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Item Alcohol intake is associated with increased risk of squamous cell carcinoma of the skin: three US prospective cohort studies(Taylor & Francis, 2016-05) Siiskonen, Satu; Han, Jiali; Li, Tricia; Cho, Eunyoung; Nijsten, Tamar; Qureshi, Abrar; Department of Epidemiology, School of Public HealthThe association between alcohol intake and cutaneous squamous cell carcinoma (cSCC) is unclear. We studied the association between alcohol intake and incident invasive cSCC in three cohorts of women and men with repeated assessments of alcohol intake in the US. Information on alcohol intake was collected repeatedly during follow-up. Cumulative average of alcohol intakes was used. Multivariable Cox proportional hazards models with time-dependent exposure were used to estimate relative risks (RRs) and 95% confidence intervals, followed by a meta-analysis. During a follow-up of 4,234,416 person-years, 2,938 cSCC were identified. Alcohol intake was associated with an increased risk of cSCC with a dose-response relationship. Each additional drink (12.8 gram of alcohol) per day was associated with a 22% increased risk of cSCC (RR 1.22, 95% confidence interval: 1.13-1.31). White wine consumption of ≥5 times/wk was associated with an increased risk of cSCC (RR 1.31, 95% confidence interval: 1.09-1.59). We found no increased risk of cSCC with other alcoholic beverages. The population-attributable risk associated with alcohol intake of ≥20 grams/d was 3% of cSCCs. In conclusion, alcohol intake was associated with an elevated risk of cSCC. Among alcoholic beverages, white wine was associated with cSCC.Item Association of omega-3 and omega-6 fatty acid intake with leukocyte telomere length in US males(Elsevier, 2022-12) Seo, Bojung; Yang, Keming; Kahe, Ka; Qureshi, Abrar A.; Chan, Andrew T.; De Vivo, Immaculata; Cho, Eunyoung; Giovannucci, Edward L.; Nan, Hongmei; Community and Global Health, Richard M. Fairbanks School of Public HealthBackground Omega-3 (n–3) and omega-6 (n–6) fatty acids may contribute to oxidative stress and inflammation, which are related to telomere shortening. Evidence supporting an association between intake of n–3 or n–6 fatty acids and leukocyte telomere length (LTL) in males has been limited. Objectives We conducted a cross-sectional study to examine the associations of total or individual n–3 or total n–6 fatty acid intake with LTL in US males. Methods We included 2,494 US males with LTL measurement from 4 nested case–control studies within the Health Professionals Follow-Up Study. Individuals with previous histories of cancers, diabetes, and cardiovascular diseases at or before blood collection were excluded. Blood collection was performed between 1993 and 1995, and relevant information including n–3 and n–6 intake was collected in 1994 by questionnaire. The LTL was log-transformed and Z scores of the LTL were calculated for statistical analyses by standardizing the LTL in comparison with the mean within each selected nested case–control study. Results We found that consumption of DHA (22:6n–3) was positively associated with LTL. In the multivariable-adjusted model, compared with individuals who had the lowest intake of DHA (i.e., first quartile group), the percentage differences (95% CIs) of LTL were −3.7 (−13.7, 7.5), 7.0 (−4.3, 19.7), and 8.2 (−3.5, 21.3) for individuals in the second, third, and fourth quartiles of consumption, respectively (P-trend = 0.0498). We did not find significant associations between total n–3 or total n–6 fatty acid intakes and LTL. In addition, we found that males who consumed canned tuna had longer LTL than those who did not; in the multivariable-adjusted model, the percentage difference of LTL was 10.5 (95% CI: 1.3, 20.4) (P = 0.02). Conclusions Our results suggest that higher intakes of DHA and canned tuna consumption are associated with longer LTL.Item Association of sun-seeking behaviors with indoor tanning behavior in US white females during high school/college in Nurses' Health Study II(Springer Nature, 2024-01-11) Seo, Bojung; Yang, Sheng; Cho, Eunyoung; Qureshi, Abrar A.; Han, Jiali; Epidemiology, Richard M. Fairbanks School of Public HealthBackground: Frequent exposure to ultraviolet light has more detrimental and longer-term effects on the skin in early life than in adulthood. Teenagers with strong sun-seeking behaviors may be more likely to use an indoor tanning bed than those who seek less sun. We aimed to examine associations between sun-seeking behaviors and indoor tanning behavior during high school/college in US females. Methods: In this cross-sectional