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Monitoring melanoma incidence time trends by tumour thickness is essential to understanding the evolution of melanoma occurrence and guiding prevention strategies. To assess long-term incidence trends, tumour thickness was extracted from pathology reports in the Cancer Registry of Norway (1983–2007) and the Norwegian Melanoma Registry (2008–2019), n = 45,635 patients. Across all anatomic sites, T1 (≤ 1 mm) incidence increased most (men annual percentage change [AAPC] = 4.6, 95% confidence interval [95% CI] 4.2–5.0; women AAPC = 3.2, 95% CI 2.8–3.6); the increase was steep until 1989/90, followed by a plateau, and a further steep increase from 2004/05. Increased incidence was also observed for T2 (>1.0–2.0) melanoma (men AAPC = 2.8, 95% CI 2.4–3.2; women AAPC = 1.5, 95% CI 1.1–1.9), and T3 (>2.0–4.0) in men (AAPC = 1.4, 95% CI 0.9–1.9). T4 (>4.0) melanoma followed a similar overall pattern (men AAPC = 1.3, 95% CI 0.9–1.7, head/neck, upper limbs, and trunk; women AAPC = 0.9, 95% CI 0.4–1.4, upper limbs and trunk). Men had the highest T3 and T4 incidence and the sex difference increased with age. Regarding birth cohorts, age-specific incidence increased in all T categories in the oldest age groups, while stabilizing in younger patients born after 1950. Overall, the steep increase in T1 melanoma was not accompanied by a decrease in thick melanoma.

Background. We studied the feasibility of transplant-clinic staff routinely providing primary prevention advice to lung transplant recipients at high risk of skin cancer. Methods. Patients enrolled by a transplant-clinic study nurse completed baseline questionnaires and received sun-safety brochures. For the 12-mo intervention, transplant physicians were alerted to provide standard sun-protection advice (use of hat, long sleeves, and sunscreen outdoors) by sun-advice prompt cards attached to participants’ medical charts at each clinic visit. Patients indicated receiving advice from their physician and from study personnel via an exit-card postclinic, and at final study clinics, they also reported their sun behaviors by questionnaire. Feasibility of the intervention was measured by patients’ and clinic staff’s study engagement; effectiveness was assessed by calculating odds ratios (ORs) for improved sun protection, using generalized estimating equations. Results. Of 151 patients invited, 134 consented (89%), and 106 (79 %) (63% male, median age 56 y, 93% of European descent) completed the study. Odds of receiving sun advice from transplant physicians and study nurses rose after the intervention compared with baseline (ORs, 1.67; 95% confidence interval [CI], 0.96-2.96 and 3.56; 95% CI, 1.38-9.14, respectively). After 12 mo of regular transplant-clinic advice, odds of sunburn decreased (OR, 0.59; 95% CI, 0.13-2.60), and odds of applying sunscreen (OR, 1.93; 95% CI, 1.20-3.09) almost doubled. Conclusions. Encouragement of primary prevention of skin cancer among organ transplant recipients by physicians and nurses during routine transplant-clinic visits is feasible and appears to be effective.

Abstract Background Sonic Hedgehog (SHH) pathway dysregulation is implicated in basal cell carcinoma (BCC) development. To evaluate the possible wider role of SHH gene variants in skin carcinogenesis, we assessed associations of genes in the SHH pathway with lifetime development of any keratinocyte cancer (KC), and with developing either BCCs or squamous cell carcinomas (SCCs) exclusively, in a 25-year prospective, population-based study of 1,621 Australians. Methods We genotyped 795 unrelated adults with available blood samples: 311 cases with any KC (186 developing BCCs-only, 55 SCCs-only, 70 BCCs and SCCs) and 484 controls. We compared allele frequencies of 158 independent SNPs across 43 SHH genes between cases and controls, and performed a gene-based analysis. Results We found associations between SNP rs4848627 (GLI2) (related to DNA synthesis in keratinocytes) and development of any KC (OR = 1.53; 95% CI = 1.06–2.13, P

