d63fa09c53e87539a22a02c25bbcaa2b pmc_10670280.pdf 42ca54b798d8d45ded3d45b1bfbbccafc6d02fbe pmc_10670280.pdf 24d1f3a954906bf5367613b9ff65a548d7be241d89944f789c76ea687cacdb3a pmc_10670280.pdf Title: The Influence of the Exposome in the Cutaneous Squamous Cell Carcinoma, a Multicenter Case–Control Study Subject: Introduction: The concept of exposome refers to the total of harmful and beneficial environmental exposures that can help predict the organism’s biological responses over time. Ultraviolet radiation (UVR) from sun exposure has been recognized as the main etiological agent of skin cancer, and squamous cell carcinoma (SCC) is one most commonly associated with chronic exposure. However, in recent years, evidence suggests that lifestyle, environmental pollution, and contaminants in water and food can have an influence. Objectives: To study the relationship between SCC and sun exposure, pollution, stress, and lifestyle in a Spanish cohort. Materials and Method: A multicenter case–control study was carried out in which 13 dermatologists from different regions of Spain recruited cases and controls between April 2020 and August 2022. The group of cases were patients diagnosed with SCC and, as a control group, people who attended Dermatology consultations as companions with no history of skin cancer. Results: A total of 62 patients with SCC and 126 controls were included (62.9% males, median age 76.46 (10.1) and 33.3%, median age 55.7 (15), respectively). The SCC group had experienced more outside work than the controls (75% vs. 22.4%, p < 0.001), less recreational exposure (sunbathing, p = 0.05, and outdoor sports, p = 0.01), and a lower annual income (p = 0.01), with an increase in tobacco exposure (p < 0.001), without differences in other carcinogens, such as ionizing radiation or chemical exposure. The control group had a higher daily screentime use (p < 0.001) and practiced more relaxation activities (p = 0.03). A higher linolenic acid intake and lower coffee consumption were the only dietary variables associated with SCC (p < 0.05). Some chronic medications (anxiolytics, antidepressants, beta-blockers, statins, hydrochlorothiazide, ACE inhibitors, metformin, and omeprazole) were also statistically associated with SCC. Statistical significance for all aforementioned variables was maintained in the multivariate analysis (p < 0.05). Conclusions: The study found a significant association between SCC and multiple exposome-related factors in addition to chronic sun exposure in the Spanish population. Primary prevention strategies should target specific populations, such as outdoor workers promoting sun-safe behaviors and stress-reducing activities, in addition to adequate skin photoprotection in patients under certain medications associated with SCC. Keywords: exposome; squamous cell carcinoma; diet; environmental exposure Author: Alba Navarro-Bielsa, Tamara Gracia-Cazaña, Manuel Almagro, Sonia De la Fuente-Meira, Ángeles Flórez, Oriol Yélamos, Trinidad Montero-Vilchez, Carlos González-Cruz, Adrián Diago, Isabel Abadías-Granado, Victoria Fuentelsaz, María Colmenero, José Bañuls, Salvador Arias-Santiago, Agustín Buendía-Eisman, Manuel Almenara-Blasco, Pedro Gil-Pallares and Yolanda Gilaberte Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Sun Nov 12 07:47:02 2023 CET ModDate: Sun Nov 12 07:55:21 2023 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 16 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1264943 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- FFAYKL+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 HCRKXL+VnURWPalladioL Type 1 Custom yes yes no 15 0 ZAZJAS+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 SHEPJQ+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 WUGYMD+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 LCJEVJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 47 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 72 0 EILUJF+CMSY10 Type 1 Builtin yes yes no 88 0 GGEEPB+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 108 0 GGEEPC+PalatinoLinotype CID TrueType Identity-H yes yes yes 111 0 GGEEPD+PalatinoLinotype TrueType WinAnsi yes yes no 117 0 GGEEPF+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 120 0 MYDOFE+EURM10 Type 1 Builtin yes yes no 127 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-05-04 02:41:43 CEST RepresentationInformation: pmc_10670280.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-04-24 02:38:52 CEST Size: 1264943 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 330 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Participants and Methods Destination: section.2 Children: Item: Title: Study Design Destination: subsection.2.1 Item: Title: Statistical Analysis Destination: subsection.2.2 Item: Title: Ethical Concerns Destination: subsection.2.3 Item: Title: Results Destination: section.3 Children: Item: Title: Demographic and Clinical Characteristics of the Sample/Study Population Destination: subsection.3.1 Item: Title: Chronic Medication Destination: subsection.3.2 Item: Title: Sun Exposure Habits and Practices Destination: subsection.3.3 Item: Title: Diet Destination: subsection.3.4 Item: Title: Lifestyle and Stress Destination: subsection.3.5 Item: Title: Multivariate Analysis Destination: subsection.3.6 Item: Title: Discussion Destination: subsection.3.7 Item: Title: Conclusions Destination: section.4 Item: Title: References Destination: section.A. Info: Title: The Influence of the Exposome in the Cutaneous Squamous Cell Carcinoma, a Multicenter Case Control Study Author: Alba Navarro-Bielsa, Tamara Gracia-Cazaña, Manuel Almagro, Sonia De la Fuente-Meira, Ángeles Flórez, Oriol Yélamos, Trinidad Montero-Vilchez, Carlos González-Cruz, Adrián Diago, Isabel Abadías-Granado, Victoria Fuentelsaz, María Colmenero, José Bañuls, Salvador Arias-Santiago, Agustín Buendía-Eisman, Manuel Almenara-Blasco, Pedro Gil-Pallares and Yolanda Gilaberte Subject: Introduction: The concept of exposome refers to the total of harmful and beneficial environmental exposures that can help predict the organism’s biological responses over time. Ultraviolet radiation (UVR) from sun exposure has been recognized as the main etiological agent of skin cancer, and squamous cell carcinoma (SCC) is one most commonly associated with chronic exposure. However, in recent years, evidence suggests that lifestyle, environmental pollution, and contaminants in water and food can have an influence. Objectives: To study the relationship between SCC and sun exposure, pollution, stress, and lifestyle in a Spanish cohort. Materials and Method: A multicenter case control study was carried out in which 13 dermatologists from different regions of Spain recruited cases and controls between April 2020 and August 2022. The group of cases were patients diagnosed with SCC and, as a control group, people who attended Dermatology consultations as companions with no history of skin cancer. Results: A total of 62 patients with SCC and 126 controls were included (62.9% males, median age 76.46 (10.1) and 33.3%, median age 55.7 (15), respectively). The SCC group had experienced more outside work than the controls (75% vs. 22.4%, p < 0.001), less recreational exposure (sunbathing, p = 0.05, and outdoor sports, p = 0.01), and a lower annual income (p = 0.01), with an increase in tobacco exposure (p < 0.001), without differences in other carcinogens, such as ionizing radiation or chemical exposure. The control group had a higher daily screentime use (p < 0.001) and practiced more relaxation activities (p = 0.03). A higher linolenic acid intake and lower coffee consumption were the only dietary variables associated with SCC (p < 0.05). Some chronic medications (anxiolytics, antidepressants, beta-blockers, statins, hydrochlorothiazide, ACE inhibitors, metformin, and omeprazole) were also statistically associated with SCC. Statistical significance for all aforementioned variables was maintained in the multivariate analysis (p < 0.05). Conclusions: The study found a significant association between SCC and multiple exposome-related factors in addition to chronic sun exposure in the Spanish population. Primary prevention strategies should target specific populations, such as outdoor workers promoting sun-safe behaviors and stress-reducing activities, in addition to adequate skin photoprotection in patients under certain medications associated with SCC. 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