Skip to main content
NCBI home page
Occupational and Environmental Medicine logoLink to Occupational and Environmental Medicine
. 2002 Apr;59(4):257–262. doi: 10.1136/oem.59.4.257

Sunlight and mortality from breast, ovarian, colon, prostate, and non-melanoma skin cancer: a composite death certificate based case-control study

D Freedman 1, M Dosemeci 1, K McGlynn 1
PMCID: PMC1740270  PMID: 11934953

Abstract

Objectives: To explore whether mortality from female breast, ovarian, colon, and prostate cancer were negatively associated with exposure to sunlight.

Methods: A death certificate based case-control study of mortality was conducted into five cancers: female breast, ovarian, colon, prostate, and non-melanoma skin cancer (as a positive control) to examine associations with residential and occupational exposure to sunlight. Cases were all deaths from these cancers between 1984 and 1995 in 24 states of the United States. Controls, which were age frequency matched to a series of cases, excluded deaths from cancer and certain neurological diseases. Multiple logistic regression was used in a model that included age, sex, race, residential exposure to sunlight (based on region), and socioeconomic status, occupational exposure to sunlight, and physical activity (the last three based on usual occupation).

Results: Residential exposure to sunlight was negatively and significantly associated with mortality from female breast, ovarian, prostate, and colon cancer. Only female breast and colon cancer, however, also showed significant negative associations with jobs with the highest occupational exposure to sunlight (odds ratio (OR) 0.82 (95% confidence interval (95% CI) 0.70 to 0.97) for female breast cancer; OR 0.90 (95% CI 0.86 to 0.94) for colon cancer). For both cancers, the negative association with occupational sunlight was greatest in the geographical region of highest exposure to sunlight and was independent of physical activity on the job. Non-melanoma skin cancer, as expected, was positively associated with both residential and occupational sunlight.

Conclusions: In this exploratory study, unlike mortality from non-melanoma skin cancer, mortality from female breast cancer and colon cancer were negatively associated with both residential and occupational sunlight.

