European Code against Cancer 4th Edition: Ultraviolet radiation and cancer

Nanotechnology as a Promising Method in the Treatment of Skin Cancer

The incidence of skin cancer continues to grow. There are an estimated 1.5 million new cases each year, of which nearly 350,000 are melanoma, which is often fatal. Treatment is challenging and often ineffective, with conventional chemotherapy playing a limited role in this context. These disadvantages can be overcome by the use of nanoparticles and may allow for the early detection and monitoring of neoplastic changes and determining the effectiveness of treatment. This article briefly reviews the present understanding of the characteristics of skin cancers, their epidemiology, and risk factors. It also outlines the possibilities of using nanotechnology, especially nanoparticles, for the transport of medicinal substances. Research over the previous decade on carriers of active substances indicates that drugs can be delivered more accurately to the tumor site, resulting in higher therapeutic efficacy. The article describes the application of liposomes, carbon nanotubes, metal nanoparticles, and polymer nanoparticles in existing therapies. It discusses the challenges encountered in nanoparticle therapy and the possibilities of improving their performance. Undoubtedly, the use of nanoparticles is a promising method that can help in the fight against skin cancer.

Latin America and the Caribbean Code Against cancer 1st edition: Environment, occupation, and cancer

Within the framework of the Latin America and Caribbean region (LAC) Code Against Cancer 1st edition, the current work presents recommendations to reduce exposure to environmental and occupational carcinogenic agents relevant for LAC. Using the methodology established by the International Agency for Research on Cancer (IARC) in the World Code Against Cancer Framework and experience from developing the European Code Against Cancer 4th edition, a working group of LAC cancer-prevention experts reviewed the list of Group I IARC carcinogenic agents, identified prevalent environmental and occupational exposures in the region, and proposed evidence-based cancer prevention recommendations suited to the epidemiological, socioeconomic, and cultural conditions of LAC countries. Two sets of recommendations were drafted: those targeting the general public and a second set for policymakers. Outdoor and indoor air pollution, ultra-violet radiation and occupational exposures to silica dust, asbestos, benzene, diesel, and welding fumes were identified as prevalent carcinogens in LAC and as agents that could be reduced or eliminated to prevent cancers. Recommendations for additional risk factors were not included due to insufficient data of their attributable burden in LAC (sunbeds, radon, aflatoxin), or lack of a clear preventive action to be taken by the individual (arsenic in drinking water, medical radiation), or lack of evidence of carcinogenicity effect (bisphenol A, phthalates, and pesticides). A broad consensus was reached on environmental and occupational carcinogenic exposures present throughout the LAC region and on individual-level and public policy-level recommendations to reduce or eliminate these exposures. Key educational content for the dissemination of these recommendations was also developed as part of LAC Code Against Cancer 1st Edition.

Latin America and the Caribbean Code Against Cancer 1st Edition: 17 cancer prevention recommendations to the public and to policy-makers (World Code Against Cancer Framework)

Preventable risk factors are responsible of at least 40% of cases and almost 45% of all cancer deaths worldwide. Cancer is already the leading cause of death in almost half of the Latin American and the Caribbean countries constituting a public health problem. Cost-effective measures to reduce exposures through primary prevention and screening of certain types of cancers are critical in the fight against cancer but need to be tailored to the local needs and scenarios. The Latin America and the Caribbean (LAC) Code Against Cancer, 1st edition, consists of 17 evidence-based recommendations for the general public, based on the most recent solid evidence on lifestyle, environmental, occupational, and infectious risk factors, and medical interventions. Each recommendation is accompanied by recommendations for policymakers to guide governments establishing the infrastructure needed to enable the public adopting the recommendations. The LAC Code Against Cancer has been developed in a collaborative effort by a large number of experts from the region, under the umbrella strategy and authoritative methodology of the World Code Against Cancer Framework. The Code is a structured instrument ideal for cancer prevention and control that aims to raise awareness and educate the public, while building capacity and competencies to policymakers, health professionals, stakeholders, to contribute to reduce the burden of cancer in LAC.

DNA Damage Induced by T-2 Mycotoxin in Human Skin Fibroblast Cell Line-Hs68

T-2 mycotoxin is the most potent representative of the trichothecene group A and is produced by various Fusarium species, including F. sporotrichioides, F. poae, and F. acuminatum. T-2 toxin has been reported to have toxic effects on various tissues and organs, and humans and animals alike suffer a variety of pathological conditions after consumption of mycotoxin-contaminated food. The T-2 toxin's unique feature is dermal toxicity, characterized by skin inflammation. In this in vitro study, we investigated the molecular mechanism of T-2 toxin-induced genotoxicity in the human skin fibroblast-Hs68 cell line. For the purpose of investigation, the cells were treated with T-2 toxin in 0.1, 1, and 10 μM concentrations and incubated for 24 h and 48 h. Nuclear DNA (nDNA) is found within the nucleus of eukaryotic cells and has a double-helix structure. nDNA encodes the primary structure of proteins, consisting of the basic amino acid sequence. The alkaline comet assay results showed that T-2 toxin induces DNA alkali-labile sites. The DNA strand breaks in cells, and the DNA damage level is correlated with the increasing concentration and time of exposure to T-2 toxin. The evaluation of nDNA damage revealed that exposure to toxin resulted in an increasing lesion frequency in Hs68 cells with HPRT1 and TP53 genes. Further analyses were focused on mRNA expression changes in two groups of genes involved in the inflammatory and repair processes. The level of mRNA increased for all examined inflammatory genes (TNF, INFG, IL1A, and IL1B). In the second group of genes related to the repair process, changes in expression induced by toxin in genes-LIG3 and APEX were observed. The level of mRNA for LIG3 decreased, while that for APEX increased. In the case of LIG1, FEN, and XRCC1, no changes in mRNA level between the control and T-2 toxin probes were observed. In conclusion, the results of this study indicate that T-2 toxin shows genotoxic effects on Hs68 cells, and the molecular mechanism of this toxic effect is related to nDNA damage.

Vegetable as a Source of Bioactive Compounds with Photoprotective Properties: Implication in the Aging Process

The skin, as an external organ, protects the entire body against harmful external factors. One of these factors is ultraviolet (UV) radiation, which in excessive amounts can lead to premature skin aging, DNA damage, and even skin cancer. Therefore, it is worth supporting skin protection not only with commercially available preparations, but also with a proper diet. Consuming certain vegetables and applying them topically may reduce the effects of UV radiation. The aim of the review was to collect information on the effects of vegetables and their compounds on the skin when used externally or included in the diet. This review summarizes studies on vegetables, such as broccoli, cucumber, kale, tomato, and carrot, which have shown significant activity in skin photoprotection. Additionally, it outlines the bioactive substances present in these vegetables and their effects.

SURVIVAL IN MELANOMA IN THE NORDIC COUNTRIES INTO THE ERA OF TARGETED AND IMMUNOLOGICAL THERAPIES

OBJECTIVES

Survival in melanoma has been increasing and the most recent interest is to observe the population-level impact of novel targeted therapies and immunotherapy. We analysed survival in melanoma from Denmark (DK), Finland (FI), Norway (NO) and Sweden (SE) over a 50-years period (1971-2020).

METHODS

Relative 1-5/1- and 5-year survival data were obtained from the NORDCAN database for the years 1971-2020. We estimated annual changes in survival rates and determined significant breaking points for trends.

RESULTS

Survival in melanoma has reached the point where 1-year survival is approaching 100% (men 97.5-98.6%, women 98.4-99.3%, depending on the country) and 5-year survival is 93% for men (91.5-95.2%) and 96% for women (95.3-97.2%). The highest survival figures were for DK. Significant increases in both 1- and 5-year survival were observed in most countries even towards the end of the follow-up (from 2006 to 2010-2011-2015 and further to 2016-2020).

CONCLUSIONS

The main increase in melanoma survival took place up to year 1990, which was probably largely achieved through successful population campaigns for sun protection and programmes for early detection of lesions. Survival increased again after year 2000 up to the last period 2016-2020. This late development coincided with the introduction of targeted therapies using BRAF and BRAF/MEK inhibitors, and towards the end of the time period availability of checkpoint inhibitors. The success of melanoma treatment in DK was mostly likely due to the efficient use of modern therapies and to the centralised treatment for metastatic disease.

