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Background Night shift work may acutely disrupt the circadian rhythm, with possible carcinogenic effects. Prostate cancer has few established risk factors though night shift work, a probable human carcinogen, may increase the risk. We aimed to study the association between night shift work and chlorinated degreasing agents (CDAs) as possible endocrine disrupters in relation to aggressive prostate cancer as verified malignancies. Methods We conducted a case-cohort study on 299 aggressive prostate cancer cases and 2056 randomly drawn non-cases in the Norwegian Offshore Petroleum Workers cohort (1965–98) with linkage to the Cancer Registry of Norway (1953–2019). Work history was recorded as years with day, night, and rollover (rotating) shift work, and CDA exposure was assessed with expert-made job-exposure matrices. Weighted Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for aggressive prostate cancer, adjusted for education and year of first employment, stratified by 10-year birth cohorts, and with 10, 15, and 20 years of exposure lag periods. Results Compared with day work only, an increased hazard of aggressive prostate cancer (HR = 1.86, 95% CI 1.18–2.91; P-trend = 0.046) was found in workers exposed to ≥19.5 years of rollover shift work. This persisted with longer lag periods (HR = 1.90, 95% CI 0.92–3.95; P-trend = 0.007). The exposure-hazard curve for a non-linear model increased linearly (HRs ≥1.00) for 18–26 years of rollover shift work. No association was found with CDA exposure. Conclusions Long-term exposure to rollover shift work may increase the hazard of aggressive prostate cancer in offshore petroleum workers.

Background Radiation pneumonitis (RP) and radiation fibrosis (RF) are common side effects after breast cancer (BC) radiotherapy (RT). However, there is a great variation in the frequency of RP and RF. This study presents the occurrence of- and the treatment-related predictors for RP and RF. Further, physician- and patient-reported pulmonary symptoms during the first year after postoperative RT for BC are demonstrated. Materials and methods From 2007 to 2008, 250 BC patients referred for postoperative RT were included in a prospective cohort study and followed during the first year after RT. High-resolution computed tomography of the lungs and symptom registration were performed before RT and 3, 6, and 12 months after RT. Patient-reported symptoms were registered by standard quality of life questionnaires. Logistic regression analyses were applied to estimate treatment-related predictors for radiological RP (rRP), clinical RP (cRP), radiological RF (rRF), and clinical RF (cRF). Results The occurrence of rRP and cRP at three months was 78% and 19%, while 12 months after RT rRF and cRF was 89% and 16%, respectively; all reported as grade 1. In multivariable analyses, mastectomy predicted cRP at three months (OR = 2.48, p = .03) and cRF at six months, ipsilateral lung volume receiving 20 Gray or more (V20), V30, and mean lung dose (MLD) predicted rRP at six months (OR = 1.06, p = .0003; OR = 1.10, p = .001; and OR = 1.03, p = .01, respectively). Endocrine treatment predicted cRF at 12 months (OR = 2.48, p = .02). Physicians reported significant more dyspnea at 3 months (p = .003) and patients reported 'a little dyspnea' more at 3 and 12 months compared to baseline (p = .007). Conclusion RP and RF are prevalent in the first year after BC radiation. Mastectomy predicted cRP at three months. V20, V30, D25, and MLD predicted rRP at 6 months, and endocrine treatment predicted cRF at 12 months. Patients and physicians reported dyspnea differently.

Background Increased risk of cutaneous melanoma and squamous cell carcinoma (SCC) has been reported among petroleum workers, but few studies include females, exposure data on ultraviolet radiation (UVR), and potential confounding factors. We aimed to examine UVR exposure in relation to risk of melanoma and SCC among male and female offshore petroleum workers. We also examined the association between UVR exposure and melanoma (Breslow) thickness. Methods The Norwegian Offshore Petroleum Workers (NOPW) cohort (n = 27,917) holds information on sunbathing, indoor tanning, sunburns, sunscreen use, and other lifestyle factors recorded in 1998. Linkage to the Cancer Registry of Norway gave information on cancer diagnosis through 2017. We used Cox and logistic regression to estimate hazard ratios (HRs) of skin cancer and odds ratios (OR) of thick (≥1 mm) melanomas, respectively, with 95% confidence intervals (CIs). Results Melanoma risk increased with increasing frequency of sunbathing after age 20 (ptrend = 0.031), sunburn average intensity (ptrend = 0.028), and sunscreen use (HR = 2.16; 95% CI: 1.42 -3.27 for almost always vs. never/rarely). The risk of thick melanoma was inversely associated with sunbathing frequency after age 20 (OR = 0.38; 95% CI: 0.16 - 0.90 for ≥4 weeks/year vs. 1 week/year). SCC risk increased with increasing frequency of indoor tanning after age 20 (HR = 2.72; 95% CI: 1.22 - 6.05 for ≥3 times/months vs. never), sunburn average intensity (ptrend