Little is known about if and how nevi and pigmentation are associated with melanoma-specific mortality. However, increased melanoma awareness in people with lighter pigmentation and many nevi may result in earlier diagnosis of thinner less-lethal tumors. The aim of this study was to investigate associations between nevus count (asymmetrical > 5 mm and small symmetrical), pigmentary characteristics (hair colour, eye colour, skin colour, freckling, pigmentary score), and melanoma-specific mortality in subjects with melanomas > 1 mm. Data from the Norwegian Women and Cancer cohort, established in 1991, with complete follow-up of melanoma patients until 2018 through the Cancer Registry of Norway, were used to estimate hazard ratios with 95% confidence intervals for the associations between nevus count, pigmentary characteristics, and melanoma-specific mortality, stratified by tumor thickness using Cox regression. Estimated hazard ratios consistently indicated a higher risk of melanoma death for those with darker vs lighter pigmentary characteristics in patients with tumors > 1.0–2.0 mm and > 2.0 mm thick (e.g. pigmentary score hazard ratio 1.25, 95% confidence interval (0.74–2.13)). Among women with melanomas > 1.0 mm thick, lighter pigmentation and asymmetrical nevi may be associated with lower melanoma-specific mortality, suggesting that factors that increase the risk of melanoma may also be associated with decreased risk of death from melanoma.

BackgroundDigital 3D total-body photography of the skin surface is an emerging imaging modality that can facilitate the identification of new and changing nevi. ObjectiveWe aimed to describe the experiences of study participants drawn from the general population who were provided 3D total-body photography and dermoscopy for the monitoring of nevi. MethodsA population-based prospective study of adults aged 20-70 years from South East Queensland, Australia was conducted. Participants underwent 3D total-body photography and dermoscopy every 6 months over a 3-year period. Participants were asked to provide closed and open-ended feedback on their 3D total-body photography and dermoscopy experience (eg, comfort, trust, intended future use, and willingness to pay) at the halfway study time point (18 months) and final study time point (36 months). We assessed changes in participants’ reported experience of 3D total-body photography, and patient characteristics associated with patient experience at the end of the study (36 months) were analyzed. ResultsA total of 149 participants completed the surveys at both the 18- and 36-month time points (median age 55, range 23-70 years; n=94, 63.1% were male). At the 18-month time point, most participants (n=103, 69.1%) stated they completely trusted 3D total-body imaging for the diagnosis and monitoring of their nevi, and this did not change at the 36-month (n=104, 69.8%) time point. The majority of participants reported that they were very comfortable or comfortable with the technology at both the 18- (n=138, 92.6%) and 36-month (n=140, 94%) time points, respectively; albeit, the number of participants reporting that they were very comfortable reduced significantly between the 18- and 36-month time points, from 71.1% (n=106) to 61.1% (n=91; P=.01). Almost all participants (n=140, 94%) would consider using this technology if it were to become commercially available, and this did not change during the two study time points. Half of the participants (n=74) cited barriers to participating in 3D total-body photography, including trust in the ability of this technology to detect and monitor suspicious lesions, digital privacy, cost, and travel requirements. ConclusionsThe majority of participants expressed positive attitudes toward 3D total-body photography for the monitoring of their moles. Half of the participants identified potential barriers to uptake.