Protective Measures From Solar Ultraviolet Radiation for Beach Lifeguards in Tuscany (Italy): Shade and Clothing Strategies

Background

The exposure to solar ultraviolet radiation is a significant risk factor generally underestimated by outdoor workers and employers. Several studies have pointed out that occupational solar exposure increased eye and skin diseases with a considerable impact on the lives and productivity of affected workers.The main purpose of this study was to evaluate the effectiveness against ultraviolet radiation of some measures recently undertaken for the protection of lifeguards in a coastal area of Tuscany.

Methods

Different shading structures (gazebos and beach umbrella) were tested during a sunny summer's day on a sandy beach by means of two radiometers; the UV protection offered by some T-shirts used by lifeguards was also tested in the laboratory with a spectrophotometer.

Results

The analysed shading structures strongly reduced the ultraviolet radiation by up to 90%, however a not always negligible diffuse radiation is also present in the shade, requiring further protective measures (T-shirt, sunglasses, sunscreen, etc.); the tested T-shirts showed a very good-excellent protection according to the Australian/New Zealand standard.

Conclusion

Results obtained in this study suggest how the adoption and dissemination of good practices, including those tested, could be particularly effective as a primary prevention for lifeguards who are subjected to very high levels of radiation for long periods.

Ultraviolet exposure of competitors during a Tokyo Olympic Sailing Regatta Test Event

BACKGROUND

Overexposure to sunlight is the main cause of skin cancer. Photoprotection practices and sunburn play a crucial role in skin cancer prevention.

OBJECTIVES

This study aimed to quantify the risk of sun exposure and to evaluate photoprotection practices in Spanish sailors during Olympic competitions.

METHODS

Solar daily ultraviolet (UV) radiation cycle, personal UV dosimetry, photoprotection practices and sunburn checking were followed during three consecutive days of competition among sailors from the Spanish Olympic Sailing Team during a Tokyo Olympic Regatta Test Event.

RESULTS

A total of 13 sailors (7 women), with mean age of 27.6 ± 4.7 years and sports experience of 17.7 ± 5.4 years, were studied. The most common phototypes were type III (53.8%) and type II (38.5%). The rate of sunburn checked was high (46.2%). The mean daily personal UV exposure received was 761.0 ± 263.6 J/m² , 3.0 ± 1.1 minimal erythemal dose and 7.6 ± 2.6 standard erythemal dose, seven times greater than the maximum permissible UV light exposure values for an 8 h working day. The use of a T-shirt was the most common practice (94.2%), followed by the use of shade (50.2%), hat/cap (44.0%), sunglasses (26.1%) and sunscreen (11.8%).

CONCLUSIONS

Olympic sailor's studies presented high levels of UV radiation received, high rate of sunburn and insufficient adherence to sun-protective behaviours (especially, to use of sunscreen) to prevent sunburn, the main cause of skin cancer. Sport Federations should develop educational campaigns addressing sun-related exposure habits and photoprotection behaviours to reduce the risk of skin cancer among these athletes.

Synthesis and Characterization of Silver Nanoparticles from Rhizophora apiculata and Studies on Their Wound Healing, Antioxidant, Anti-Inflammatory, and Cytotoxic Activity

Silver nanoparticles (AgNPs) have recently gained interest in the medical field because of their biological features. The present study aimed at screening Rhizophora apiculata secondary metabolites, quantifying their flavonoids and total phenolics content, green synthesis and characterization of R. apiculata silver nanoparticles. In addition, an assessment of in vitro cytotoxic, antioxidant, anti-inflammatory and wound healing activity of R. apiculata and its synthesized AgNPs was carried out. The powdered plant material (leaves) was subjected to Soxhlet extraction to obtain R. apiculata aqueous extract. The R. apiculata extract was used as a reducing agent in synthesizing AgNPs from silver nitrate. The synthesized AgNPs were characterized by UV-Vis, SEM-EDX, XRD, FTIR, particle size analyzer and zeta potential. Further aqueous leaf extract of R. apiculata and AgNPs was subjected for in vitro antioxidant, anti-inflammatory, wound healing and cytotoxic activity against A375 (Skin cancer), A549 (Lung cancer), and KB-3-1 (Oral cancer) cell lines. All experiments were repeated three times (n = 3), and the results were given as the mean ± SEM. The flavonoids and total phenolics content in R. apiculata extract were 44.18 ± 0.086 mg/g of quercetin and 53.24 ± 0.028 mg/g of gallic acid, respectively. SEM analysis revealed R. apiculata AgNPs with diameters ranging from 35 to 100 nm. XRD confirmed that the synthesized silver nanoparticles were crystalline in nature. The cytotoxicity cell viability assay revealed that the AgNPs were less toxic (IC₅₀ 105.5 µg/mL) compared to the R. apiculata extract (IC₅₀ 47.47 µg/mL) against the non-cancerous fibroblast L929 cell line. Antioxidant, anti-inflammatory, and cytotoxicity tests revealed that AgNPs had significantly more activity than the plant extract. The AgNPs inhibited protein denaturation by a mean percentage of 71.65%, which was equivalent to the standard anti-inflammatory medication diclofenac (94.24%). The AgNPs showed considerable cytotoxic effect, and the percentage of cell viability against skin cancer, lung cancer, and oral cancer cell lines was 31.84%, 56.09% and 22.59%, respectively. R. apiculata AgNPs demonstrated stronger cell migration and percentage of wound closure (82.79%) compared to the plant extract (75.23%). The overall results revealed that R. apiculata AgNPs exhibited potential antioxidant, anti-inflammatory, wound healing, and cytotoxic properties. In future, R. apiculata should be further explored to unmask its therapeutic potential and the mechanistic pathways of AgNPs should be studied in detail in in vivo animal models.

Sun Protection Behaviour and Sunburns in Spanish Cyclists

Sunburn caused by overexposure to ultraviolet radiation is the main cause of preventable skin cancer. This study aimed to describe the sun protection habits and rate of sunburns associated with the practice of cycling and to identify predictive factors of sunburn among cyclists. A descriptive observational study based on online surveys was conducted. Recruitment of participants was conducted through the Andalusian Cycling Federation (Spain). A questionnaire on behaviour, attitudes, and knowledge related to sun exposure was used. A bivariate analysis was carried out with sunburn episodes during the previous year as outcome variable, and a multivariate logistic regression model was built. Of the 1018 surveys returned, 87.6% were answered by men, mean age was 41.8 years (SD: 11.0), and 37.6% of the participants had phototype I or II. Sunburns during the previous year were reported by 45.6% (95% CI: 42.5-48.7) of the respondents. Sunscreen use was reported by 39.2%, and 61.0% did not examine their skin regularly despite the fact that 34 subjects (3.4%) reported a personal history of skin cancer. The multivariate logistic regression analysis showed that there was a negative correlation between episodes of sunburn and age, phototypes I-II, more than 2 h of sun exposure, and inconsistent use of sunscreen. Cyclists have high rates of sunburns and thus constitute a high-risk group for developing skin cancer. Educational interventions specifically aimed at this group of athletes would improve sun protection knowledge and practices, particularly the use of sunscreen.

[The UV Protection Alliance in Germany-Purpose and goals]

Despite the serious health consequences of UV radiation, protection against UV radiation is even now still not a matter of course. The population has a largely realistic view of UV radiation-related health risks but this does not seem to instigate a change in personal risk assessments and towards an adequate UV protection behavior. This is not least due to the partly contradictory statements and recommendations regarding the positive and negative health effects, also from the scientific community. A harmonization as well as a collation of the statements and activities of individual players in UV protection related to the prevention of UV-related diseases gives the key messages the necessary strength to make UV protection a matter of course in society. To this end, the UV Protection Alliance was initiated by the Federal Office for Radiation Protection (BfS). This article reports on the UV Protection Alliance, presents the partners in the Alliance, the goals of the UV Protection Alliance, previous results of work by the Alliance and actions and interventions of the Alliance partners. The public impact of the UV Protection Alliance is explained and an outlook is given on future tasks of the Alliance.