study, we used data from The Nurses' Health Study II, a large prospective cohort of US female nurses. We included a total of 81,746 white females who provided responses on the average annual frequency of indoor tanning during high school/college. Our study exposures were number of times/week spent outdoors in a swimsuit and percentage of time wearing sunscreen at the pool/beach as a teenager, weekly hours spent outdoors in direct sunlight during the daytime during high school/college, and number of severe sunburns that blistered between ages 15-20 years. The main outcome was annual frequency of indoor tanning bed usage during high school/college. Results: In multivariable-adjusted logistic regression, we demonstrated positive associations between sun-seeking behaviors and indoor tanning use. Specifically, teenagers who spent 7 times/week outdoors in a swimsuit (adjusted odds ratio [aOR], 95% confidence interval [CI] for daily vs. <1/week: 2.68, 1.76-4.09) were more likely to use indoor tanning beds ≥ 12 times/year. Teenagers with ≥ 10 sunburns (aOR, 95% CI for ≥ 10 vs. never: 2.18, 1.53-3.10) were more likely to use indoor tanning beds ≥ 12 times/year. Also, teenagers/undergraduates who spent ≥ 5 h/week outdoors in direct sunlight (aOR, 95% CI for ≥ 5 h/week vs. <1 h/week: 2.18, 1.39-3.44) were more likely to use indoor tanning ≥ 12 times/year. However, there was not a significant association between average usage of sunscreen at the pool/beach and average usage of indoor tanning beds. Multivariable-adjusted linear regression models also showed similar results. Conclusions: Teenagers who spent more time outdoors in a swimsuit/direct sunlight or got more sunburns tended to use indoor tanning more frequently. These findings provide evidence that teenagers with stronger sun-seeking behaviors may have more exposure to artificial ultraviolet radiation as well.Item Caffeine Intake, Coffee Consumption, and Risk of Cutaneous Malignant Melanoma(Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins, 2015-11) Wu, Shaowei; Han, Jiali; Song, Fengju; Cho, Eunyoung; Gao, Xiang; Hunter, David J.; Qureshi, Abrar A.; Department of Epidemiology, Richard M. Fairbanks School of Public HealthBACKGROUND: Caffeine has been shown to prevent ultraviolet radiation-induced carcinogenesis and to inhibit growth of melanoma cells in experimental studies. We evaluated the association among caffeine intake, coffee consumption, and melanoma risk among three large cohort studies. METHODS: The analysis used data from 89,220 women in the Nurses' Health Study II (1991-2009), 74,666 women in the Nurses' Health Study (1980-2008), and 39,424 men in the Health Professionals Follow-up Study (1986-2008). We used Cox proportional hazards models to estimate the hazard ratios (HR) with 95% confidence intervals (CIs) of melanoma associated with dietary intakes. RESULTS: We documented 2,254 melanoma cases over 4 million person-years of follow-up. After adjustment for other risk factors, higher total caffeine intake was associated with a lower risk of melanoma (≥393 mg/day vs. <60 mg/day: HR = 0.78, 95% CI = 0.64, 0.96; Ptrend = 0.048). The association was more apparent in women (≥393 mg/day vs. <60 mg/day: HR = 0.70, 95% CI = 0.58, 0.85; Ptrend = 0.001) than in men (HR = 0.94, 95% CI = 0.75, 1.2; Ptrend = 0.81), and more apparent for melanomas occurring on body sites with higher continuous sun exposure (head, neck, and extremities; ≥393 mg/day vs. <60 mg/day: HR = 0.71, 95% CI = 0.59, 0.86; Ptrend = 0.001) than for melanomas occurring on body sites with lower continuous sun exposure (trunk including shoulder, back, hip, abdomen, and chest; HR = 0.90, 95% CI = 0.70, 1.2; Ptrend = 0.60). This pattern of association was similar to that for caffeinated coffee consumption, whereas no association was found for decaffeinated coffee consumption and melanoma risk. CONCLUSIONS: Increasing caffeine intake and caffeinated coffee consumption is associated with decreased risk of cutaneous malignant melanomas.Item Citrus Consumption and Risk of Basal Cell Carcinoma and Squamous Cell Carcinoma of the Skin(Oxford, 2015-10) Wu, Shaowei; Cho, Eunyoung; Feskanich, Diane; Li, Wen-Qing; Sun, Qi; Han, Jiali; Qureshi, Abrar A.; Department of Epidemiology, Richard M. Fairbanks School of Public HealthAnimal experiments have demonstrated the photocarcinogenic properties of furocoumarins, a group of naturally occurring chemicals that are rich in citrus products. We conducted a prospective study for citrus consumption and risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin based on data from 41530 men in the Health Professionals