Abstract Introduction: A Melanoma Screening Summit was held in Brisbane, Australia, to review evidence regarding current approaches for early detection of melanomas and explore new opportunities. Results: Formal population‐based melanoma screening is not carried out in Australia, but there is evidence of considerable opportunistic screening as well as early detection. Biopsy rates are rising and most melanomas are now diagnosed when in situ. Based on evidence review and expert opinion, the Summit attendees concluded that there is currently insufficient information in terms of comparative benefits, harms and costs to support change from opportunistic to systematic screening. Assessment of gains in precision and cost‐effectiveness of integrating total body imaging, artificial intelligence algorithms and genetic risk information is required, as well as better understanding of clinical and molecular features of thin fatal melanomas. Conclusions: Research is needed to understand how to further optimise early detection of melanoma in Australia. Integrating risk‐based population stratification and more precise diagnostic tests is likely to improve the balance of benefits and harms of opportunistic screening, pending assessment of cost‐effectiveness. Implications for public health: The Summit Group identified that the personal and financial costs to the community of detecting and treating melanoma are rising, and this may be mitigated by developing and implementing a more systematic process for diagnosing melanoma.

Objectives: To review the most recent population-based estimates of keratinocyte cancer incidence in Australia, to describe the trends over time and to calculate lifetime risk of developing these skin cancers. Methods: We conducted a literature search of PubMed/MEDLINE from 2001 to August 2021 to identify relevant literature. We defined eligible articles as those reporting population-based studies of adults and excluded studies that reported only on high-risk or paediatric populations, or on incidence of precursor or related lesions. We summarised identified studies qualitatively. We calculated lifetime risk of developing keratinocyte cancer using the methods of Cancer Research UK, adjusting for multiple primaries and the competing risk of death. Results: We identified six eligible studies. In the absence of compulsory notifications of keratinocyte cancer to state and territory cancer registries in Australia, all estimates of national incidence rates of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) have limitations. The most recent population-based estimates of people annually affected for the period 2011–2014 (BCC: 770/100 000 person years; SCC: 271/100 000 person years) represent the lower end of the possible range of incidence rates nationally. Because many people are affected by multiple lesions, the lesion-based incidence estimates are more than double the person-based rates (BCC: 1565/100 000 person years; SCC: 580/100 000 person years). Analyses of temporal trends in treatment rates (excisions, cryotherapy/curettage) show increases over time, most marked for people aged 55 years or older. We estimate that 69% of Australians will have at least one excision for histologically confirmed keratinocyte cancer in their lifetime (60% to age 79 years). Conclusion: The available evidence on national incidence rates is out of date and of moderate quality, but indicates very high rates of keratinocyte cancer in Australia. We recommend that population-based cancer registries work towards statutory notification and routine reporting of keratinocyte cancer in Australia.

Objectives and importance of study: Sunscreens are widely used, not only to prevent acute sunburn, but also for skin cancer prevention and protection against photoaging and other skin conditions related to cumulative solar ultraviolet radiation (UVR) exposure. When correctly applied, sunscreens reduce the amount of UVR reaching the skin and therefore they can reduce harmful effects of such exposures. This paper examines the benefits and risks of sunscreens, compliance requirements and how sunscreen should be used for optimal effectiveness. Study type: Narrative review. Methods: We reviewed evidence relating to the benefits and risks of sunscreens, sunscreen manufacturing compliance, consumer usage of sunscreen and how sunscreen should be used to be most effective. Results: There is strong evidence that sunscreen is safe to use and, when applied correctly, reduces the risk of skin cancer. There is a need to address questions about the impact of sunscreen on vitamin D and its risk to the environment, as well as a need to develop sun protection factor (SPF) sunscreen testing methods that are more reproducible and ethically based. The amount of sunscreen and the way it is applied varies considerably between individuals, and this in turn markedly affects the degree and duration of protection received. Sunscreen should be used in combination with other sun protection measures that include clothing, hats, sunglasses and seeking shade. Conclusions: Regulation is essential to ensure high-quality, safe and effective sunscreen products are available to the Australian population. There is an important role for governments to put in place skin cancer prevention policies and long-term funding arrangements to build on our successful sunscreen programs so that future generations are afforded the highest level of topical protection against solar UVR.

