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Abstract
Sun exposure is a major environmental risk factor for skin cancers and is also an important source of vitamin D. However, while experimental evidence suggests that vitamin D may have a protective effect on skin cancer risk, epidemiologic studies investigating the influence of 25-hydroxyvitamin D (25(OH)D) level and/or vitamin D intake on skin cancer risk are conflicting. A systematic review and dose–response meta-analyses of prospective studies was conducted to clarify these associations. Relevant studies were identified by searching the PubMed database up to 30th August 2019. Random effects dose–response meta-analyses were used to estimate summary relative risks (SRRs) and 95% confidence intervals (CIs). Overall, thirteen prospective studies were included. Circulating level of 25(OH)D was associated with higher risks of melanoma (SRR (95% CI) per 30 nmol = 1.42 (1.17–1.72)) and keratinocyte cancer (KC) (SRR (95% CI) per 30 nmol/L = 1.30 (1.13–1.49)). The SRR (95% CI) per 30 nmol/L increase in 25(OH) D level was 1.41 (1.19–1.67), and 1.57 (0.64–3.86), for basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), respectively. However, while we found that vitamin D intake (from diet, supplemental and total) was not associated with risks of melanoma and SCC, vitamin D intake was associated with slightly increased BCC risk, albeit with no heterogeneity across skin cancer type. This meta-analysis suggests positive associations between circulating 25(OH)D level and risk of melanoma and KC, however, this finding is most likely confounded by sun exposure. We found no associations between vitamin D intake skin cancers, except positive associations with BCC risk.
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1 Université Paris Saclay, CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Villejuif, France (GRID:grid.460789.4) (ISNI:0000 0004 4910 6535); Gustave Roussy, Inserm U1018, Villejuif, France (GRID:grid.14925.3b) (ISNI:0000 0001 2284 9388)
2 Imperial College, Department of Epidemiology and Biostatistics, School of Public Health, London, UK (GRID:grid.7445.2) (ISNI:0000 0001 2113 8111); Bjørknes University College, Department of Nutrition, Oslo, Norway (GRID:grid.7445.2); Oslo University Hospital Ullevål, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo, Norway (GRID:grid.55325.34) (ISNI:0000 0004 0389 8485)
3 Leibniz Center for Diabetes Research At Heinrich Heine University, Institute for Biometrics and Epidemiology, German Diabetes Center, Düsseldorf, Germany (GRID:grid.429051.b) (ISNI:0000 0004 0492 602X)