Follow-up Study (1986–2010) and 63759 women in the Nurses’ Health Study (1984–2010) who were free of cancers at baseline. Over 24–26 years of follow-up, we documented 20840 incident BCCs and 3544 incident SCCs. Compared to those who consumed citrus products less than twice per week, the pooled multivariable-adjusted hazard ratios were 1.03 [95% confidence interval (95% CI): 0.99–1.08] for BCC and 1.14 (95% CI: 1.00–1.30) for SCC for those who consumed two to four times per week, 1.06 (95% CI: 1.01–1.11) for BCC and 1.15 (95% CI: 1.02–1.28) for SCC for five to six times per week, 1.11 (95% CI: 1.06–1.16) for BCC and 1.22 (95% CI: 1.08–1.37) for SCC for once to 1.4 times per day and 1.16 (95% CI: 1.09–1.23) for BCC and 1.21 (95% Cl: 1.06–1.38) for SCC for 1.5 times per day or more (P trend = 0.001 for BCC and 0.04 for SCC). In contrast, consumption of non-citrus fruit and juice appeared to be inversely associated with risk of BCC and SCC. Our findings support positive associations between citrus consumption and risk of cutaneous BCC and SCC in two cohorts of men and women, and call for further investigations to better understand the potential photocarcinogenesis associated with dietary intakes.Item Citrus Consumption and Risk of Cutaneous Malignant Melanoma in the Women’s Health Initiative(Routledge, 2020) Melough, Melissa M.; Wu, Shaowei; Li, Wen-Qing; Eaton, Charles; Nan, Hongmei; Snetselaar, Linda; Wallace, Robert; Qureshi, Abrar A.; Chun, Ock K.; Cho, Eunyoung; Epidemiology, School of Public HealthCitrus products are rich sources of furocoumarins, a class of photoactive compounds. Certain furocoumarins combined with ultraviolet radiation can induce skin cancer. We examined the relationship between citrus consumption and cutaneous melanoma risk among 56,205 Caucasian postmenopausal women in the Women’s Health Initiative. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of melanoma by citrus intake level. During a mean follow-up of 15.7 years, 956 incident melanoma cases were documented. In multivariable adjusted models, the HR (95% CI) for melanoma was 1.12 (0.91, 1.37) among the highest citrus consumers (1.5+ servings/day of fruit or juice) versus the lowest (<2 servings/week), 0.95 (0.76, 1.20) among the highest citrus fruit consumers (5+ servings/week) versus non-consumers, and was 1.13 (0.96, 1.32) for the highest citrus juice consumers (1+ servings/day) versus the lowest (<1 serving/week). In stratified analyses, an increased melanoma risk associated with citrus juice intake was observed among women who spent the most time outdoors in summer as adults; the HR for the highest versus lowest intake was 1.22 (1.02, 1.46) (p-trend = 0.03). Further research is needed to explore the association of melanoma with citrus juices among women with high sun exposure.Item Cox-II inhibitors show no preventive effect in the development of skin cancer(Wiley, 2022) Yen, Hsuan; Yen, Hsi; Drucker, Aaron M.; Han, Jiali; Li, Wen-Qing; Li, Tricia; Qureshi, Abrar; Cho, Eunyoung; Epidemiology, Richard M. Fairbanks School of Public HealthBackground: Some clinical trials found that cyclooxygenase-2 (COX-2) inhibitor use lowered the risk of skin cancer in high-risk groups. Patients and methods: To determine whether COX-2 inhibitor use is associated with lower risk of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and melanoma, we analyzed COX-2 inhibitor use and risk of skin cancer based on three prospective cohort studies, the Nurses' Health Study (NHS), NHS II, and the Health Professionals Follow-up Study, including 153,882 participants. Multivariable hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association of COX-2 inhibitor use with risk of BCC, cSCC, and melanoma were estimated using Cox proportional hazards models. We pooled the results using a fixed effects model. Results: 16,142 BCC, 1,973 cSCC, and 631 melanoma cases were documented. Ever vs. never use of COX-2 inhibitor was associated with a modestly increased risk of BCC (multivariable HR 1.09, 95 % CI 1.05-1.14). The hazard ratio was similar for cSCC (multivariable HR 1.12, 95 % CI 1.00-1.27) and melanoma (multivariable HR 1.10, 95 % CI 0.89-1.38), but was not statistically significant. Conclusions: Ever use of COX-2 inhibitor was not associated with a decreased skin cancer risk but was instead associated with a modest, increased risk of BCC.Item Genetic variants in TKT and DERA in the NADPH pathway predict melanoma survival(Elsevier, 2020-09) Gu, Ning; Dai, Wei; Liu, Hongliang; Ge, Jie; Luo, Sheng; Cho, Eunyoung; Amos, Christopher I.; Lee, Jeffrey E.; Li, Xin; Nan, Hongmei; Yuan, Hua; Wei, Qingyi; Epidemiology, School