Temporal Trends in the Incidence and Mortality of Skin Malignant Melanoma in China from 1990 to 2019

Purpose

Skin malignant melanoma (SMM) is one of the fastest-growing cancers in China, with a poor prognosis, high invasiveness, and high mortality rate. The aim of this study was to determine the long-term trends in the incidence and mortality of SMM in China between 1990 and 2019. Patients and Methods. Incidence and mortality data were extracted from the Global Burden of Disease Study 2019 and were analyzed using an age-period-cohort framework.

Results

The annual incidence net drifts were 3.523% (95% confidence interval (CI): 3.318% to 3.728%) and 3.779% (95% CI: 3.585% to 3.974%) for males and females, respectively, while the corresponding annual net drifts of mortality were −0.754% (95% CI: −1.073% to −0.435%) and –0.826% (95% CI: −1.164% to −0.487%). The local drift from 1990 to 2019 was highest in males aged from 25 to 29 years. After controlling for period deviations in a single birth cohort, the SMM incidence and mortality increased exponentially with age for both sexes. Similar increasing monotonic trends were found for period and cohort effects on the incidence, while a declining trend was found for mortality.

Conclusion

While the age-standardized mortality rate of SMM in China has decreased in both sexes over the past 30 years, the crude incidence rate, age-standardized incidence rate, and crude mortality rate have all increased. SMM may greatly threaten the health of the elderly in China due to the aging population. Appropriate changes should be made to raise the awareness, reduce the exposure to risk factors, and promote the early detection of SMM.

Cluster Randomized Trial: Sun Protection Intervention 'Clever in Sun and Shade for Preschools'-Effectiveness and Dissemination

Skin cancer is one of the most common types of cancer and UV radiation is one of the main risk factors. Therefore, sun protection, especially in childhood, is strongly recommended. We examined the effectiveness of the ‘Clever in Sun and Shade for Preschools’ program (CLEVER) in promoting sun protection behavior among preschool staff (trial registration: DRKS00023468) and describe its dissemination. Within a cluster randomized trial with 24 preschools (n = 273 staff members) stating a high need for sun protection measures, an educational workshop for preschool staff and a project kit with materials applicable in preschool groups was provided. Staff members of preschools taking part in CLEVER report significantly stronger sun protection behavior to avoid the sun (effect size [ES] 0.70, 95% confidence interval [CI] 0.04 0.71, p < 0.05) and less perceived impediments to avoid the sun (ES −0.56, CI −0.82 −0.17, p < 0.01) after 12 months as well as higher self-efficacy to avoid the sun (ES 1.09, CI 0.39 1.07, p < 0.001) and to use sunscreen (ES 0.71, CI 0.03 0.88, p < 0.05) after 1 month. Compared to the control group, there was no significant effect on sunscreen use and further psychosocial outcomes. The effectiveness of CLEVER may be underrated due to a high drop-out rate. Within three years, an enhanced free-of-charge program kit, including a media-based workshop and materials, had reached over 4000 preschools, i.e., 7.1% of all daycare centers in Germany. The results show that CLEVER can strengthen sun protection, offer high-quality information at low cost, and is easily disseminable.

Personal Solar Ultraviolet Radiation Exposure of Farmworkers: Seasonal and Anatomical Differences Suggest Prevention Measures Are Required

INTRODUCTION

Farmworkers are at risk of excess exposure to solar ultraviolet radiation (UVR) during their work activities, especially if they work in geographical areas with high ambient solar UVR levels such as in South Africa. Excess exposure to solar UVR may lead to several negative health effects such as certain cataracts and skin cancer. This study evaluated personal solar UVR exposure of a group of farmworkers to determine if they were at risk of health-related problems due to excess solar UVR exposure.

METHODS

Polysulphone film (PSF) badges were placed on the shoulder, arm, and top of the head of outdoor and indoor farmworkers on a macadamia nut and avocado farm in the Limpopo province for the duration of their daily work shift to evaluate their total daily solar UVR exposure. Sixteen days were assessed for each of the three, high solar UVR seasons, i.e. autumn, spring, and summer.

RESULTS

During autumn, farmworkers' arms received the highest solar UVR exposures (geometric mean (GM) = 7.8 SED, where 1 standard erythemal dose (SED) = 100 J/m2, 95% CI 6.1-9.8 SED) while the highest exposures were on the top of the head during spring (GM = 11.6 SED, 95% CI 7.3-17.4 SED) and summer (GM = 13.9, 95% CI 10.4-17.9 SED). Statistically significant differences in solar UVR exposure were found between the body sites during spring and summer but not autumn.

CONCLUSIONS

The relatively high daily solar UVR exposure levels of farmworkers suggest this occupational group is at risk of excess solar UVR exposure and preventive measures with awareness information to safeguard health is necessary for employers and employees.

Individual and neighbourhood socioeconomic measures and the risk of non-central nervous system solid tumours in children: A nationwide register-based case-control study in Denmark

BACKGROUND

The aetiology for most solid tumours in childhood is largely unknown. The lack of evidence concerns also the relationship between socioeconomic position (SEP) and risk of childhood solid tumours other than in the central nervous system (CNS). We sought to access the association between individual and neighbourhood SEP measures and risk of childhood non-CNS solid tumours in Denmark and to evaluate whether associations varied by measure of SEP, time point of SEP assessment (during pregnancy versus before diagnosis) and tumour type.

METHODS

We conducted a nationwide case-control study based on Danish registry data. We identified all children born in 1980-2013 and diagnosed with a non-CNS solid tumour at ages 0-19 years (N = 1961) from the Danish Cancer Registry and sampled four individually matched controls per case using the Population Registry. We fitted conditional logistic regression models to estimate associations with register-based individual-level and neighbourhood-level SEP measures.

RESULTS

We observed a tendency of increased odd ratios (OR) in association with medium and high maternal income for most tumour types (e.g. OR for the highest income quintile and malignant bone tumours = 2.11; 95 % CI: 1.01, 4.38) and for parental education in association with higher education for some tumour types. For malignant epithelial neoplasms, higher parental education and income level were overall associated with an increased risk, e.g. OR = 1.63 (95 % CI: 1.00, 2.65) for the fourth group of maternal income during pregnancy. We found no risk pattern for neighbourhood SEP.

CONCLUSION

This large register-study with minimal risk of bias found a tendency of slightly to moderately increased risks for most childhood non-CNS solid tumours in association with higher maternal income and parental education. Future research examining the underlying mechanisms of these socioeconomic differences in non-CNS solid tumours as well as other childhood cancer types are warranted.

Novel sunprotection interventions to prevent skin cancer: A randomized study targeting Danes going on vacation to destinations with high UV index

Background

In Denmark, 16,500 cases of melanoma and keratinocyte cancers were registered in 2015, of which 90% could have been avoided by behavioral changes. We aimed to test novel interventions in a randomized design. The interventions targeted Danes going on vacation to high UVI destinations aiming to decrease sunburn by increasing use of sun protection to prevent skin cancer in the Danish population.

Methods

We report a randomized behavioral intervention during May-Dec 2018 with 1548 Danish adults on vacation in 2018 for a period of 1–3 weeks. The study population was population-based and aged 18–65 years. We tested two protection routines against minimal intervention control group (2-by2-factorial design): 1) Avoidance of the sun during peak hours and shade, use of the UV-index and planning of indoor/outdoor activity respectively and, 2) Coverage by increasing use of the hat advice and increasing sunscreen amount by application routine. Outcome was use of protection and sunburn.

Results

There were no differences in sunburn prevalence between intervention and control groups. Protection routine 1 and 2 both increased the overall protection score compared to non-users. Protection routine 1 increased the reported use of shade and decreased time exposed in the sun. Protection routine 2 increased the use of hat and sunscreen amount.

