Citrus Consumption and the Risk of Non-Melanoma Skin Cancer in the Women’s Health Initiative

Abstract

Evidence from animal studies suggests that furocoumarins, compounds present in citrus products, can increase the risk of non-melanoma skin cancer (NMSC) when combined with ultraviolet radiation. The objective of this study was to determine the relationship between citrus intake and NMSC risk among postmenopausal women from the Women’s Health Initiative (WHI) Observational Study, who were aged 50–79 years at enrollment (1993–1998). The consumption of citrus fruit, citrus juice, and non-citrus fruit and juice were measured at the baseline of the study using a food frequency questionnaire (FFQ). NMSC cases (basal or squamous cell carcinomas) were self-reported during annual follow-up surveys. The outcome data used for this analysis were collected through March 2020. The relative risk (RR) for incident NMSC by citrus consumption was calculated. Among 49,007 non-Hispanic white participants, there were 8642 cases of incident NMSC. Using less than one serving of citrus juice per week as reference, the RRs and 95% confidence intervals (CI) for incident NMSC by citrus juice intake were 1.03 (0.95, 1.10) for one serving/week, 1.06 (1.00, 1.12) for two to four servings/week, 0.98 (0.90, 1.07) for five to six servings/week, and 1.08 (1.02, 1.13) for one or more serving/day (p-trend = 0.007). Subgroup analyses did not reveal meaningful associations by sun exposure variables. In conclusion, there were indications of a slightly higher risk of incident NMSC among citrus juice consumers; however, further longitudinal and mechanistic studies are needed to confirm the key risk factors.

The Role of Dietary Antioxidants in Melanoma and Nonmelanoma Skin Cancer

“…Overall, the study suggested that the intake of furocoumarins may lead to an increase in the development of BCC (HR, 1.16; 95% CI, 1.11-1.21; P=.002); however, there was no significant association identified between total intake of furocoumarins in the risk for SCC or melanoma. 80 Furthermore, Sakaki et al 81 conducted a survey study looking at the consumption of citrus products and the development of NMSC. The group found that there was an increased risk for NMSC in those consuming an increased amount of citrus products (P=.007).…”

“…The group found that there was an increased risk for NMSC in those consuming an increased amount of citrus products (P=.007). 81…”

Coffee, Citrus, and Alcohol: A Review of What We Drink and How it May Affect our Risk for Skin Cancer

“…In another prospective cohort study of nearly 50,000 post-menopausal non-Hispanic white women, ages 50-79 at enrollment, Sakaki et al [11] found that one or more servings per day of citrus juice was associated with a greater risk of developing KC. Notably, citrus fruits were not associated with increased risk, only citrus juice.…”

“…In an effort to elucidate whether exposure to UV radiation along with dietary citrus juice intake may influence carcinogenesis, Sakaki et al [11] also investigated possible effect modification on citrus juice consumption of different levels of regional solar radiation exposure, skin reaction to sun, time spent outdoors, and sunscreen use. Looking between different categories within these subgroups, they found no modification in the already significant effect on risk of KC.…”