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing a joint methodology for estimating the national and global work-related burden of disease and injury (WHO/ILO joint methodology), with contributions from a large network of experts. In this paper, we present the protocol for two systematic reviews of parameters for estimating the number of deaths and disability-adjusted life years from melanoma and non-melanoma skin cancer (or keratinocyte carcinoma) from occupational exposure to solar ultraviolet radiation, to inform the development of the WHO/ILO joint methodology. Objectives: We aim to systematically review studies on occupational exposure to solar ultraviolet radiation (Systematic Review 1) and systematically review and meta-analyse estimates of the effect of occupational exposure to solar ultraviolet radiation on melanoma and non-melanoma skin cancer (Systematic Review 2), applying the Navigation Guide systematic review methodology as an organizing framework and conducting both systematic reviews in tandem and in a harmonized way. Data sources: Separately for Systematic Reviews 1 and 2, we will search electronic academic databases for potentially relevant records from published and unpublished studies, including Ovid Medline, PubMed, EMBASE, and Web of Science. We will also search electronic grey literature databases, Internet search engines and organizational websites; hand-search reference list of previous systematic reviews and included study records and consult additional experts. Study eligibility and criteria: We will include working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State, but exclude children (

Background and Methods: Skipped nodal metastasis (SNM) is a recognized phenomenon of visceral cancers when metastases bypass the regional basin and skip to a distant nodal basin without evidence of distant metastases. Its occurrence is undocumented in cutaneous melanoma patients but of potential prognostic significance. We therefore assessed the frequency of SNM in a large series of patients with limb melanomas. Patients and Methods: We studied melanoma patients attending a tertiary oncology hospital in northwest England using two approaches. First, we systematically searched medical records of an unselected patient sample treated 2002–2015, and second, we studied lymphoscintigrams of all patients with limb melanoma who underwent sentinel node biopsy 2008–2019. Results: Of 672 melanoma patients whose clinical records were examined, 16 had regional nodal metastases without apparent visceral spread and one appeared to have SNM but further scans were uncovered that showed concurrent pulmonary metastases. Of 667 limb melanoma patients with lymphoscintigrams, 7 showed dual lymphatic drainage patterns to distal as well as regional nodal basins, but none had micro-metastases solely in the distant basin. Conclusion: Occurrence of SNM in cutaneous melanoma is highly unlikely.

Melanocytic nevus count is associated with melanoma risk. In this study, a meta-analysis of 11 nevus GWAS studies identifies novel SNPs in KITLG and 9q32, and bivariate analysis with melanoma GWAS meta-analysis reveals that most nevus genes affect melanoma risk, while melanoma risk loci do not alter the nevus count.

Abstract Objective: To characterise use of support services in patients diagnosed with high‐risk primary melanoma by their location of residence. Methods: In a cross‐sectional study of 787 patients with histologically‐confirmed clinical stage 1B‐2 melanoma, we estimated odds ratios (ORs) using regression models to assess the association of support service use with residence in rural, regional or urban areas. We also evaluated demographic and clinical correlates of support service use. Results: Among 113 rural patients, 33 (29%) used support services around time of diagnosis compared to 88 (39%) of 224 regional participants and 164 of 448 (37%) urban participants. Regional participants more commonly used support services compared to rural participants (OR 1.84; CI 1.09–3.10), but there was no association with urban versus rural residence (OR 1.32; CI 0.82–2.13). As well, females (OR 1.58; CI 1.15–2.18), those

The original version of this Article contained errors in the spelling of the authors Fan Liu and M. Arfan Ikram, which were incorrectly given as Fan Lui and Arfan M. Ikram. In addition, the original version of this Article also contained errors in the author affiliations which are detailed in the associated Publisher Correction.