Conclusion

Simple measures can help avoid the majority of one of the most widespread cancers worldwide. Vacations to high UVI destinations is a major influence on the annual Danish UV-exposure. We influenced travelers to protect themselves better and to increase sun protection behavior.

Trends in mortality rates for oral and oropharyngeal cancer in Spain, 1979-2018

OBJECTIVE

To analyse mortality rate trends in Spain for oral cavity and oropharyngeal cancer (OCOPC) from 1979 to 2018, evaluating differences between oral cavity cancer (OCC) and oropharyngeal cancer (OPC).

MATERIALS AND METHODS

Death certificates and mid-year population data were collected from the Spanish National Statistics Institute. Age-standardized mortality rates were calculated using the direct method. Joinpoint regressions were used to identify significant changes in mortality trends. Independent effects of age, period and cohort (APC) were estimated.

RESULTS

A total of 52,057 deaths were registered from OCOPC, 38,988 from OCC and 13,069 from OPC between 1979 and 2018. While OCC mortality rates declined, OCOPC rates increased slightly and OPC significantly. OCC and OPC mortality reached their highest values between 1979 and 1992, when OCC rates began to decrease in males and OPC levelled off until 2018. Lip cancer suffered the highest drop. APC models showed a mortality increase in males and females from 40 to 45 and 50 to 55 years of age, respectively.

CONCLUSIONS

Favourable OCC mortality trends was plausibly influenced by decreased tobacco/alcohol consumption, while OPC rise was probably associated with increased human papillomavirus infection. The importance of closely monitoring these cancers by age group, sex and location, and continuing with preventive measures against known risk factors, is highlighted.

Association of serum 25-Hydroxyvitamin D with Vitamin D intervention and outdoor activity among children in North China: an observational study

Background

Living at high latitudes is one of the risk factors for vitamin D deficiency in children. However, evidence on vitamin D improvement for this pediatric population to date is limited. This study aims at evaluating the association of different vitamin D intervention methods and outdoor activity on the vitamin D status of children in North China.

Methods

In this observational study, a total of 55,925 children aged 1 month to 18 years old were recruited from pediatric outpatient departments from July 2016 to June 2017. Data on demographics, anthropometric measurements, vitamin D intervention (either prescribed by physicians or given by parents) and outdoor activity were recorded. The serum levels of 25-hydroxycholecalciferol (25(OH)D) were determined by high performance liquid chromatography tandem–mass spectrometry. Logistic regression analysis was performed to assess the association of vitamin D intervention or outdoor activity with blood vitamin D status, adjusted for age, gender, BMI for age, and seasons.

Results

The overall rate of hypovitaminosis D was 65.60%. Of the children’s outdoor activity, 35.63, 31.95, and 32.42% were below 30 min/d, 30–60 min/d and over 60 min/d, respectively. Furthermore, the proportion of therapeutic intervention, supplementation intervention and no vitamin D intervention among the children was 16.48, 32.87, and 50.65%, respectively. After adjusted for confounding factors, vitamin D intervention was associated with a lower risk of hypovitaminosis D, with OR (95% CI) of 0.191 (0.180, 0.202) in children with therapeutic doses and 0.423 (0.404, 0.443) in those with supplementation doses, compared with children without vitamin D intervention. In addition, longer outdoor time was associated with a lower risk of hypovitaminosis D [0.479 (0.456, 0.504) for 60 min/d, 0.737 (0.701, 0.776) for 30–60 min/d], independent of vitamin D intervention.

Conclusions

High prevalence of vitamin D deficiency was found in children living at high latitudes. Vitamin D intervention and outdoor activity are all negatively associated with children’s vitamin D deficiency. Routine vitamin D intervention combined with increased outdoor time might be an effective approach to prevent hypovitaminosis D among children, especially those at school, living at high latitudes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-020-02435-9.

Improved protection of outdoor workers from solar ultraviolet radiation: position statement

The vast majority of non-melanoma skin cancer (NMSC) is attributable to excessive exposure to ultraviolet radiation (UVR). Outdoor workers are exposed to an UVR dose at least 2 to 3 times higher than indoor workers and often to daily UVR doses 5 times above internationally recommended limits. The risk of UVR workplace exposure is vastly neglected, and the evident future challenges presented in this statement are contrasted with the current situation regarding legal recognition, patient care and compensation. While prevention is crucial to reduce cancer risks for outdoor workers, it is as much of relevance to better protect them through legally binding rules and regulations. Specific actions are outlined in five recommendations based on a Call to Action (table 1). The role of health professionals, including dermatologists, in this context is crucial.

A Clinicoepidemiological Study of Melanoma in Young Patients (20 Years of Age or Less) in Alberta, Canada, From 1992 to 2011

The epidemiological trends of malignant melanoma have been well described in the literature. However, there remains a paucity of population-based studies assessing melanoma epidemiology in our younger patients (20 years of age or less). Other studies indicate that melanoma incidence has risen in pediatric populations over the last several decades and that these tumors may display different clinical characteristics from those arising in adult populations. We conducted a retrospective, population-based analysis of all incident cases of melanoma occurring in young patients aged ≤20 years in Alberta from 1992 to 2011. Information, including patient age, sex, anatomical location, date of diagnosis, histological subtype (if available), level of invasion, and date of death (if applicable), was obtained from the Alberta Cancer Registry. All cases occurring during a 10-year period from 1993 to 2011 have been reviewed. A total of 71 cases were diagnosed during this time (63% female and 37% male). Age range was 0-20 years (mean of 17.5 years). Truncal melanomas made up 36% of cases, while 28% occurred on the lower limbs, 17% on the upper limbs, and 18% in the head and neck region. Average Breslow thickness was 1.97 mm; 67% of tumors were less than 1 mm thick. Unfortunately, 8 of 71 patients died from their disease. Overall, the incidence of melanoma in patients aged ≤20 years appeared to decrease in Alberta in the past 20 years; however, there has been an increase in the thickness of melanoma at diagnosis, which needs to be addressed.

A Comparison of Solar Ultraviolet Radiation Exposure in Urban Canyons in Venice, Italy and Johannesburg, South Africa

Urban environments can have high-risk spaces that can provide excess personal sun exposure, such as urban or street canyons, and the spaces between buildings, among others. In these urban spaces, sun exposure can be high or low depending on several factors. Polysulphone film (PSF) was used to assess possible daily solar ultraviolet radiation (UVR) exposure in urban canyons in Venice, Italy and, for the first time in Africa, in Johannesburg, South Africa. The photodegradation of PSF upon solar exposure was monitored at a wavelength of 330 nm by ultraviolet-visible spectrophotometry, and the resultant change was converted to standard erythemal dose (SED) units (1 SED = 100 J m^-2 ). Mean daily ambient solar UVR exposure measured for Venice and Johannesburg ranged between 20-28 SED and 33-43 SED, respectively. Canyon-located PSF exposures were lower in Venice (1-9 SED) than those in Johannesburg (9-39 SED), depending mainly on the sky view factor and orientation to the sun. There was large variation in solar UVR exposure levels in different urban canyons. These preliminary results should be bolstered with additional studies for a better understanding of excess personal exposure risk in urban areas, especially in Africa.

Spectral transmission of solar radiation by plastic and glass materials

It is well known that excessive exposure to solar ultraviolet (UV) radiation can have serious adverse effects. Many everyday materials influence the UV radiation received by humans, for example, those used in construction and on the exterior of buildings such as plastics and glass can reduce the UV exposure of persons exposed to solar radiation. In this paper we analyse the spectral transmission of solar radiation of widely used materials using the transmittance parameter. The measurements were performed on clear days, at 8 h and 12 solar hours, in July 2018 (five days) and in January 2019 (three days). The spectral transmittances of these materials and the integrated transmittances in the UVB from 300 nm, UVA, visible (VIS) and near infrared ranges (NIR) were calculated. In summer in the UVB range from 300 nm methacrylate and smoked glass have the highest transmittance values (56%) and polycarbonate present the lowest (30%). In the VIS and NIR ranges methacrylate (95%) and smoked glass (80%) have the highest transmittances and polycarbonate the lowest (45%). In general the 8 h transmittances are higher than those at 12 h and are also higher in winter than summer. For two biological functions (erythemal and DNA-damage) and for the UVB range from 300 nm, the transmittance for most materials (except fibreglass) is in the range 6-14%. The exposure times obtained show that erythemal damage could occur after long exposure to solar radiation through the materials studied, information which should be made available to the general public.