Background and aims In familial hypercholesterolemia (FH), statin treatment should be considered from 8 to 10 years of age, but the prevalence of statin use among children is not known. Methods Statin use (2008–2018) among children aged 10–14 and 15–19 years was obtained from the national prescription databases in Norway, Sweden and Denmark. We assumed that all statin users in these age groups had FH, and that the estimated prevalence of FH is 1 in 250 inhabitants. Changes in prevalence rates of statin use between 2008 and 2018 by country, age and sex were estimated using the Joinpoint Regression Program version 4.8.0.1. Differences in prevalence rate ratio each year between countries were analyzed using Poisson regression. Results Among children aged 10–14 years, there was a significant increase in statin use in Norway and Denmark between 2008 and 2018, while in Sweden an increase was only seen after 2014. Among children aged 15–19 years, an increase in statin use was only observed in Norway and Sweden between 2008 and 2018. Statin use was significantly more prevalent in Norway than in Sweden and Denmark each year, and in 2018 the proportion of children using statins was 4–5 times (10–14 years) and 3 times (15–19 years) higher in Norway compared with Sweden and Denmark. In 2018 in Norway, 19% and 35% of children aged 10–14 years and 15–19 years estimated to have FH used statins respectively; corresponding percentages in Sweden were 4.5% and 10%, and in Denmark 3% and 12%. In Norway, the increase in statin use between 2008 and 2018 roughly corresponded to the increase in children with genetically verified FH. Conclusions Between 2008 and 2018, statin use increased in children aged 10–19 years in Norway, Sweden and Denmark, but with large differences between the countries; statin use was 3–5 times more prevalent in Norway than in Sweden and Denmark, which may be due to a more widespread use of genetic testing for FH in Norway.

Purpose Cutaneous melanoma is among the fastest growing malignancies in Norway and ultraviolet radiation (UVR) exposure is the primary environmental risk factor. Immunomodulating drugs can increase skin photosensitivity and suppress immune responses, and by such mechanisms influence melanoma risk. We, therefore, aimed to examine the associations between use of immunomodulating drugs and melanoma risk, at a nationwide population level. Patients and methods In the Cancer Registry of Norway, we identified all cases aged 18-85 with a first primary cutaneous melanoma diagnosed in 2007-2015 (n=12,106). These were matched to population controls from the Norwegian National Registry 1:10 (n=118,564), on sex and year of birth using risk set sampling. Information on prescribed drugs (2004-2015) was obtained by linkage to the Norwegian Prescription Database (NorPD). Conditional logistic regression was used to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for associations between use of immunomodulating drugs (immunosuppressants and corticosteroids) and melanoma risk, adjusted for ambient UVR and other drug use. Results Compared with ≤1 prescription, use of ≥8 prescriptions of immunosuppressants was associated with increased risk of melanoma (RR 1.50, 95% CI 1.27, 1.77). Similar associations were found for subgroups of immunosuppressants: drugs typically prescribed to organ transplant recipients (OTRs) (RR 2.02, 95% CI 1.35, 3.03) and methotrexate (RR 1.27, 95% CI 1.04, 1.55). Similar results were found for high levels of cumulative doses and across all histological subtypes. Use of corticosteroids was not associated with melanoma risk. Conclusion We found a positive association between use of immunosuppressants and melanoma risk, with the highest risk seen for drugs prescribed to OTRs. Knowledge about this risk increase is important for physicians and users of these drugs, for intensified surveillance, awareness and cautious sun exposure.

Previous studies of serum 25-hydroxyvitamin D (25(OH)D) in relation to melanoma have shown conflicting results. We conducted a nested case–control study of 708 cases and 708 controls, using prediagnostically collected serum, to study 25(OH)D and melanoma risk in the population-based Janus Serum Bank Cohort. Stratified Cox regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for ultraviolet radiation (UVR) indicators and stratified by ambient UVB of residence and body mass index (BMI). Non-linear associations were studied by restricted cubic splines. Missing data were handled with multiple imputation by chained equations. We found an HR of melanoma risk of 1.01 (95% CI: 0.99, 1.04) and an HRimputed of 1.02 (95% CI: 1.00, 1.04) per 5-nmol/L increase. The spline model showed exposure-risk curves with significantly reduced melanoma risk between 60 and 85 nmol/L 25(OH)D (reference 50 nmol/L). Non-significant J-shaped curves were found in sub-analyses of subjects with high ambient UVB of residence and of subjects with BMI 2. Our data did not yield persuasive evidence for an association between 25(OH)D and melanoma risk overall. Serum levels within the medium range might be associated with reduced risk, an association possibly mediated by BMI.