Full Text

The Full Text of this article is available as a PDF (156.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Albanes D., Blair A., Taylor P. R. Physical activity and risk of cancer in the NHANES I population. Am J Public Health. 1989 Jun;79(6):744–750. doi: 10.2105/ajph.79.6.744. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Blair A., Zahm S. H., Pearce N. E., Heineman E. F., Fraumeni J. F., Jr Clues to cancer etiology from studies of farmers. Scand J Work Environ Health. 1992 Aug;18(4):209–215. doi: 10.5271/sjweh.1578. [DOI] [PubMed] [Google Scholar]
  3. Bostick R. M., Potter J. D., Sellers T. A., McKenzie D. R., Kushi L. H., Folsom A. R. Relation of calcium, vitamin D, and dairy food intake to incidence of colon cancer among older women. The Iowa Women's Health Study. Am J Epidemiol. 1993 Jun 15;137(12):1302–1317. doi: 10.1093/oxfordjournals.aje.a116640. [DOI] [PubMed] [Google Scholar]
  4. Braun M. M., Helzlsouer K. J., Hollis B. W., Comstock G. W. Colon cancer and serum vitamin D metabolite levels 10-17 years prior to diagnosis. Am J Epidemiol. 1995 Sep 15;142(6):608–611. doi: 10.1093/oxfordjournals.aje.a117682. [DOI] [PubMed] [Google Scholar]
  5. Braun M. M., Helzlsouer K. J., Hollis B. W., Comstock G. W. Prostate cancer and prediagnostic levels of serum vitamin D metabolites (Maryland, United States) Cancer Causes Control. 1995 May;6(3):235–239. doi: 10.1007/BF00051795. [DOI] [PubMed] [Google Scholar]
  6. Cerhan J. R., Cantor K. P., Williamson K., Lynch C. F., Torner J. C., Burmeister L. F. Cancer mortality among Iowa farmers: recent results, time trends, and lifestyle factors (United States). Cancer Causes Control. 1998 May;9(3):311–319. doi: 10.1023/a:1008877204830. [DOI] [PubMed] [Google Scholar]
  7. Colston K. W., Berger U., Coombes R. C. Possible role for vitamin D in controlling breast cancer cell proliferation. Lancet. 1989 Jan 28;1(8631):188–191. doi: 10.1016/s0140-6736(89)91204-x. [DOI] [PubMed] [Google Scholar]
  8. Cooper S. P., Buffler P. A., Lee E. S., Cooper C. J. Health characteristics by longest held occupation and industry of employment: United States, 1980. Am J Ind Med. 1993 Jul;24(1):25–39. doi: 10.1002/ajim.4700240104. [DOI] [PubMed] [Google Scholar]
  9. Corder E. H., Guess H. A., Hulka B. S., Friedman G. D., Sadler M., Vollmer R. T., Lobaugh B., Drezner M. K., Vogelman J. H., Orentreich N. Vitamin D and prostate cancer: a prediagnostic study with stored sera. Cancer Epidemiol Biomarkers Prev. 1993 Sep-Oct;2(5):467–472. [PubMed] [Google Scholar]
  10. Eisman J. A., Barkla D. H., Tutton P. J. Suppression of in vivo growth of human cancer solid tumor xenografts by 1,25-dihydroxyvitamin D3. Cancer Res. 1987 Jan 1;47(1):21–25. [PubMed] [Google Scholar]
  11. El Abdaimi K., Dion N., Papavasiliou V., Cardinal P. E., Binderup L., Goltzman D., Ste-Marie L. G., Kremer R. The vitamin D analogue EB 1089 prevents skeletal metastasis and prolongs survival time in nude mice transplanted with human breast cancer cells. Cancer Res. 2000 Aug 15;60(16):4412–4418. [PubMed] [Google Scholar]
  12. Figgs L. W., Dosemeci M., Blair A. United States non-Hodgkin's lymphoma surveillance by occupation 1984-1989: a twenty-four state death certificate study. Am J Ind Med. 1995 Jun;27(6):817–835. doi: 10.1002/ajim.4700270606. [DOI] [PubMed] [Google Scholar]
  13. Frampton R. J., Omond S. A., Eisman J. A. Inhibition of human cancer cell growth by 1,25-dihydroxyvitamin D3 metabolites. Cancer Res. 1983 Sep;43(9):4443–4447. [PubMed] [Google Scholar]