Global patterns and trends in cancers of the lip, tongue and mouth

OBJECTIVES

Global descriptions of international patterns and trends in oral cancer are informative in providing insight into the shifting epidemiologic patterns and the potential prevention of these tumours. We present global statistics on these cancers using the comprehensive set of national estimates and recorded data collated at the International Agency for Research on Cancer (IARC).

METHODS

The estimated number of lip and oral cavity cases and deaths in the 185 countries for the year 2018 was extracted from IARC's GLOBOCAN database of national estimates. To examine trends, recorded data series on lip and oral cavity cancers, as well as corresponding population-at-risk data were extracted from successive volumes of Cancer Incidence in Five Continents.

RESULTS

Globally, the highest incidence was found in South-Central Asia and parts of Oceania, with the highest estimated incidence rates in Papua New Guinea, Pakistan and India. The highest observed rates of lip cancer were in Australia, while India had the highest incidence rates of mouth and oral tongue cancer. Trends are diverse, with lip cancer incidence rates continuing to decrease for both sexes; the incidence rates of mouth cancer are also in decline in males, although increasing rates among females were observed in some populations.

CONCLUSION

There are some grounds for optimism given the prospects for control of these cancers. Primary prevention should however focus on the reduction of the main causes, namely, tobacco and alcohol consumption.

Ultraviolet Radiation Exposure: Some Observations and Considerations, Focusing on Some Italian Experiences, on Cancer Risk, and Primary Prevention

Solar ultraviolet radiation may cause acute and chronic health effects on the skin, eyes, and also on the immune system. Actinic keratosis, non-melanoma skin cancers, and malignant melanoma are the main long-term adverse skin effects. In the white population, the most common type of cancer worldwide is skin cancer, and the incidence of this cancer has increased during the last decades. The most important risk factor responsible for this trend seems to be Ultraviolet Radiation (UVR). IARC has classified UVR as being carcinogenic to humans. UV radiation exposure is ubiquitous; to study skin cancer risk, it is important to take into account the fact that UV exposure may occur both for occupational activities but also during vacation or recreational activities. Furthermore, exposure to artificial UVR such as those emitted by artificial devices, classified by IARC as carcinogenic to humans, is also to be considered. Due to the prominent role of UVR, primary prevention of skin cancer is very suitable, because when following specific rules this risk factor can be reduced. The incidence rate of skin cancer is higher in people with fair skin. Outdoor workers exposed to solar UVR are at risk of developing skin cancer, particularly non-melanoma skin cancers, and welders exposed to artificial UVR are at risk of developing ocular melanoma. A specific project on solar UVR risk in outdoor workers in Tuscany, Italy, has shown that outdoor workers had an unsatisfactory sun protection behaviour. The project demonstrates the complexity of studying UVR exposure and recommended the need for prevention programs. Risk increases with increasing ambient solar radiation and with unsafe behaviours in the sun or when using artificial UVR (e.g., sunbeds). Effective prevention strategies have to be adopted both for the outdoor workers and for the general population exposed to UVR. A standardized program of proven efficacy, such as that implemented in Australia, should also be implemented in other countries. All these strategies could contribute to the aim of decreasing the morbidity and mortality of cancers associated with this exposure. The aim of this paper is to provide an overview of UVR exposure risk, particularly occupational risk, and to give some elements to understand the complexity of the relation between UVR exposure and cancer risk, as well as to outline primary prevention measures, focusing also on Italian experiences that could be useful for providing additional elements of knowledge on this topic.

Are Environmental Interventions Targeting Skin Cancer Prevention among Children and Adolescents Effective? A Systematic Review

Skin cancer, which is increasing exceedingly worldwide, is substantially preventable by reducing unprotected exposure to ultraviolet radiation (UVR). Several comprehensive interventions targeting sun protection behaviors among children and adolescents in various outdoor settings have been developed; however, there is a lack of insight on stand-alone effectiveness of environmental elements. To compose future skin cancer prevention interventions optimally, identification of effective environmental components is necessary. Hence, an extensive systematic literature search was conducted, using four scientific databases and one academic search engine. Seven relevant studies were evaluated based on stand-alone effects of various types of environmental sun safety interventions on socio-cognitive determinants, sun protection behaviors, UVR exposure, and incidence of sunburns and nevi. Free provision of sunscreen was most often the environmental component of interest, however showing inconsistent results in terms of effectiveness. Evidence regarding shade provision on shade-seeking behavior was most apparent. Even though more research is necessary to consolidate the findings, this review accentuates the promising role of environmental components in skin cancer prevention interventions and provides directions for future multi-component sun safety interventions targeted at children and adolescents in various outdoor settings.

Does sunscreen use comply with official recommendations? Results of a nationwide survey in Germany

BACKGROUND

The use of sunscreen can reduce the risk of UV-induced skin lesions. Health authorities have provided recommendations for the correct use of sunscreen use: Sufficient amount of sunscreen should be applied at least 30 min before the sun exposure and should be reapplied every 2 h.

OBJECTIVE

We aimed to research the practice of sunscreen use in a population-based and representative sample in Germany.

METHODS

For this cross-sectional survey, 3000 German residents aged 14-45 years were surveyed in standardized telephone interviews in 2018. Survey participants provided data on the frequency of sunscreen use in summer, timing of (re-)application and their skin characteristics. The data were weighted by age, sex, educational level and federal state to ensure the national representativeness of the sample.

RESULTS

Overall, 79.4% of respondents used sunscreen always, often or sometimes when being exposed to the sun. However, 87.2% of sunscreen users did not follow the recommendations on timing of application, 59.5% did not comply with the timing of reapplication. We also saw, that people potentially used too little sunscreen. These data did not differ noticeably by skin types of participants.

CONCLUSION

Our study revealed deficits in use of sunscreen in Germany, indicating that people here pay little attention to the recommendations of health authorities, regardless of their skin type. There is therefore an urgent need for targeted public information on this issue. Improving public knowledge on correct sunscreen use through educational campaigns or individual counselling by health professionals could be a first step.

Changes in the total ozone content over the period 2006 to 2100 and the effects on the erythemal and vitamin D effective UV doses for South America and Antarctica

Recent studies show that the ozone layer will recover by the middle part of this century. This is a significant result arising from the Montreal Protocol, and highlights the success of this environmental protection agreement. Climate change projections show that Total Ozone Content (TOC) levels will increase significantly by the end of this century, mainly at higher latitudes. This increase may result in a reduction of the adverse effects of UV radiation overexposure. By contrast, reduced UV radiation levels at the surface of the Earth can result in reduced levels of vitamin D synthesis among the inhabitants of these regions. In this study we provide estimates for the UVI, erythemal, and vitamin-D weighted daily doses for ten different locations in South America and Antarctica. Our calculations were based on ozone projections provided by climate models set forth in the last IPCC report. Results show that the increase of TOC levels in middle and high latitude regions may result in decreased UVI and UV doses throughout the century. In high latitudes, erythemal doses and vitamin D synthesis doses may be reduced by up to 22 and 39%, respectively, if anthropogenic emissions continue to rise throughout the century. Furthermore, there may be reductions of up to 9 and 12%, respectively, in mid-latitudes (20°S to 35°S). Significant variations at Equatorial sites were not observed. In most of South America, the attenuation in UVR caused by increases in TOC during the 21^st century is neither enough to promote protective effects from this radiation, nor for the lack of UVR for vitamin D synthesis. The incidence of UVR in tropical and sub-tropical areas of the continent will continue to be a public health risk for the entire 21^st century during all seasons, regardless of the climatic scenarios. Our results can be used as an important tool for health studies focusing on the excess and/or lack of sun exposure.