Abstract Objective: To describe the approach underpinning a national project to estimate the numbers and proportions of cancers occurring in Australia in 2010 that are attributable to modifiable causal factors. Methods: We estimated the population attributable fraction (PAF) (or prevented fraction) of cancers associated with exposure to causal (or preventive) factors using standard formulae. Where possible, we also estimated the potential impact on cancer incidence resulting from changes in prevalence of exposure. Analyses were restricted to factors declared causal by international agencies: tobacco smoke; alcohol; solar radiation; infectious agents; obesity; insufficient physical activity; insufficient intakes of fruits, vegetables and fibre; red and processed meat; menopausal hormone therapy (MHT); oral contraceptive pill (OCP); and insufficient breast feeding. Separately, we estimated numbers of cancers prevented by: aspirin; sunscreen; MHT; and OCP use. We discuss assumptions pertaining to latent periods between exposure and cancer onset, choices of prevalence data and risk estimates, and approaches to sensitivity analyses. Results: Numbers and population attributable fractions of cancer are presented in accompanying papers. Conclusions: This is the first systematic assessment of population attributable fractions of cancer in Australia.

Abstract Objective: To estimate the numbers and proportions of cancers occurring in Australia in 2010 attributable to modifiable causal factors. Methods: We estimated the population attributable fraction (PAF) of cancers associated with exposure to 13 causal factors using standard formulae incorporating exposure prevalence and relative risk data. We also calculated the potential impact of changing exposure to some factors. Results: A total of 32% of all cancers diagnosed in Australia in 2010 (excluding keratinocyte cancers) were attributable to the 13 factors assessed (men 33%; women 31%). Leading factors were tobacco smoke (PAF all cancers: 13.4%), solar radiation (6.2%), inadequate diet (6.1%) and overweight/obesity (3.4%). Factors conferring highest PAFs differed by sex: highest PAFs for men were tobacco smoke (15.8%), solar radiation (7.1%) and alcohol (3.0%); while highest PAFs for women were tobacco smoke (10.1%), solar radiation (5.0%) and overweight/obesity (4.5%). Sites with the highest counts of potentially preventable cancers were lung (8,569), colorectal (7,404), melanoma of the skin (7,220) and breast (3,233). Conclusions: At least one in three cancers in Australia is attributable to exposure to known modifiable factors. Implications: Up to 37,000 cancers could be prevented in Australia each year if the population avoided exposure to 13 common factors known or strongly suspected to cause cancer.

Abstract Objectives: To estimate the proportion and numbers of cancers occurring in Australia attributable to solar ultraviolet radiation (UVR) and the proportion and numbers prevented by regular sun protection factor (SPF) 15+ sunscreen use. Methods: We estimated the population attributable fraction (PAF) and numbers of melanomas and keratinocyte cancers (i.e. basal cell carcinomas and squamous cell carcinomas) due to exposure to ambient UVR resulting from residing in Australia versus residing in the UK (for melanoma) or Scandinavia (for keratinocyte cancers). We also estimated the prevented fraction (PF): the proportion of cancers that would have occurred but were likely prevented by regular sunscreen use. Results: An estimated 7,220 melanomas (PAF 63%) and essentially all keratinocyte cancers occurring in Australia were attributable to high ambient UVR levels in Australia. We estimated that regular sunscreen use prevented around 14,190 (PF 9.3%) and 1,730 (PF 14%) people from developing SCC and melanoma, respectively. Conclusions: Although our approach was conservative, a high proportion of skin cancers in Australia are attributable to high ambient levels of UVR. Prevailing levels of sunscreen use probably reduced skin cancer incidence by 10–15%. Implications: Most skin cancers are preventable. Sunscreen should be a component of a comprehensive sun protection strategy.

Abstract Objectives: To estimate the proportion and number of cancers occurring in Australia in 2010 attributable to parous women having breastfed for total durations of ≤12 months. Methods: We estimated the population attributable fraction (PAF) of breast cancers (the only cancer site with convincing evidence of causal association) associated with women breastfeeding for ≤12 months in total, using standard formulae incorporating breastfeeding prevalence data, relative risks associated with breastfeeding and cancer incidence. We also estimated the proportion change in disease incidence (potential impact fraction [PIF]) that might have occurred under two hypothetical scenarios of women breastfeeding for longer durations. Results: An estimated 235 (1.7%) breast cancer cases that occurred in Australian in 2010 could be attributed to women breastfeeding for total durations of ≤12 months. Assuming a hypothetical increase in breastfeeding, we estimated that the number of breast cancers prevented would range from 36 to 51 (prevented fraction = 0.3% to 0.4%). Conclusions: More than 200 breast cancers were attributable to women breastfeeding for total durations of ≤12 months. Implications: Policies to increase breastfeeding duration may help prevent breast cancers in the future.