Background Most antihypertensives can induce dermal photosensitivity, which may increase melanoma risk. However, corroborating evidence is limited. We examined the associations between use of antihypertensives and melanoma risk. Methods A nationwide nested case-control study was conducted using data from the Cancer Registry of Norway, the National Registry and the Norwegian Prescription Database in 2004–15. Ten controls were randomly selected for each melanoma case, matched on sex and birth year. The study included 12 048 cases and 117 895 controls. We estimated rate ratios (RRs) with 95% confidence intervals (CIs). All analyses were adjusted for ambient ultraviolet radiation (UVR). We additionally performed active comparator analyses, and sensitivity analyses by only including new users, distinguishing between exclusive and mixed users, allowing for different latency periods, and subgroup analyses by melanoma subtype and clinical stage. Results Compared with non-use, we observed a slightly increased melanoma risk in users of diuretics (RR 1.08, CI 1.01–1.15), calcium-channel blockers (RR 1.10, CI 1.04–1.18) and drugs affecting the renin-angiotensin system (RR 1.10, CI 1.04–1.16), but not for beta blockers (RR 0.97, CI 0.92–1.03). We found no heterogeneity of associations by melanoma subtype or clinical stage and no dose-response relationship between the cumulative defined daily doses (DDDs) and melanoma. No interaction was found between cumulative DDDs and ambient UVR. Conclusions Weak associations, with lack of a dose-response relationship and lack of interactions with ambient UVR, in the DDD analysis in this nationwide study do not support a causal relationship between antihypertensives and melanoma risk.

Bettina K Andreassen,1 Helga H Hektoen,1 Karol Axcrona,2 Hilde Langseth,1 Jo S Stenehjem,1 Trude E Robsahm1 1Department of Research, Cancer Registry of Norway, Oslo, Norway; 2Department of Urology, Akershus University Hospital, Lørenskog, NorwayCorrespondence: Helga H Hektoen Email Helga.Helseth.Hektoen@kreftregisteret.no View the original paper by Dr Hektoen and colleagues This is in response to the Letter to the Editor

Background Petrochemical workers are exposed to a variety of airborne toxic compounds which have been associated with increased risk for respiratory outcomes. However, long-term exposure to SO2, NO2, O3, H2S and NH3 in relation to spirometric parameters and self-reported respiratory problems is largely unknown. Methods Airborne concentration levels of SO2, NO2, O3, H2S and NH3 were collected from two fixed stations over a 3-year period in a petrochemical complex. We assessed spirometric parameters and respiratory symptoms in the petrochemical workers (n = 200) and in an unexposed group (n = 200). We calculated β-coefficients (β) and odds ratios (ORs) with 95% confidence intervals (CIs) before and after adjustment for covariates. Results The mean airborne pollution levels were 159 µg/m3 for SO2, 43 µg/m3 for NO2, 66 µg/m3 for O3, 6 µg/m3 for H2S, and 24 µg/m3 for NH3. We found a significant reduction in spirometric parameters among petrochemical workers compared to the unexposed: FEV1 (forced expiratory volume in 1s) (adjusted β -12; 95%CI -16, -7.64), FEV1/ FVC (forced vital capacity) (β -7.26; 95%CI -9.23, -5.28), and PEF (peak expiratory flow) (β -6.61; 95%CI -12, -0.76). Additionally, we observed higher adjusted risks for any respiratory symptom (OR 4.69; 95%CI 1.76, 12), mucus (OR 4.36; 95%CI 1.70, 11) and shortness of breath (OR 15; 4.95, 46) among petrochemical workers compared to the unexposed group. Conclusions Most measured airborne pollution levels were within the ambient recommendation levels. Still, long-term exposure to low level airborne pollutants, reduced FEV1, FEV1/FVC and PEF, and increased respiratory symptoms in Iranian petrochemical workers compared to unexposed controls.

IntroductionTraumatic injuries constitute a major cause of mortality and morbidity. Still, the public health burden of trauma in Norway has not been characterised using nationwide registry data. More knowledge is warranted on trauma risk factors and the long-term outcomes following trauma. The Injury Prevention and long-term Outcomes following Trauma project will establish a comprehensive research database. The Norwegian National Trauma Registry (NTR) will be merged with several data sources to pursue the following three main research topics: (1) the public health burden of trauma to society (eg, excess mortality and disability-adjusted life-years (DALYs)), (2) trauma aetiology (eg, socioeconomic factors, comorbidity and drug use) and (3) trauma survivorship (eg, survival, drug use, use of welfare benefits, work ability, education and income).Methods and analysisThe NTR (n≈27 000 trauma patients, 2015–2018) will be coupled with the data from Statistics Norway, the Norwegian Patient Registry, the Cause of Death Registry, the Registry of Primary Health Care and the Norwegian Prescription Database. To quantify the public health burden, DALYs will be calculated from the NTR. To address trauma aetiology, we will conduct nested case–control studies with 10 trauma-free controls (drawn from the National Population Register) matched to each trauma case on birth year, sex and index date. Conditional logistic regression models will be used to estimate trauma risk according to relevant exposures. To address trauma survivorship, we will use cohort and matched cohort designs and time-to-event analyses to examine various post-trauma outcomes.Ethics and disseminationThe project is approved by the Regional Committee for Medical Research Ethics. The project’s data protection impact assessment is approved by the data protection officer. Results will be disseminated to patients, in peer-reviewed journals, at conferences and in the media.