Overview on vitamin D and sunbed use

Vitamin D seems to be associated with a protective effect in a vast range of diseases, including cardiovascular, autoimmune and oncologic conditions. Since ultraviolet (UV) B light is the most important prerequisite for the cutaneous synthesis of vitamin D, sunbeds are able to increase serum vitamin D levels, although only transiently in most cases. In this scenario, the artificial tanning industry relentlessly tries to promote the use of sunbeds as a 'safe' therapeutic measure to achieve an adequate serum vitamin D status. The World Health Organization classified UV-emitting tanning devices, as well as the whole UV spectrum, as group-1 carcinogens, as they significantly increase the risk of melanoma and non-melanoma skin cancer. In case of vitamin D deficiency or insufficiency, the current risk-benefit ratio is therefore in favour of vitamin D supplementation instead of sunbed use. Artificial tanning devices should never be considered as an option to achieve an appropriate vitamin D status. Their supposedly beneficial effects, vastly publicised by the artificial tanning industry, are not worth the carcinogenic risk associated with sunbed use.

Human health in relation to exposure to solar ultraviolet radiation under changing stratospheric ozone and climate

The Montreal Protocol has limited increases in the UV-B (280-315 nm) radiation reaching the Earth's surface as a result of depletion of stratospheric ozone. Nevertheless, the incidence of skin cancers continues to increase in most light-skinned populations, probably due mainly to risky sun exposure behaviour. In locations with strong sun protection programs of long duration, incidence is now reducing in younger age groups. Changes in the epidemiology of UV-induced eye diseases are less clear, due to a lack of data. Exposure to UV radiation plays a role in the development of cataracts, pterygium and possibly age-related macular degeneration; these are major causes of visual impairment world-wide. Photodermatoses and phototoxic reactions to drugs are not uncommon; management of the latter includes recognition of the risks by the prescribing physician. Exposure to UV radiation has benefits for health through the production of vitamin D in the skin and modulation of immune function. The latter has benefits for skin diseases such as psoriasis and possibly for systemic autoimmune diseases such as multiple sclerosis. The health risks of sun exposure can be mitigated through appropriate sun protection, such as clothing with both good UV-blocking characteristics and adequate skin coverage, sunglasses, shade, and sunscreen. New sunscreen preparations provide protection against a broader spectrum of solar radiation, but it is not clear that this has benefits for health. Gaps in knowledge make it difficult to derive evidence-based sun protection advice that balances the risks and benefits of sun exposure.

Beliefs, attitudes and perceptions to sun-tanning behaviour in the Norwegian population: a cross-sectional study using the health belief model

BACKGROUND

Norway has one of the highest incidences of melanoma in the world. It has been suggested that the majority of all skin cancers could be prevented by changes related to sun-tanning behaviour. This study explores the sun-tanning behaviour of the Norwegian population using a modified Health Belief Model (HBM). Increased knowledge about beliefs, attitudes and sun-tanning behaviour can provide information which may be useful for future sun protection interventions.

METHODS

In 2017, 1004 members of the Norwegian population completed cross-sectional online surveys. People who seek the sun for tanning purposes was the eligibility criterion for this study, reducing the study population to 569. With the aid of the constructs from the HBM, predictive factors explaining sun-tanning behaviour were determined using multivariate linear regression adjusted for demographics (gender, age, education and income). Furthermore, the predictor variables, empowerment and benefits of tanning, were added to the model.

RESULTS

Five of the constructs in the modified HBM showed significant correlation with sun-tanning behaviour using bivariate analysis. The strongest correlation was perceived barriers of sun protection (0.42), with the next strongest being the benefits of tanning (0.30). The modified model explained 31% of the variation in sun-tanning behaviour using multivariate analysis. Significant predictors from the HBM to sun-tanning behaviour were perceived barriers to sun protection (Beta = 0.36, p < 0.001) and the severity of melanoma (Beta = - 0.20, p < 0.001). In addition, empowerment (Beta = 0.05, p = 0.05) and the benefits of tanning (Beta = 0.28, p < 0.001) proved to be variables with significant effect on sun-tanning behaviour. The demographic factors age, education and income were also associated with sun-tanning behaviour (p < 0.05).

CONCLUSION

Based on the results of this study, several factors in the modified HBM had a significant impact on Norwegians' sun-tanning behaviour. The results indicate that future sun protection interventions should focus on reducing barriers in relation to sun protection behaviour, as well as emphasizing the severity of adverse tanning behaviour and melanoma. Efforts to alter the perceptions of the beneficial factors of tanning behaviour can also be appropriate in health promotion campaigns and interventions. Finally, implementing empowerment strategies could have a positive effect on promoting healthy sun-tanning behaviour.

SEOM clinical guidelines to primary prevention of cancer (2018)

Cancer is the leading social and healthcare problem of the twenty-first century. The aim of primary prevention is to decrease the incidence of cancer by avoiding the known causes and risk factors. Nevertheless, it has been estimated that cancer diagnoses could be halved through primary prevention measures. A comprehensive review of the scientific evidence regarding the main carcinogens and risk factors and primary prevention recommendations have been put forth based on this evidence. The GRADE scale has been used to classify the grade of evidence. We present the scientific evidence and recommendations for primary prevention of the major modifiable risk factors: smoking, alcohol, diet, obesity, physical activity, occupational and environmental factors, ultraviolet radiation, infections, and socioeconomic factors. Primary prevention is a simple, effective means to lower the incidence of cancer. Preventive measures must be circulated in the fight against cancer.

Prevalence of beliefs about actual and mythical causes of cancer and their association with socio-demographic and health-related characteristics: Findings from a cross-sectional survey in England

BACKGROUND

Literature on population awareness about actual causes of cancer is growing but comparatively little is known about the prevalence of people's belief concerning mythical causes of cancer. This study aimed to estimate the prevalence of these beliefs and their association with socio-demographic characteristics and health behaviours.

METHODS

A survey containing validated measures of beliefs about actual and mythical cancer causes and health behaviours (smoking, alcohol consumption, physical activity, fruit and vegetable consumption, overweight) was administered to a representative English population sample (N = 1330).

RESULTS

Awareness of actual causes of cancer (52% accurately identified; 95% confidence interval [CI] 51-54) was greater than awareness of mythical cancer causes (36% accurately identified; 95% CI 34-37; P < 0.01). The most commonly endorsed mythical cancer causes were exposure to stress (43%; 95% CI 40-45), food additives (42%; 95% CI 39-44) and non-ionizing electromagnetic frequencies (35%; 95% CI 33-38). In adjusted analysis, greater awareness of actual and mythical cancer causes was independently associated with younger age, higher social grade, being white and having post-16 qualifications. Awareness of actual but not mythical cancer causes was associated with not smoking and eating sufficient fruit and vegetables.

CONCLUSIONS

Awareness of actual and mythical cancer causes is poor in the general population. Only knowledge of established risk factors is associated with adherence to behavioural recommendations for reducing cancer risk.

Cutaneous melanoma in France in 2015 attributable to solar ultraviolet radiation and the use of sunbeds

BACKGROUND

Exposure to solar ultraviolet radiation (UVR) and the use of UV-emitting tanning devices are associated with cutaneous malignant melanoma occurrence.

OBJECTIVE

The aim of this study was to quantify the proportion and number of melanoma cases attributable to solar UVR exposure and sunbed use in France in 2015.

METHODS

Population attributable fractions (PAFs) and numbers of melanoma cases attributable to solar UVR exposure were estimated by age and sex using the incidence rates of a 1903 birth cohort as the primary reference. Further analyses were performed using the following: (i) contemporary melanoma incidence rates in low-incidence regions within France and (ii) national melanoma incidence rates for the year 1980, as additional references. Assuming a 15-year lag period, PAF and melanoma cases attributable to sunbed use were calculated using prevalence estimates from a cross-sectional population survey and published relative risk estimates.

RESULTS

In 2015, an estimated 10 340 melanoma cases diagnosed in French adults were attributable to solar UVR exposure, corresponding to 83% of all melanomas and 3% of all cancer cases in that year. PAFs for melanoma were highest in the youngest age group (30-49 years) and higher in men than in women (89% vs. 79%). A total of 382 melanoma cases occurring in French adults in 2015 were attributed to the use of sunbeds, equivalent to 1.5% and 4.6% of all melanoma cases in men and women, respectively.