Abstract Objectives: To estimate the proportion and number of cancers in Australia in 2010 that may have been prevented from occurring due to daily use of aspirin in the population. Methods: We calculated the Prevented Fraction (PF) of colorectal and oesophageal cancers using standard formulae. The PF is the proportion of the hypothetical total load of cancer in the population that was prevented by exposure to aspirin. The formula incorporates estimates of the prevalence of aspirin use in Australian adult populations, the relative risks associated with aspirin use and cancer incidence. Results: An estimated 335 colorectal cancers, 22 oesophageal adenocarcinomas and 29 oesophageal squamous cell carcinomas (SCC) were potentially prevented due to daily aspirin use. These figures equate to 2.2%, 3.1% and 5.4% of all colorectal cancers, oesophageal adenocarcinomas and oesophageal SCCs, respectively, that would otherwise have occurred but were potentially avoided due to the daily use of aspirin pertaining in the Australian population. Conclusions: At current levels of consumption, a small but measurable reduction in cancer incidence can be attributed to daily aspirin use. Implications: Assuming the benefits outweigh the harms of known gastrointestinal toxicity and other hazards, aspirin use may be considered for some people to prevent the development of particular gastrointestinal cancers.

Abstract Objectives: To estimate the proportion and number of cancers occurring in Australia in 2010 attributable to combined oral contraceptive pill (OCP) use. Methods: We estimated the population attributable fraction (PAF) for cancers causally associated with combined OCP use (breast, cervix), and the proportion of endometrial and ovarian cancers prevented (prevented fraction [PF]). We used standard formulae incorporating prevalence of combined OCP use in the Australian population, relative risks of cancer associated with this exposure and cancer incidence. Results: An estimated 105 breast and 52 cervical cancers (0.7% and 6.4% of each cancer, respectively) in Australia in 2010 were attributable to current use of combined OCP. Past combined OCP use was estimated to have prevented 1,032 endometrial and 308 ovarian cancers in 2010, reducing the number of cancers that would otherwise have occurred by 31% and 19%, respectively. Conclusions: A small proportion of breast and cervical cancers is attributable to combined OCP use; OCP use is likely to have prevented larger numbers of endometrial and ovarian cancers. Implications: Women seeking contraceptive advice should be told of potential adverse effects, but should also be told that – along with reproductive health benefits – combined OCP use can reduce long‐term risks of ovarian and endometrial cancers.

Abstract Objectives: To estimate the proportion and number of cancers occurring in Australia in 2010 attributable to menopausal hormone therapy (MHT) use. Methods: We estimated the population attributable fraction for cancers causally associated with MHT (breast, endometrium, ovary), and the proportion of colorectal cancers prevented by MHT. We used standard formulae incorporating Australian prevalence data, relative risks of cancer associated with MHT and cancer incidence. We also estimated potential change in cancer incidence under two hypothetical scenarios whereby 25% fewer Australian women used MHT, or women exclusively used oestrogen‐only MHT. Results: An estimated 539 cancers in Australia in 2010 were attributable to MHT: 453 breast, 67 endometrial and 19 ovarian cancers equating to 3.4%, 3.1% and 1.6% of each cancer type, respectively. In contrast, MHT may have prevented 52 colorectal cancers. If 25% fewer women used MHT, then 141 cancers may have been avoided. If women exclusively used oestrogen‐only MHT then 240 cancers may have been avoided. Conclusions: MHT use caused more than 500 cancers in Australian women in 2010 and prevented ∼50 colorectal cancers. Implications: MHT use continues to cause an excess of cancers. The risks, benefits, regimen and treatment duration should be carefully considered for each woman before MHT is commenced.