A number of lifestyle associated factors, such as high body mass index (BMI), low physical activity, and related metabolic disorders, are associated with increased risk of cancer at several sites. For urinary bladder cancer (BC), such studies show inconsistent results, which could result from inadequate adjustment for smoking and occupational exposure. In the population‐based Janus Cohort (n = 292 851), we investigated the independent and combined impact of BMI, physical activity, blood pressure, and blood lipids on the risk of BC, by thorough adjustment for smoking and potential occupational exposure. We used cox proportional hazard regression to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the associations between the lifestyle associated factors and BC risk. The associations observed were dependent on smoking status and gender. Among men, diastolic blood pressure (DBP) (HR 1.07, 95% CI 1.02‐1.12) and systolic blood pressure (SBP) (HR 1.04, 95% CI 1.01‐1.07) were positively associated with BC risk. Stratification by smoking status revealed a positive association between DBP and BC risk in never smokers (HR 1.14, 95% CI 1.00‐1.30), while no association was seen for current and former smokers. A risk score, integrating information across the lifestyle factors was positively associated with BC risk in men (p trend = 0.043). In women, physical activity was associated with a decreased BC risk, but only among never smokers (HR 0.65, 95% CI 0.45‐0.94). In conclusion, relations between lifestyle associated factors and BC risk were most evident in never smokers, suggesting that smoking dominates the relation in current smokers., In this large population‐based cohort of Norwegian men and women, we have examined relations between lifestyle associated factors (e.g. BMI, physical activity and metabolic disorders) and risk of bladder cancer, with thorough adjustments for smoking and occupational exposure. We found that relations between lifestyle associated factors and BC risk were dependent on smoking status, being most evident in never and former smokers, suggesting that smoking dominates the relation in current smokers.

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© 2018. This is the authors' accepted and refereed manuscript to the chapter. Locked until 27.3.2019 due to copyright restrictions. The final authenticated version is available online at: http://dx.doi.org/10.1038/s41409-018-0342-y

Purpose Melanoma is the cancer with the most rapidly rising incidence rate in Norway. Although exposure to ultraviolet radiation (UVR) is the major environmental risk factor, other factors may also contribute. Antidepressants have cancer inhibiting and promoting side effects, and their prescription rates have increased in parallel with melanoma incidence. Thus, we aimed to prospectively examine the association between use of antidepressants and melanoma by using nation-wide data from the Cancer Registry of Norway, the National Registry, the Norwegian Prescription Database and the Medical Birth Registry of Norway. Patient and Methods All cases aged 18–85 with a primary cutaneous invasive melanoma diagnosed during 2007–2015 (n=12,099) were matched to population controls 1:10 (n=118,467) by sex and year of birth using risk-set sampling. We obtained information on prescribed antidepressants and other potentially confounding drug use (2004–2015). Conditional logistic regression was used to estimate adjusted rate ratios (RRs) and 95% confidence intervals (CIs) for the association between overall and class-specific use of antidepressants and incident melanoma. Results Compared with ≤1 prescription, ≥8 prescriptions of antidepressants overall were negatively associated with melanoma (RR 0.81 CI 0.75–0.87). Class-specific analyses showed decreased RRs for selective serotonin reuptake inhibitors (RR 0.82 CI 0.73–0.93) and mixed antidepressants (RR 0.77 CI 0.69–0.86). The negative association was found for both sexes, age ≥50 years, residential regions with medium and highest ambient UVR exposure, all histological subtypes, trunk, upper and lower limb sites and local disease. Conclusion Use of antidepressants was associated with decreased risk of melanoma. There are at least two possible explanations for our results; cancer-inhibiting actions induced by the drug and less UVR exposure among the most frequent users of antidepressants.

Adiposity and inactivity have been associated with increased risk of hypertension. However, reports on the joint effect of these two risk factors in relation to hypertension are scarce and their interaction poorly understood. We prospectively examined both independent and joint effects of measured body mass index (BMI) and self-reported physical activity on the risk of hypertension. We conducted a longitudinal study of 11,238 men and 15,301 women who participated in the Nord-Trondelag Health Study (HUNT) in Norway. Poisson regression was used to estimate adjusted risk ratios (RRs) of hypertension (≥140/90 mmHg) according to BMI and physical activity. BMI was positively associated with risk of hypertension in both sexes (Ptrends

Background: Obstructive and restrictive dysfunction in long-term lymphoma survivors (LSs) after high-dose therapy with autologous stem-cell transplantation (HDT-ASCT) has not been addressed systematically previously. Material and methods: LSs treated in Norway 1987–2008 with HDT-ASCT who performed spirometry, measurement of static lung volumes and echocardiography 2012–2014 at either Oslo or St. Olavs University Hospitals was eligible. Smoking data were recorded by questionnaire. Treatment data were collected from medical records or hospital databases. Factors associated with obstructive and restrictive impairments (dichotomous outcomes) were examined by Poisson regression. Linear regression with the margins post-estimation command was used to derive adjusted mean values of forced expiratory volume in 1 s (FEV1). We used the normative reference data recommended by the European Respiratory Society for calculating percent predicted values. Results: A total of 226 LSs were studied, of whom 11.5 and 5.8% had obstructive and restrictive impairment, respectively. For women and men, mean FEV1 was 2.31 and 3.34 l corresponding to 11.4%- and 11.1%-points below that predicted from norms, respectively. In multivariable regression analyses, cumulative doxorubicin dose (400–775 mg/m2) and current smoking were associated with increased risk of obstructive impairment, and chest RT (>13–66 Gy) was associated with increased risk of restrictive impairment. Currently smoking LSs within the highest doxorubicin category (400–775 mg/m2), had the lowest adjusted mean FEV1. Conclusions: Despite intensive cancer treatment, our analysis showed modest reductions in obstructive parameters among long-term LSs after HDT-ASCT compared to normative reference data. To limit obstructive impairments in LSs after HDT-ASCT, we suggest that targeted smoking-cessation advice is directed towards patients who have received high cumulative doses of doxorubicin.