CONCLUSIONS

A considerable proportion of melanoma cases in France in 2015 were attributable to solar UVR exposure, suggesting that targeted prevention strategies need to be implemented.

Global burden of cutaneous melanoma attributable to ultraviolet radiation in 2012

Ultraviolet radiation (UVR) is a strong and ubiquitous risk factor for cutaneous melanoma, emitted naturally by the sun but also artificial sources. To shed light on the potential impact of interventions seeking to reduce exposure to UVR in both high and low risk populations, we quantified the number of cutaneous melanomas attributable to UVR worldwide. Population attributable fractions and numbers of new melanoma cases in adults due to ambient UVR were calculated by age and sex for 153 countries by comparing the current melanoma burden with historical data, i.e., the melanoma burden observed in a population with minimal exposure to UVR. Secondary analyses were performed using contemporary melanoma incidence rates in dark-skinned African populations with low UVR susceptibility as reference. Globally, an estimated 168,000 new melanoma cases were attributable to excess UVR in 2012, corresponding to 75.7% of all new melanoma cases and 1.2% of all new cancer cases. This burden was concentrated in very highly developed countries with 149,000 attributable cases and was most pronounced in Oceania, where 96% of all melanomas (representing 9.3% of the total cancer burden) were attributable to excess UVR. There would be approximately 151,000 fewer melanoma cases worldwide were incidence rates in every population equivalent to those observed in selected low-risk (dark-skinned, heavily pigmented) reference populations. These findings underline the need for public health action, an increasing awareness of melanoma and its risk factors, and the need to promote changes in behavior that decrease sun exposure at all ages.

Hyperpigmentation and higher incidence of cutaneous malignancies in moderate-high PCB- and dioxin exposed individuals

Polychlorinated biphenyls (PCB) are well known persistent and toxic environmental pollutants. Our aim was to identify effects of moderate-high exposure to dioxin-like (dl) and non-dioxin-like (ndl)-PCBs on the skin in order to provide more insight in the pathophysiological effects of these compounds. We performed a dermatological examination on 92 former workers from a transformer recycling company with known elevated serum PCB and/or dioxin (polychlorinated dibenzo-p-dioxin/polychlorinated dibenzo-p-furan (PCDD/F)) levels. In addition, we performed a skin cancer screening over a period of seven years (2010-2016) on resp. 268, 271, 210, 149, 92, 129 and 79 participants. We found a higher incidence of acne and malignancies of the skin (malignant melanoma, basal cell carcinoma and mycosis fungoides) in the workers compared to normal population. The probability of having hyperpigmentation on the skin was statistically significantly higher in workers with higher sumPCBs- (OR:1.09(1.12-2.17)), dioxin-like (dl)-PCBs- (OR:1.56(1.12-2.17)) and dioxin (PCDD/Fs) (OR:1.09(1.02-1.16)) levels. Age was a confounding factor in this model. Formation of hyperpigmentation could be an indicator for (moderate-high) exposure to toxic compounds like PCBs. The higher incidence of cutaneous malignancies found in the workers might be associated with PCB- and dioxin exposure, warranting further investigation on larger cohorts.

Sun sensitivity and sun protective behaviors during sun exposure among indoor office workers in the American Midwest

BACKGROUND/PURPOSE

Sun sensitivity, a confounder between sun exposure and sun protection, is often overlooked. We examined how sun exposure and sun protection behaviors among indoor workers varied by sun sensitivity.

METHODS

Sun exposure and sun protection diaries over a 45-day period from Midwestern United States indoor workers were examined. We categorized sun sensitivity (fair and non-fair complexion) using tanning inability and sunburn tendency. Total exposure (sunrise to sunset) and peak exposure (10 am and 4 pm) lasting at least 60 minutes were examined. Percentages of time using sun protection were reported. We determined associations between fair complexion, mean sun exposure, and mean sun protection times with logistic regression.

RESULTS

Fair individuals spent less time in the sun than non-fair individuals, but a greater proportion of time using sun protection behaviors, including sunscreen with SPF 30+ (odds ratio (OR) = 1.36; 95% confidence interval (95% CI) = 0.98, 1.87)), or wearing long-sleeved shirts (OR = 2.89; 95% CI = 1.24, 6.73).

CONCLUSION

Fair individuals spent less time in the sun and practiced more sun protective behaviors than non-fair individuals. This complex association between sun sensitivity, sun protection and sun exposure has not consistently been addressed in studies of skin cancer.

Facial exposure to ultraviolet radiation: Predicted sun protection effectiveness of various hat styles

BACKGROUND/PURPOSE

Solar ultraviolet radiation (UVR) doses received by individuals are highly influenced by behavioural and environmental factors. This study aimed at quantifying hats' sun protection effectiveness in various exposure conditions, by predicting UVR exposure doses and their anatomical distributions.

METHODS

A well-defined 3-dimensional head morphology and 4 hat styles (a cap, a helmet, a middle- and a wide-brimmed hat) were added to a previously published model. Midday (12:00-14:00) and daily (08:00-17:00) seasonal UVR doses were estimated at various facial skin zones, with and without hat wear, accounting for each UVR component. Protection effectiveness was calculated by the relative reduction in predicted UVR dose, expressed as a predictive protection factor (PPF).

RESULTS

The unprotected entire face received 2.5 times higher UVR doses during a summer midday compared to a winter midday (3.3 vs 1.3 standard erythema dose [SED]) with highest doses received at the nose (6.1 SED). During a cloudless summer day, the lowest mean UVR dose is received by the entire face protected by a wide-brimmed hat (1.7 SED). No hat reached 100% protection at any facial skin zone (PPF_max : 76%). Hats' sun protection effectiveness varied highly with environmental conditions and was mainly limited by the high contribution of diffuse UVR, irrespective of hat style. Larger brim sizes afforded greater facial protection than smaller brim sizes except around midday when the sun position is high.

CONCLUSION

Consideration of diffuse and reflected UVR in sun educational messages could improve sun protection effectiveness.

Prevalence of vitamin D insufficiency and evidence for disease prevention in the older population

The prevalence of vitamin D insufficiency, usually assessed by the analysis of circulating 25-hydroxyvitamin D (25[OH])D), is very high in the aging German population. An important factor that reduces endogenous vitamin D synthesis in older persons is physical inactivity or care-dependency that limits the time spent outside. Additionally, it has been suggested that the age-dependent decline in the glomerular filtration rate is associated with a reduced production of bioactive calcitriol. As this phenomenon is not detectable by the assessment of 25(OH)D, it is necessary to analyze the level of parathyroid hormone as a marker of calcitriol function. Because 25(OH)D levels are highly correlated with an active and healthy life style, data from epidemiological studies are not necessarily suitable to elucidate the role of vitamin D in disease prevention. Recently published meta-analyses of randomized controlled trials (RCTs) showed moderate effects of vitamin D supplementation on fracture risk and found that vitamin D was more effective when administered in combination with calcium. The role of vitamin D in the prevention of falls and frailty remains unclear. Much evidence has demonstrated the beneficial effects of vitamin D on respiratory tract infections and asthma, which are very relevant health issues in the older population. To conclude, vitamin D, particularly combined with calcium, has moderately beneficial effects on the skeletal system and is useful for the prevention of respiratory tract infections.