of Public HealthBackground: Cutaneous melanoma (CM) is the most lethal type of skin cancers. Nicotinamide adenine dinucleotide phosphate (NADPH) plays an important role in anabolic reactions and tumorigenesis, but many genes are involved in the NADPH system. Methods: We used 10,912 single-nucleotide polymorphisms (SNPs) (2018 genotyped and 8894 imputed) in 134 NADPH-related genes from a genome-wide association study (GWAS) of 858 patients from The University of Texas MD Anderson Cancer Center (MDACC) in a single-locus analysis to predict CM survival. We then replicated the results in another GWAS data set of 409 patients from the Nurses' Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). Results: There were 95 of 858 (11.1%) and 48 of 409 (11.7%) patients who died of CM, respectively. In multivariable Cox regression analyses, we identified two independent SNPs (TKT rs9864057 G > A and deoxyribose phosphate aldolase (DERA) rs12297652 A > G) to be significantly associated with CM-specific survival [hazards ratio (HR) of 1.52, 95% confidence interval (CI) = 1.18-1.96, P = 1.06 × 10-3 and 1.51 (1.19-1.91, 5.89 × 10-4)] in the meta-analysis, respectively. Furthermore, an increasing number of risk genotypes of these two SNPs was associated with a higher risk of death in the MDACC, the NHS/HPFS, and their combined data sets (Ptrend<0.001, = 0.004 and <0.001, respectively). In the expression quantitative trait loci analysis, TKT rs9864057 G > A and DERA rs12297652 A > G were also significantly associated with higher mRNA expression levels in sun-exposed lower-leg skin (P = 0.043 and 0.006, respectively). Conclusions: These results suggest that these two potentially functional SNPs may be valuable prognostic biomarkers for CM survival, but larger studies are needed to validate these findings.Item Higher susceptibility to sunburn is associated with decreased plasma glutamine and increased plasma glutamate levels among US women: An analysis of the Nurses' Health Study I and II(Elsevier, 2021) Yang, Keming; Li, Xin; Zeleznik, Oana A.; Eliassen, A. Heather; Clish, Clary B.; Cho, Eunyoung; Somani, Ally-Khan B.; Qureshi, Abrar A.; Giovannucci, Edward L.; Nan, Hongmei; Epidemiology, School of Public HealthTo the Editor: The metabolism of glutamine and glutamate, 2 important amino acids synthesized in the human body, may have an etiologic role in melanoma, an aggressive skin malignancy. 1 , 2 Preclinical experiments and clinical trials have found that metabotropic glutamate receptor 1 blocker and glutamate release inhibitor (eg, Riluzole) can suppress melanoma cell migration, invasion, and proliferation. 2 Additionally, inhibiting glutaminase, the enzyme that converts glutamine to glutamate, further reduced glutamate bioavailability and suppressed tumor progression. 1 Susceptibility to sunburn, a pigmentary trait, is a well-known risk factor for melanoma. 3 However, it is unclear whether plasma glutamate and glutamine are affected by this host factor even before cancer onset.Item History of Severe Sunburn and Risk of Skin Cancer Among Women and Men in 2 Prospective Cohort Studies(Oxford University Press, 2016-05-01) Wu, Shaowei; Cho, Eunyoung; Li, Wen-Qing; Weinstock, Martin A.; Han, Jiali; Qureshi, Abrar A.; Epidemiology, School of Public HealthAbstract. Few studies have assessed the relationship between sunburn and risk of different skin cancers (melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC)) in prospective studies simultaneously, and little is known about the association of severe sunburns at different body sites with skin cancer risk. We used data on 87,166 women in the Nurses' Health Study (1982–2010) and 32,959 men in the Health Professionals Follow-up Study (1992–2010) to investigate skin cancer risk associated with history of severe sunburns at different body sites (face/arms, trunk, and lower limbs). After adjustment for other risk factors, overall baseline history of severe sunburn was more apparently associated with risk of melanoma than with risk of SCC and BCC in men (multivariable-adjusted hazard ratios were 2.41 (95% confidence interval (CI): 1.32, 4.41) for melanoma, 1.48 (95% CI: 1.08, 2.03) for SCC, and 1.18 (95% CI: 1.06, 1.32) for BCC) but not in women. Sunburn on the trunk appeared to be more closely associated with melanoma risk, but not risk of SCC and BCC, when compared with sunburns at other body sites (face/arms and lower limbs). These differences were more apparent in men than in women. Pending further investigation, our findings add novel insights to the existing literature on sunburn history and skin cancer risk