The aim of the present study was to prospectively examine risk of cutaneous melanoma (CM) according to measured anthropometric factors, adjusted for exposure to ultraviolet radiation (UVR), in a large population-based cohort in Norway. The Janus Cohort, including 292,851 Norwegians recruited 1972-2003, was linked to the Cancer Registry of Norway and followed for CM through 2014. Cox regression was used to estimate hazard ratios (HRs) of CM with 95% confidence intervals (CIs). Restricted cubic splines were incorporated into the Cox models to assess possible non-linear relationships. All analyses were adjusted for attained age, indicators of UVR exposure, education, and smoking status. During a mean follow-up of 27 years, 3,000 incident CM cases were identified. In men, CM risk was positively associated with body mass index, body surface area (BSA), height and weight (all ptrends

Background: Excess skin cancer mortality and incidence have been reported among both land-based and offshore petroleum workers. The association between skin cancer and ultraviolet radiation (UVR) exposure has not been examined in these workers, although they have long off-duty periods and high average income that may allow travelling to sunny destinations. In addition, they have access to solariums free of charge on many accommodation platforms. Aims: To prospectively examine risk of incident cutaneous melanoma (CM) and non-melanoma skin cancer (NMSC), according to sun-tanning habits with adjustment for aromatic hydrocarbon exposure. Methods: A cohort of men employed offshore from 1965 to 1999 was linked through the Cancer Registry of Norway 1999–2012. Cox regression adapted to a stratified case-cohort design was used to estimate hazard ratios with 95% confidence intervals. Results: The cohort included 24917 men. During 13.5 years of follow-up, 112 CMs and 70 NMSCs occurred. A positive dose–response relationship was seen between sunburn frequency and risk of CM (Ptrend < 0.05) and NMSC (Ptrend < 0.01). Solarium use both before and after age 20 was related to increased risk of NMSC. Sunscreen use was associated with increased risk of NMSC (Ptrend < 0.001). Conclusions: UVR exposure seems to be a significant contributor to the elevated risk of skin cancer observed in North Sea offshore workers. The positive association between solarium use and NMSC risk adds to the growing body of literature on artificial UV devices as carcinogenic. This research has been published in Occupational Medicine. © 2017 Oxford University Press

Background: We prospectively examined skin cancer risk according to occupational exposure to aromatic hydrocarbons with adjustment for ultraviolet radiation exposure, in a cohort of 24 917 male offshore petroleum workers. Methods: Hazard ratios (HRs) and 95% confidence intervals were estimated with Cox regression adapted to a stratified case‐cohort design. Results: During 13.5 years of follow‐up, 112 cutaneous melanomas (CMs) and 70 non‐melanoma skin cancers were identified. Increased risks of CM and of squamous cell carcinoma on the forearm and hand were seen among those ever exposed to crude oil or benzene. For skin cancers of the forearm and hand combined, cumulative and duration metrics of benzene exposure showed Ptrends of 0.031 and 0.003, respectively. Conclusions: Our results support an association between exposure to crude oil or benzene and skin cancer risk on hands and forearms among offshore petroleum workers. Dermal uptake of polycyclic aromatic hydrocarbons or benzene may explain this association. This research has been published in the American Journal of Industrial Medicine. © 2017 Wiley

IntroductionThe incidence of cutaneous melanoma (hereafter melanoma) has increased dramatically among fair-skinned populations worldwide. In Norway, melanoma is the most rapidly growing type of cancer, with a 47% increase among women and 57% among men in 2000–2016. Intermittent ultraviolet exposure early in life and phenotypic characteristics like a fair complexion, freckles and nevi are established risk factors, yet the aetiology of melanoma is multifactorial. Certain prescription drugs may have carcinogenic side effects on the risk of melanoma. Some cardiovascular, antidepressant and immunosuppressive drugs can influence certain biological processes that modulate photosensitivity and immunoregulation. We aim to study whether these drugs are related to melanoma risk.Methods and analysisA population-based matched case–control study will be conducted using nation-wide registry data. Cases will consist of all first primary, histologically verified melanoma cases diagnosed between 2007 and 2015 identified in the Cancer Registry of Norway (14 000 cases). Ten melanoma-free controls per case (on date of case melanoma diagnosis) will be matched based on sex and year of birth from the National Registry of Norway. For the period 2004—2015, and by using the unique personal identification numbers assigned to all Norwegian citizens, the case–control data set will be linked to the Norwegian Prescription Database for information on drugs dispensed prior to the melanoma diagnosis, and to the Medical Birth Registry of Norway for data regarding the number of child births. Conditional logistic regression will be used to estimate associations between drug use and melanoma risk, taking potential confounding factors into account.Ethics and disseminationThe project is approved by the Regional Committee for Medical Research Ethics in Norway and by the Norwegian Data Protection Authority. The study is funded by the Southeastern Norway Regional Health Authority. Results will be published in peer-reviewed journals and disseminated further through scientific conferences, news media and relevant patient interest groups.