  14. Freedman D. M., Dosemeci M., Alavanja M. C. Mortality from multiple sclerosis and exposure to residential and occupational solar radiation: a case-control study based on death certificates. Occup Environ Med. 2000 Jun;57(6):418–421. doi: 10.1136/oem.57.6.418. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Gann P. H., Ma J., Hennekens C. H., Hollis B. W., Haddad J. G., Stampfer M. J. Circulating vitamin D metabolites in relation to subsequent development of prostate cancer. Cancer Epidemiol Biomarkers Prev. 1996 Feb;5(2):121–126. [PubMed] [Google Scholar]
  16. Garland C. F., Comstock G. W., Garland F. C., Helsing K. J., Shaw E. K., Gorham E. D. Serum 25-hydroxyvitamin D and colon cancer: eight-year prospective study. Lancet. 1989 Nov 18;2(8673):1176–1178. doi: 10.1016/s0140-6736(89)91789-3. [DOI] [PubMed] [Google Scholar]
  17. Garland C. F., Garland F. C. Do sunlight and vitamin D reduce the likelihood of colon cancer? Int J Epidemiol. 1980 Sep;9(3):227–231. doi: 10.1093/ije/9.3.227. [DOI] [PubMed] [Google Scholar]
  18. Garland C., Shekelle R. B., Barrett-Connor E., Criqui M. H., Rossof A. H., Paul O. Dietary vitamin D and calcium and risk of colorectal cancer: a 19-year prospective study in men. Lancet. 1985 Feb 9;1(8424):307–309. doi: 10.1016/s0140-6736(85)91082-7. [DOI] [PubMed] [Google Scholar]
  19. Garland F. C., Garland C. F., Gorham E. D., Young J. F. Geographic variation in breast cancer mortality in the United States: a hypothesis involving exposure to solar radiation. Prev Med. 1990 Nov;19(6):614–622. doi: 10.1016/0091-7435(90)90058-r. [DOI] [PubMed] [Google Scholar]
  20. Gorham E. D., Garland F. C., Garland C. F. Sunlight and breast cancer incidence in the USSR. Int J Epidemiol. 1990 Dec;19(4):820–824. doi: 10.1093/ije/19.4.820. [DOI] [PubMed] [Google Scholar]
  21. Green L. W. Manual for scoring socioeconomic status for research on health behavior. Public Health Rep. 1970 Sep;85(9):815–827. [PMC free article] [PubMed] [Google Scholar]
  22. Hanchette C. L., Schwartz G. G. Geographic patterns of prostate cancer mortality. Evidence for a protective effect of ultraviolet radiation. Cancer. 1992 Dec 15;70(12):2861–2869. doi: 10.1002/1097-0142(19921215)70:12<2861::aid-cncr2820701224>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  23. Hiatt R. A., Krieger N., Lobaugh B., Drezner M. K., Vogelman J. H., Orentreich N. Prediagnostic serum vitamin D and breast cancer. J Natl Cancer Inst. 1998 Mar 18;90(6):461–463. doi: 10.1093/jnci/90.6.461. [DOI] [PubMed] [Google Scholar]
  24. Holick M. F. Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr. 1995 Mar;61(3 Suppl):638S–645S. doi: 10.1093/ajcn/61.3.638S. [DOI] [PubMed] [Google Scholar]
  25. Iino Y., Yoshida M., Sugamata N., Maemura M., Ohwada S., Yokoe T., Ishikita T., Horiuchi R., Morishita Y. 1 alpha-hydroxyvitamin D3, hypercalcemia, and growth suppression of 7,12-dimethylbenz[a]anthracene-induced rat mammary tumors. Breast Cancer Res Treat. 1992;22(2):133–140. doi: 10.1007/BF01833343. [DOI] [PubMed] [Google Scholar]
  26. Janowsky E. C., Lester G. E., Weinberg C. R., Millikan R. C., Schildkraut J. M., Garrett P. A., Hulka B. S. Association between low levels of 1,25-dihydroxyvitamin D and breast cancer risk. Public Health Nutr. 1999 Sep;2(3):283–291. doi: 10.1017/s1368980099000385. [DOI] [PubMed] [Google Scholar]
  27. John E. M., Schwartz G. G., Dreon D. M., Koo J. Vitamin D and breast cancer risk: the NHANES I Epidemiologic follow-up study, 1971-1975 to 1992. National Health and Nutrition Examination Survey. Cancer Epidemiol Biomarkers Prev. 1999 May;8(5):399–406. [PubMed] [Google Scholar]
  28. Kearney J., Giovannucci E., Rimm E. B., Ascherio A., Stampfer M. J., Colditz G. A., Wing A., Kampman E., Willett W. C. Calcium, vitamin D, and dairy foods and the occurrence of colon cancer in men. Am J Epidemiol. 1996 May 1;143(9):907–917. doi: 10.1093/oxfordjournals.aje.a008834. [DOI] [PubMed] [Google Scholar]