Acute exposure to sunscreen containing titanium induces an adaptive response and oxidative stress in Mytillus galloprovincialis

The use of sunscreens to protect against ultraviolet radiation exposure progressively increases as result of a greater awareness of the people and the greater arrival of tourists. The components of these creams can end up in the waters affecting coastal species. Mediterranean mussels (Mytillus galloprovincialis) were subjected to an acute exposure of a sunscreen with TiO₂ in their composition during 24h. The low and medium concentrations used in the assays contained a concentration of TiO₂ in the range of values found in coastal waters of the Balearic Islands. Titanium and metallothionein concentrations were progressively increasing in gills with the sunscreen concentration in a dose-dependent manner. The activities of the antioxidant enzymes and the detoxification glutathione s-transferase evidenced a hormetic shape response with increased activities at lower sunscreen concentrations, a response that was abolished at the highest concentration. In accordance with these enzyme activities, the levels of malondialdehyde, as a marker of lipid peroxidation, were significantly elevated by the higher sunscreen concentrations. Acetylcholinesterase activity maintained control activities except for the highest sunscreen concentration, where a significant decrease was evidenced. In conclusion, the treatment of mussels with a sunscreen containing TiO₂ in the range of Balearic coastal waters induces an adaptive response that is overcome by the highest concentration. Follow-up biomonitoring studies are necessary to control the concentration of sunscreen compound in coastal waters such as titanium since they can induce oxidative stress to affected organisms.

Trends in incidence of thick, thin and in situ melanoma in Europe

BACKGROUND

We analysed trends in incidence for in situ and invasive melanoma in some European countries during the period 1995-2012, stratifying for lesion thickness.

MATERIAL AND METHODS

Individual anonymised data from population-based European cancer registries (CRs) were collected and combined in a common database, including information on age, sex, year of diagnosis, histological type, tumour location, behaviour (invasive, in situ) and lesion thickness. Mortality data were retrieved from the publicly available World Health Organization database.

RESULTS

Our database covered a population of over 117 million inhabitants and included about 415,000 skin lesions, recorded by 18 European CRs (7 of them with national coverage). During the 1995-2012 period, we observed a statistically significant increase in incidence for both invasive (average annual percent change (AAPC) 4.0% men; 3.0% women) and in situ (AAPC 7.7% men; 6.2% women) cases.

DISCUSSION

The increase in invasive lesions seemed mainly driven by thin melanomas (AAPC 10% men; 8.3% women). The incidence of thick melanomas also increased, although more slowly in recent years. Correction for lesions of unknown thickness enhanced the differences between thin and thick cases and flattened the trends. Incidence trends varied considerably across registries, but only Netherlands presented a marked increase above the boundaries of a funnel plot that weighted estimates by their precision. Mortality from invasive melanoma has continued to increase in Norway, Iceland (but only for elder people), the Netherlands and Slovenia.

Development of Octyl Methoxy Cinnamates (OMC)/Silicon Dioxide (SiO₂) Nanoparticles by Sol-Gel Emulsion Method

Although octyl methoxy cinnamates (OMC) is the most used Ultraviolet B (UVB) filter in sunscreen, it has poor light stability in emulsion system. In this study, OMC/SiO₂ nanoparticles were prepared via sol-gel emulsion method. Tetraethoxy silane (TEOS) was used as the silica source to encapsulate OMC. Modification of experimental parameters such as stirring speed of condensation reaction and emulsion condition, pH value of acid-catalyzed, surfactant and different percentage of TEOS and OMC, adding of OMC and surfactant to different phase may affect the particle size, and yield and entrapment efficiency in preparation process of OMC/SiO₂ nanoparticles. Concluding all the parameter, we found that when condensation reaction and emulsion conditions are at 1000 rpm, pH 1.5, Span 80/Tween 20, TEOS/OMC ratios 1:1, OMC and surfactants added in oil phase, resulting in smaller particle sizes 476.5 nm, higher yield 95.8%, and higher entrapment efficiency 61.09%. Fourier transform infrared (FTIR) analysis demonstrated that OMC/SiO₂ nanoparticles were successfully prepared. In vitro release profile supposed that OMC/SiO₂ nanoparticles can delay OMC releasing and had 60.83% decreasing of cumulative amount. Therefore, the OMC/SiO₂ nanoparticles have the potential to develop as new sunscreen materials in the use for cosmetics field in the future.

Evolutionarily derived networks to inform disease pathways

Methods to identify genes or pathways associated with complex diseases are often inadequate to elucidate most risk because they make implicit and oversimplified assumptions about underlying models of disease etiology. These can lead to incomplete or inadequate conclusions. To address this, we previously developed human phenotype networks (HPN), linking phenotypes based on shared biology. However, such visualization alone is often uninterpretable, and requires additional filtering. Here, we expand the HPN to include another method, evolutionary triangulation (ET). ET utilizes the hypothesis that alleles affecting disease risk in multiple populations are distributed consistently with differences in disease prevalence and compares allele frequencies among populations and their relationship to phenotype prevalence. We hypothesized that combining these methods will increase our ability to detect genetic patterns of association in complex diseases. We combined HPN and ET to identify network patterns associated with type 2 diabetes mellitus (T2DM), a leading cause of death worldwide. Fasting glucose, a continuous trait, was used as a proxy for T2DM and differs significantly among continental populations. The combined method identified several diabetes-related traits and several phenotypes related to cardiovascular diseases, for which diabetes is a major risk factor. ET-HPN found more phenotypes related to our target and related phenotypes than the application of either method alone. Not only could we detect phenotype connections related to T2DM, but we also identified phenotypes that are distributed in parallel to it, e.g., amyotrophic lateral sclerosis. Our analyses showed that ET-filtered HPN provides information that neither technique can individually.

The acute effects of ultraviolet radiation on the blood transcriptome are independent of plasma 25OHD3

The molecular basis of many health outcomes attributed to solar ultraviolet radiation (UVR) is unknown. We tested the hypothesis that they may originate from transcriptional changes in blood cells. This was determined by assessing the effect of fluorescent solar simulated radiation (FSSR) on the transcriptional profile of peripheral blood pre- and 6h, 24h and 48h post-exposure in nine healthy volunteers. Expression of 20 genes was down-regulated and one was up-regulated at 6h after FSSR. All recovered to baseline expression at 24h or 48h. These genes have been associated with immune regulation, cancer and blood pressure; health effects attributed to vitamin D via solar UVR exposure. Plasma 25-hydroxyvitamin D₃ [25OHD₃] levels increased over time after FSSR and were maximal at 48h. The increase was more pronounced in participants with low basal 25OHD₃ levels. Mediation analyses suggested that changes in gene expression due to FSSR were independent of 25OHD₃ and blood cell subpopulations.

Ultraviolet radiation and skin mast cells: Effects, mechanisms and relevance for skin diseases

Mast cells (MCs) are well known as versatile effector cells in allergic reactions and several other immune responses. Skin MCs and cutaneous MC responses are subject to the effects of environmental factors including ultraviolet radiation (UVR). Numerous studies have assessed the effects of UVR on MCs, in vitro and in vivo. Interestingly, UVR seems to have variable effects on non-activated and activated mast cells. In general, UV therapy is beneficial in the treatment of urticaria and mastocytosis, but the effects are variable depending on treatment regimen and type of UVR. Here, we review and summarise key reports from the older and current literature on the crosstalk of UVR and skin MCs. Specifically, we present the literature and discuss published reports on the effects of UVR on skin MCs in rodents and humans. In addition, we review the role of MCs in UVR-driven skin diseases and the influence of UV light on MC-mediated skin diseases. This summary of our current understanding of the interplay of skin MCs and UVR may help to improve the management of patients with urticaria and other MC disorders, to identify current gaps of knowledge, and to guide further research.

Sunscreen Increasingly Overshadows Alternative Sun-Protection Strategies

The present study assessed perceptions of effective sun-protection strategies among the general public and whether these perceptions have changed in recent years. During five summers from 2007/2008 to 2011/2012, 4217 adolescents and adults living in a region with very high levels of solar UV radiation participated in annual, cross-sectional telephone surveys. Respondents' perceptions of the most effective sun-protection strategy were measured with a single open-ended question. In all survey years, sunscreen was the by far most frequently nominated sun-protection strategy, with an average mention rate of 71.0 %. The tendency to nominate sunscreen increased significantly over the 5-year study period and on average, was more common among adolescents compared to adults (81.6 vs 60.0 %) and females compared to males (73.6 vs 68.3 %). Despite respondents' increasing tendency to nominate sunscreen as the most effective sun-protection strategy, health experts have voiced concerns about flawed application practices. Current sun-protection hierarchies indicate that protective clothing and shade are better options.