Whether sunscreen use affects melanoma risk has been widely studied with contradictory results. To answer this question we performed a systematic review of all published studies, accounting for sources of heterogeneity and bias. We searched for original articles investigating the sunscreen‐melanoma association in humans to February 28, 2018. We then used random‐effects meta‐analysis to combine estimates of the association, stratified by study design. Stratified meta‐analysis and meta‐regression were used to identify sources of heterogeneity. We included 21,069 melanoma cases from 28 studies published 1979–2018: 23 case–control (11 hospital‐based, 12 population‐based), 1 ecological, 3 cohort and 1 randomised controlled trial (RCT). There was marked heterogeneity across study designs and among case–control studies but adjustment for confounding by sun exposure, sunburns and phenotype systematically moved estimates toward decreased melanoma risk among sunscreen users. Ever‐ vs. never‐use of sunscreen was inversely associated with melanoma in hospital‐based case–control studies (adjusted odds ratio (OR) = 0.57, 95%confidence interval (CI) 0.37–0.87, p heterogeneity < 0.001), the ecological study (rate ratio = 0.48, 95%CI 0.35–0.66), and the RCT (hazard ratio (HR) = 0.49, 95%CI 0.24–1.01). It was not associated in population‐based case–control studies (OR = 1.17, 95%CI 0.90–1.51, p heterogeneity < 0.001) and was positively associated in the cohort studies (HR = 1.27, 95%CI 1.07–1.51, p heterogeneity = 0.236). The association differed by latitude (p interaction = 0.042), region (p interaction = 0.008), adjustment for naevi/freckling (p interaction = 0.035), and proportion of never‐sunscreen‐users (p interaction = 0·012). Evidence from observational studies on sunscreen use and melanoma risk was weak and heterogeneous, consistent with the challenges of controlling for innate confounding by indication. The only RCT showed a protective effect of sunscreen., What's new? Effectiveness of sunscreen in reducing UV‐induced skin damage has been proven in experimental studies, but effectiveness in reducing melanoma in humans remains inconclusive. This is the first meta‐analysis to analyze data from four study designs, stratify hospital‐ and population‐based case–control studies, and include as many as five prospective studies. Evidence from observational studies on the sunscreen‐melanoma association was heterogeneous, consistent with the challenges of controlling for innate confounding by indication. The only randomized controlled trial showed a protective effect. Public health recommendations should place greater emphasis on the proper use of sunscreen in conjunction with other means of sun protection.

Background: Cardiorespiratory fitness as measured by peak oxygen consumption (VO2peak) is a strong predictor of longevity and may be compromised by anticancer therapy, inactivity, and smoking. We compared VO2peak among lymphoma survivors (LSs) with reference data from healthy sedentary subjects, after a 10.2-year (mean) follow-up post high-dose chemotherapy with autologous stem cell transplantation (HDT-ASCT). We further examined the association between VO2peak and treatment, physical activity, smoking, pulmonary, and cardiac function. Methods: Lymphoma survivors treated with HDT-ASCT in Norway 1987–2008 were eligible. VO2peak was assessed by cardiopulmonary exercise testing. Pulmonary function testing and echocardiography were also conducted. Data on treatment, physical activity, and smoking were collected from hospital records and questionnaires. VO2peak was compared with age–sex predicted reference data. Linear regression was used to associate clinical factors with VO2peak cross-sectionally. Results: A total of 194 LSs without heart failure were studied. Mean VO2peak was 4.5% and 7.7% below norms in females and males, respectively. Twenty-two percent had impaired (

BACKGROUND: Work history data often require major data management including handling of overlapping jobs to avoid overestimating exposure before exposure linkage to job-exposure matrices (JEMs) is possible. METHODS: In a case-cohort study of 1825 Norwegian offshore petroleum workers, 3979 jobs were reported (mean duration 2417 days/job; maximum 8 jobs/worker). Each job was assigned to one of 27 occupation categories. Overlapping jobs of the same category (1142 jobs) were collapsed and overlapping jobs of different categories (1013 jobs) were split. The resulting durations were weighted by a factor accounting for the number of overlapping jobs. RESULTS: Collapsing overlapping jobs within the same category resulted in 3295 jobs (mean 2629 days/job). Splitting overlapping jobs of different categories increased the number to 4239 jobs (mean 2043 days/job), while the total duration in days dropped with 10%. CONCLUSIONS: We demonstrated that overlapping employment data structures can be harmonized in a systematic and unbiased way, preparing work history data for linkage to several JEMs.

