• skin cancer;
  • sun protection behaviors;
  • survivor;
  • radiation;
  • siblings



Previous research from the Childhood Cancer Survivor Study (CCSS) has shown that risk of skin cancer is strongly associated with exposure to radiation therapy. The potential role of ultraviolet radiation exposure in survivors has not been described.


The CCSS is a retrospective cohort study designed to investigate late effects among 5-year survivors of children and adolescents diagnosed with cancer between 1970-1986. Data regarding current sun protection behavior were collected on 9298 survivors and 2950 sibling controls. Median age at follow-up was 31 years (range, 17-54).


In this cohort, childhood cancer survivors and siblings showed similar patterns of sunscreen use (67% vs 66%). Survivors were significantly less likely to report having sunbathed in the previous year (none vs any in previous year: relative risk (RR) = 0.92; 95% confidence interval (CI) = 0.89-0.95) or use artificial tanning (none vs any in previous year: RR = 0.76; 95% CI = 0.70-0.83). Compared with survivors without radiation therapy, survivors with radiation exposure showed increased use of sunscreen (RR = 1.06; 95% CI = 1.03-1.10), and less sunbathing (none vs any in previous year: RR = 0.89; 95% CI = 0.86-0.92) or artificial tanning (none vs any in previous year: RR = 0.62; 95% CI = 0.56-0.69). In adjusted multivariable analysis, statistically significant factors for regular sunscreen use in the past summer (vs never/rarely) in the survivor population were being female, having lighter skin complexions, having previously been examined for skin cancer, and having skin that burned when in the sun unprotected.


Survivors of childhood cancer self-reported lower tanning practices than siblings. However, because of the potential increased risk of skin cancer from therapy-related exposures, future research should be directed at intervention studies to further reduce UV exposures. Cancer 2009;115(18 suppl):4374–84. © 2009 American Cancer Society.