  29. Keller-Byrne J. E., Khuder S. A., Schaub E. A. Meta-analyses of prostate cancer and farming. Am J Ind Med. 1997 May;31(5):580–586. doi: 10.1002/(sici)1097-0274(199705)31:5<580::aid-ajim13>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  30. Landin-Wilhelmsen K., Wilhelmsen L., Wilske J., Lappas G., Rosén T., Lindstedt G., Lundberg P. A., Bengtsson B. A. Sunlight increases serum 25(OH) vitamin D concentration whereas 1,25(OH)2D3 is unaffected. Results from a general population study in Göteborg, Sweden (The WHO MONICA Project). Eur J Clin Nutr. 1995 Jun;49(6):400–407. [PubMed] [Google Scholar]
  31. Lefkowitz E. S., Garland C. F. Sunlight, vitamin D, and ovarian cancer mortality rates in US women. Int J Epidemiol. 1994 Dec;23(6):1133–1136. doi: 10.1093/ije/23.6.1133. [DOI] [PubMed] [Google Scholar]
  32. Liu L., Deapen D., Bernstein L. Socioeconomic status and cancers of the female breast and reproductive organs: a comparison across racial/ethnic populations in Los Angeles County, California (United States). Cancer Causes Control. 1998 Aug;9(4):369–380. doi: 10.1023/a:1008811432436. [DOI] [PubMed] [Google Scholar]
  33. Lointier P., Wargovich M. J., Saez S., Levin B., Wildrick D. M., Boman B. M. The role of vitamin D3 in the proliferation of a human colon cancer cell line in vitro. Anticancer Res. 1987 Jul-Aug;7(4B):817–821. [PubMed] [Google Scholar]
  34. Mantell D. J., Owens P. E., Bundred N. J., Mawer E. B., Canfield A. E. 1 alpha,25-dihydroxyvitamin D(3) inhibits angiogenesis in vitro and in vivo. Circ Res. 2000 Aug 4;87(3):214–220. doi: 10.1161/01.res.87.3.214. [DOI] [PubMed] [Google Scholar]
  35. Martínez M. E., Giovannucci E. L., Colditz G. A., Stampfer M. J., Hunter D. J., Speizer F. E., Wing A., Willett W. C. Calcium, vitamin D, and the occurrence of colorectal cancer among women. J Natl Cancer Inst. 1996 Oct 2;88(19):1375–1382. doi: 10.1093/jnci/88.19.1375. [DOI] [PubMed] [Google Scholar]
  36. Martínez M. E., Willett W. C. Calcium, vitamin D, and colorectal cancer: a review of the epidemiologic evidence. Cancer Epidemiol Biomarkers Prev. 1998 Feb;7(2):163–168. [PubMed] [Google Scholar]
  37. McTiernan A., Ulrich C., Slate S., Potter J. Physical activity and cancer etiology: associations and mechanisms. Cancer Causes Control. 1998 Oct;9(5):487–509. doi: 10.1023/a:1008853601471. [DOI] [PubMed] [Google Scholar]
  38. Miettinen O. S., Wang J. D. An alternative to the proportionate mortality ratio. Am J Epidemiol. 1981 Jul;114(1):144–148. doi: 10.1093/oxfordjournals.aje.a113161. [DOI] [PubMed] [Google Scholar]
  39. Percy C. L., Miller B. A., Gloeckler Ries L. A. Effect of changes in cancer classification and the accuracy of cancer death certificates on trends in cancer mortality. Ann N Y Acad Sci. 1990;609:87–99. doi: 10.1111/j.1749-6632.1990.tb32059.x. [DOI] [PubMed] [Google Scholar]
  40. Reichel H., Koeffler H. P., Norman A. W. The role of the vitamin D endocrine system in health and disease. N Engl J Med. 1989 Apr 13;320(15):980–991. doi: 10.1056/NEJM198904133201506. [DOI] [PubMed] [Google Scholar]
  41. Schwartz G. G., Hulka B. S. Is vitamin D deficiency a risk factor for prostate cancer? (Hypothesis). Anticancer Res. 1990 Sep-Oct;10(5A):1307–1311. [PubMed] [Google Scholar]
  42. Tangrea J., Helzlsouer K., Pietinen P., Taylor P., Hollis B., Virtamo J., Albanes D. Serum levels of vitamin D metabolites and the subsequent risk of colon and rectal cancer in Finnish men. Cancer Causes Control. 1997 Jul;8(4):615–625. doi: 10.1023/a:1018450531136. [DOI] [PubMed] [Google Scholar]
  43. Webb A. R., Kline L., Holick M. F. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab. 1988 Aug;67(2):373–378. doi: 10.1210/jcem-67-2-373. [DOI] [PubMed] [Google Scholar]

Articles from Occupational and Environmental Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES