The risk for cutaneous malignant melanoma, melanoma in situ and intraocular malignant melanoma in relation to tobacco use and body mass index

Authors

  • Å. Odenbro,

    1. Department of Medical Epidemiology and Biostatistics, PO Box 281, Karolinska Institutet, 171 77 Stockholm, Sweden
    Search for more papers by this author
  • P. Gillgren,

    1. Department of Surgery, Stockholm Söder Hospital, 118 83 Stockholm, Sweden
    Search for more papers by this author
  • R. Bellocco,

    1. Department of Medical Epidemiology and Biostatistics, PO Box 281, Karolinska Institutet, 171 77 Stockholm, Sweden
    2. Department of Statistics, University of Milan-Bicocca, 20126 Milan, Italy
    Search for more papers by this author
  • P. Boffetta,

    1. Department of Medical Epidemiology and Biostatistics, PO Box 281, Karolinska Institutet, 171 77 Stockholm, Sweden
    2. International Agency for Research on Cancer, Lyon, France
    Search for more papers by this author
  • N. Håkansson,

    1. National Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
    Search for more papers by this author
  • J. Adami

    1. Department of Medical Epidemiology and Biostatistics, PO Box 281, Karolinska Institutet, 171 77 Stockholm, Sweden
    2. Department of Medicine, Clinical Epidemiology Unit, Karolinska University Hospital, 171 76 Stockholm, Sweden
    Search for more papers by this author

  • Conflicts of interest None declared.

Åsa Odenbro.
E-mail: asa.odenbro@ki.se

Summary

Background  The incidence of cutaneous malignant melanoma (CMM) and melanoma in situ (MIS) has been increasing during the last 50 years. Malignant melanoma (MM) is also the most common intraocular malignancy (IMM). Besides ultraviolet radiation, the cause of these tumours is largely unknown.

Objectives  We designed a study to examine the effect of body mass index (BMI) and tobacco use on the risk for MM and MIS.

Methods  Analyses were performed on a nationwide cohort of 339 802 Swedish construction workers. Exposure information was collected prospectively by questionnaires combined with personal interviews.

Results  Follow up yielded a total of 7 663 400 person-years during which 1639 workers developed MM/MIS. The risk for MM/MIS was reduced in current or previous smokers compared with those who had never smoked, both when analysing all smoking tobacco products combined and when analysing cigarette and pipe smokers separately. The risk was further diminished with longer duration of smoking and greater quantity of tobacco smoked. The effect was more evident in CMM/MIS than in IMM. Snuff taking conferred a decreased risk for CMM/MIS, and a BMI over normal weight range conferred an increased risk for CMM.

Conclusions  Tobacco smoking was found to be inversely associated with the risk for CMM and MIS. The mechanism of action is unknown but it has been suggested to be due to the immune suppressive effect that tobacco exerts which would be protective against deleterious immune reactions caused by, for example, the sun. Neither is the mechanism behind the higher risk for CMM due to being overweight known. One hypothesis is that it is an effect of a hormonal imbalance. Further studies are required to elucidate these mechanisms.

Ancillary