730 men in the Health Professionals Follow-up Study (1986-2012) with data from prior nested case-control studies. Participants were free of skin cancer at toenail collection and followed for incident basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. Cox proportional hazards models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) of skin cancer associated with the elements in each study. We calculated pooled multivariable HRs using a fixed-effects model. During 26 to 28 years of follow-up, 2,433 BCC, 334 SCC, and 130 melanoma cases were documented.

RESULTS:

Higher toenail mercury levels were associated with risk of BCC [pooled HR for top vs. bottom quintiles = 1.34 (95% CI, 1.18-1.52), P trend < 0.0001]. Similar direct associations were found with risks of SCC [pooled HR for top vs. bottom quartiles = 1.41 (95% CI, 1.03-1.94), P trend = 0.04] and melanoma [pooled HR for top vs. bottom quartiles = 1.88 (95% CI, 1.12-3.16), P trend = 0.02]. Chromium was positively associated with BCC in women only. No associations were found between other metals and skin cancer risk.

CONCLUSIONS:

Our prospective data found that increased toenail mercury concentrations were associated with increased skin cancer risk.

IMPACT:

If our novel findings are confirmed, mercury may play a role in skin carcinogenesis.

PMID:
31217167
PMCID:
PMC6726507
[Available on 2020-03-01]
DOI:
10.1158/1055-9965.EPI-19-0214

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