Background Breslow thickness is the most important prognostic factor of localized cutaneous melanoma (CM), but associations with anthropometric factors have been sparsely and incompletely investigated. Objectives To examine prediagnostic body mass index (BMI), body surface area (BSA), and height, weight and weight change in relation to Breslow thickness, overall and by anatomical site and histological subtype; and to assess possible nonlinear associations between these anthropometric factors and Breslow thickness. Methods CMs in the Janus Cohort were identified between 1972 and 2014. Linear regression was used to estimate geometric mean ratios (GMRs) of Breslow thickness with 95% confidence intervals (CIs) according to anthropometric factors. Restricted cubic splines in generalized linear models predicted adjusted mean Breslow thickness, and were used to assess possible nonlinear relationships. Results Of 2570 cases of CM, obese patients had a GMR of 1·16 (95% CI 1·04–1·30) of Breslow thickness vs. normal‐weight patients. For BSA and weight, quintile 5 showed GMRs of 1·13 (95% CI 1·00–1·27) and 1·17 (95% CI 1·03–1·33) of Breslow thickness vs. quintile 1, respectively. Associations seemed restricted to superficial spreading melanomas and CMs on the trunk and lower limbs. The associations plateaued at an adjusted mean Breslow thickness of about 2·5 mm (BMI 29 kg m−2, BSA 2·05 m2 and weight 90 kg), before declining for the highest values. No associations were found for height and weight change. Conclusions This large case‐series of incident CM demonstrated positive associations between BMI, BSA, weight and Breslow thickness, and suggested that behavioural or other mechanisms apply at high values. This is the peer reviewed version of the article, which has been published in final form at Wiley. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions."

The objective of this study was to examine self-reported frequency of occupational exposure reported by 28,000 Norwegian offshore oil workers in a 1998 survey. Predictors of self-reported exposure frequency were identified to aid future refinements of an expert-based job-exposure-time matrix (JEM). We focus here on reported frequencies for skin contact with oil and diesel; exposure to oil vapor from shaker, to exhaust fumes, vapor from mixing chemicals used for drilling, natural gas, chemicals used for water injection and processing, and to solvent vapor. Exposure frequency was reported by participants as the exposed proportion of the work shift, defined by six categories, in their current or last position offshore (between 1965 and 1999). Binary Poisson regression models with robust variance were used to examine the probabilities of reporting frequent exposure (≥frac14; vs.frac14; of work shift) according to main activity, time period, supervisory position, type of company, type of installation, work schedule, and education. Holding a non-supervisory position, working shifts, being employed in the early period of the offshore industry, and having only compulsory education increased the probability of reporting frequent exposure. The identified predictors and group-level patterns may aid future refinement of the JEM previously developed for the present cohort.

Background Physical activity may counteract the adverse effects of adiposity on cardiovascular mortality; however, the evidence of a similar effect on diabetes is sparse. This study examines whether physical activity may compensate for the adverse effect of adiposity on diabetes risk. Methods The study population consisted of 38 231 individuals aged 20 years or more who participated in two consecutive waves of the prospective longitudinal Nord-Trøndelag Health Study in Norway: in 1984–1986 and in 1995–1997. A Poisson regression model with SEs derived from robust variance was used to estimate adjusted risk ratios of diabetes between categories of body mass index and physical activity. Results Risk of diabetes increased both with increasing body mass (Ptrend

Diffusing capacity impairment is prevalent in long-term lymphoma survivors after high-dose therapy with autologous stem cell transplantation

IntroductionBladder cancer (BC) (including renal pelvis, ureter and urethra) is one of the most common urogenital cancers and the fourth most frequent cancer in men in the USA. In Norway, the incidence of BC has increased over the last decades. The age-standardised incidence rates per 100 000 for 2011-2015 were 53.7 in men and 16.5 in women. Compared to the 5-year period 2006–2010, the percentage increase in incidence was 6.1% in men and 12.3% in women. The recurrence rate of BC is over 50%, the highest recurrence rate of any malignancy. Smoking and occupational exposure to aromatic amines are recognised as the major risk factors. Recently, low-serum level of 25-hydroxy vitamin D (25(OH)D) and obesity have been suggested to increase the BC risk, and leptin, which is important in weight regulation, may be involved in bladder carcinogenesis. More knowledge on potential risk factors for BC is necessary for planning and implementing primary prevention measures.Methods and analysesCohort and nested case–control studies will be carried out using the population-based Janus Serum Bank Cohort consisting of prediagnostic sera, clinical measurement data (body height and weight, body surface area and weight change over time, blood pressure, cholesterol and triglycerides) and self-reported information on lifestyle factors (smoking, physical activity). Participants were followed from cohort inclusion (1972–2003) through 2014. The cohort will be linked to the Cancer Registry of Norway (cancer data), the National Cause of Death Registry (date and cause of death), National Population Registry (vital status) and Statistic Norway (education and occupation). Serum samples will be analysed for 25(OH)D, vitamin D binding protein, leptin, albumin, calcium and parathyroid hormone. Cox regression and conditional logistic regression models and mediation analysis will be used to estimate association between the exposures and BC.Ethics and disseminationThe study has been approved by the Regional Committee for Medical Research Ethics and is funded by the Norwegian Cancer Society. Results will be published in peer-reviewed journals, at scientific conferences and through press releases.