Abstract Objective: To compare sun protection by Australian‐born and migrant mothers of three‐year‐old children. Methods: Australian‐born and migrant mothers taking part in the Environments for Healthy Living prospective birth‐cohort study were asked standard questions about their child's sun protection. Children were given a skin cancer susceptibility score based on grandparents' ethnic origin. Logistic regression was used to estimate odds ratios (ORs) to measure the association of sun protection of children according to mothers' migrant status adjusted for socio‐demographic characteristics. Results: A total of 613 Australian‐born and 224 migrant mothers of three‐year‐old children were studied. Mothers who had migrated less than four years ago were more likely to allow their three‐year‐old to spend more than two hours outdoors between 10 am and 3 pm compared to Australian‐born mothers (OR=2.80, 95%CI 1.20–6.57). Mothers from high latitude countries (>45 degrees) were more likely to apply sunscreen to their child than those from lower latitude countries (OR=3.15, 95%CI 1.03–9.61). Conclusions and implications: Strategies should aim to increase general awareness about the need for sun protection of young children, and recent migrants should be alerted to the harms of excessive sun exposure.

Objective: Studies evaluating the relationships between coffee, tea and caffeine and ovarian cancer risk have given inconsistent results. We have examined these associations using data from an Australian population-based case–control study.Methods: Women with epithelial ovarian cancer (EOC) (n = 696) and control women selected from the Electoral Roll (n = 786) provided comprehensive reproductive and lifestyle data and completed a food frequency questionnaire.Results: Increasing coffee consumption was associated with a decreased risk of invasive EOC (p trend = 0.009) with an odds ratio (OR) of 0.51 (95% confidence interval (CI) 0.32–0.80) for consumption of ≥4 cups of coffee per day compared to non-drinkers. The association was significant only for serous and endometrioid/clear cell histological subtypes. There was no association with borderline tumours (OR: 1.20, 95% CI: 0.58–2.47). An inverse relationship was also seen between caffeine intake and EOC but tea consumption was not related to EOC (OR: 1.10 95% CI: 0.76–1.61 for ≥4 cups/day versus none).Conclusions: As tea contributed significantly to caffeine intake in this population we conclude that the association we observed with coffee is not due to caffeine, but to other components within coffee. We suggest future studies consider the type as well as the amount of each beverage consumed. [ABSTRACT FROM AUTHOR]

Purpose To assess melanoma risk in relation to sunscreen use and to compare high- with low-sun protection factor (SPF) sunscreens in relation to sunbathing habits in a large cohort study. Materials and Methods We used data from the Norwegian Women and Cancer Study, a prospective population-based study of 143,844 women age 40 to 75 years at inclusion with 1,532,247 person-years of follow-up and 722 cases of melanoma. Multivariable Cox proportional hazards regression was used to estimate the association between sunscreen use (never, SPF < 15, SPF ≥ 15) and melanoma risk by calculating hazard ratios and 95% CIs. The population attributable fraction associated with sunscreen use was estimated. Results Sunscreen users reported significantly more sunburns and sunbathing vacations and were more likely to use indoor tanning devices. SPF ≥ 15 sunscreen use was associated with significantly decreased melanoma risk compared with SPF < 15 use (hazard ratio, 0.67; 95% CI, 0.53 to 0.83). The estimated decrease in melanoma (population attributable fraction) with general use of SPF ≥ 15 sunscreens by women age 40 to 75 years was 18% (95% CI, 4% to 30%). Conclusion Use of SPF ≥ 15 rather than SPF < 15 sunscreens reduces melanoma risk. Moreover, use of SPF ≥ 15 sunscreen by all women age 40 to 75 years could potentially reduce their melanoma incidence by 18%.