Background: The aim of this work was to examine the risk of lymphohaematopoietic (LH) cancer according to benzene exposure among offshore workers. Methods: Cancer registry data were used to identify 112 cancer cases diagnosed during 1999–2011 in a cohort of 24 917 Norwegian men reporting offshore work between 1965 and 1999. Analyses were conducted according to a stratified case–cohort design with a reference subcohort of 1661 workers. Cox regression was used to estimate hazard ratios with 95% confidence intervals, adjusted for other benzene exposure and smoking. Results: Most workers were exposed to benzene for

Introduction The incidence and mortality rates of cutaneous melanoma (CM) are increasing among fair-skinned populations worldwide. Ultraviolet radiation (UVR) is the principal risk factor for CM, but is also the main source of 25-hydroxyvitamin D (25(OH)D), which has been associated with reduced risk and better prognosis of some cancer types. However, both low and high 25(OH)D levels have been associated with increased risk of CM. Obesity as measured by body mass index (BMI) is associated with risk of several cancers and has also been suggested as a risk factor for CM, and may also be related to insufficient 25(OH)D and/or high leptin levels. Moreover, contracting a CM diagnosis has been associated with increased risk of developing second cancer. We aim to study whether low prediagnostic serum levels of 25(OH)D, high prediagnostic levels of BMI and high serum leptin levels influence CM incidence, Breslow thickness and CM mortality, and risk of second cancer and survival after a CM diagnosis. Methods and analysis Cohort and nested case–control studies will be carried out using the population-based Janus Serum Bank Cohort (archival prediagnostic sera, BMI, smoking and physical activity), with follow-up from 1972 to 2014. Additional data will be received from the Cancer Registry of Norway, the national Cause of Death Registry, Statistics Norway (education and occupation) and exposure matrices of UVR. Time-to-event regression models will be used to analyse the cohort data, while the nested case–control studies will be analysed by conditional logistic regression. A multilevel approach will be applied when incorporating group-level data. Ethics and dissemination The project is approved by the Regional Committee for Medical Research Ethics and is funded by the Norwegian Cancer Society. Results will be published in peer-reviewed journals, at scientific conferences and in the news media.

Cancer incidence among Norwegian offshore oil industry workers has been studied in two equally sized cohorts of 28000 workers, in a survey-based cohort study followed 1999-2005 and a register-based cohort study followed 1981-2003.To determine the overall cancer incidence in both cohorts merged, with an extended follow-up.The merged cohort yielded 41,140 individuals followed for cancer diagnoses 1999-2009. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were computed by gender and by period of first employment using cancer registry data.Among female workers, the total number of cancers was slightly higher than expected (SIR 1.17, 95% CI 1.02-1.34), and excesses of acute myeloid leukaemia (AML) (SIR 5.29, 95% CI 1.72-12), malignant melanoma (SIR 2.13, 95% CI 1.41-3.08) and lung cancer (SIR 1.69, 95% CI 1.03-2.61) were observed. Among male workers, the total number of cancer cases was close to that expected (SIR 1.03, 95% CI 0.99-1.08), but cases of pleural cancer (SIR 2.56, 95% CI 1.58-3.91) and bladder cancer (SIR 1.25, 95% CI 1.05-1.49) were higher than expected. Among male workers first employed before 1986, the numbers of observed cancer cases were higher than expected for most sites, while this was not evident among those employed later.Further studies with exposure data and confounder control are needed to address whether the observed excesses of pleural cancer and AML can be attributed to offshore work.

Objectives Several studies have found associations between chemical exposures in the oil industry and cancer incidence. However, few studies have looked at Norwegian offshore oil industry workers. Thus, the main objective of the present project is to assess the impact of chemical exposures on cancer incidence in Norwegian offshore workers. Methods The project includes 28 000 workers who in 1998–1999 gave detailed information on work history through a questionnaire. Four studies will be conducted; a descriptive study on self-reported exposures, two case-cohort studies where job-exposure-matrices will be used to assess the impact of benzene and asbestos on lymphohemtaopoietic cancers and mesotheliomas/lung cancer, respectively, and a validation study. The latter aims at comparing the Cancer Registry of Norway (CRN) offshore cohort with offshore workers registered in the Norwegian Registry of employers and employees, and, additionally, report historical cancer incidence by year of first employment. Preliminary Results In 2007, the offshore cohort was linked to the CRN main database for a preliminary evaluation of cancer incidence in the offshore cohort in the period 1999–2005 with the Norwegian population as a reference group. For acute myeloid leukemia and cancer of the pleura it was estimated standardised incidence ratios at 2.0 (95% CI; 1.0 to 3.7) and 2.2 (95% CI; 0.9 to 4.6), respectively (Aas et al Scand J Work Environ Health 2009;35:397–9). Conclusions The results from the 2007-linkage have to be interpreted cautiously due to few cases and no use of exposure data. The results do, however, suggest an excess of risk in some types of cancer among offshore workers. The announced studies are expected to give more precise information.