Baseline and lifetime alcohol consumption and risk of skin cancer in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC)

Experimental evidence suggests that alcohol induces cutaneous carcinogenesis, yet epidemiological studies on the link between alcohol intake and skin cancer have been inconsistent. The European Prospective Investigation into Cancer and Nutrition (EPIC) is a prospective cohort initiated in 1992 in 10 European countries. Alcohol intake at baseline and average lifetime alcohol intake were assessed using validated country-specific dietary and lifestyle questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated in Cox models. A total of 14 037 skin cancer cases (melanoma: n = 2457; basal-cell carcinoma (BCC): n = 8711; squamous-cell carcinoma (SCC): n = 1928; unknown: n = 941) were identified among 450 112 participants (average follow-up: 15 years). Baseline alcohol intake was positively associated with SCC (>15 vs 0.1-4.9 g/day: HR = 1.44, 95% CI = 1.17-1.77; Ptrend = .001), BCC (HR = 1.12, 95% CI = 1.01-1.23; Ptrend = .04), and melanoma risks in men (HR = 1.17, 95% CI = 0.95-1.44; Ptrend = .17), while associations were more modest in women (SCC: HR = 1.09, 95% CI = 0.90-1.30; Ptrend = .13; BCC: HR = 1.08, 95% CI = 1.00-1.17,Ptrend = .03; melanoma: HR = 0.93, 95% CI = 0.80-1.08, Ptrend = .13). Associations were similar for lifetime alcohol intake, with an attenuated linear trend. Lifetime liquor/spirit intake was positively associated with melanoma (fourth vs first quartile: HR = 1.47, 95% CI = 1.08-1.99; Ptrend = .0009) and BCC risks in men (HR = 1.17, 95% CI = 1.04-1.31;Ptrend = .14). Baseline and lifetime intakes of wine were associated with BCC risk (HR = 1.25 in men; HR = 1.11-1.12; in women). No statistically significant associations were found between beverage types and SCC risk. Intake of beer was not associated with skin cancer risk. Our study suggests positive relationships between alcohol intake and skin cancer risk, which may have important implications for the primary prevention of skin cancer. What's new? Drinking alcohol can make the skin more sensitive to sunlight and vulnerable to skin cancer. Here, the authors conducted a large prospective cohort study to evaluate whether alcohol consumption correlates with skin cancer risk. Among the 450 112 participants, there were 2457 cases of melanoma, 8711 of basal cell carcinoma, and 1928 of squamous cell carcinoma. There was a positive association between alcohol and all three cancer types, stronger in men than in women. The association varied somewhat by beverage type

Exposure to Drugs and Skin Cancer Risk in the E3N Prospective Cohort

Les cancers cutanés sont les néoplasmes les plus fréquents en France et leur incidence est en constante augmentation. L'exposition solaire est actuellement le seul facteur de risque pour lequel une prévention est possible. Plusieurs études ont suggéré que l'exposition à certains médicaments était associée au risque de cancers cutanés, soit en augmentant ce risque, via un effet photosensibilisant par exemple, soit en le diminuant, via un effet anti-inflammatoire pour certaines molécules. Cependant, les études pharmaco-épidémiologiques évaluant les liens entre médicaments et risque de cancers cutanés restent relativement peu nombreuses, avec des résultats souvent contradictoires. En outre, très peu ont inclus des données sur l'exposition solaire ou le phénotype pigmentaire des participants, qui sont pourtant des facteurs de risque importants et sont essentiels pour évaluer un éventuel rôle du caractère photosensibilisant des médicaments étudiés. Enfin, peu d'études ont évalué le risque en fonction de la dose ou la durée des traitements. L’objectif de cette thèse était d’explorer les relations entre plusieurs classes de médicaments largement utilisées en France et dans le monde (statines, anti-inflammatoires non stéroïdiens (AINS), antihypertenseurs) et le risque de cancers cutanés dans la cohorte prospective E3N (Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale (MGEN)), qui suit 98 995 femmes françaises nées entre 1925 et 1950 depuis 1990. Dans cette cohorte, les données de remboursement de médicaments ont été fournies par la MGEN depuis le 1er janvier 2004. Les analyses statistiques ont été réalisées au moyen de modèles à risques proportionnels de Cox. Nos résultats suggèrent des associations modestes entre la prise de certaines classes de médicaments et le risque de cancers cutanés, avec notamment une association inverse entre l’utilisation de statines et le risque de carcinome basocellulaire (CBC), et une association positive entre la prise d’AINS hors aspirine et le risque de mélanome, tandis qu’il n’y avait pas d’association globale entre prise d’antihypertenseurs et risque de cancers cutanés. Cependant, nous avons observé diverses associations différentielles selon l’exposition résidentielle aux UV, le phénotype pigmentaire ou les classes de certains grands types de médicaments. Ces résultats suggèrent des relations complexes entre expositions médicamenteuses et risque de cancers cutanés, qui pourraient refléter un rôle contradictoire de certains mécanismes impliqués tels que photosensibilisation et inflammation.Skin cancers are the most common neoplasms in France and their incidence is constantly increasing. Solar exposure is currently the only risk factor for which prevention is possible. Several studies have suggested that exposure to certain drugs is associated with the risk of skin cancer, either by increasing this risk, for example through a photosensitizing effect, or by decreasing it, e.g. via an anti-inflammatory effect. However, pharmacoepidemiological studies evaluating the relation between drugs and the risk of skin cancers remain relatively scarce, with often contradictory results. In addition, very few included data on participants' exposure to the sun or their pigmentary phenotype, which are important risk factors that are essential to assess a possible role of the photosensitizing nature of the drugs under study. Finally, few studies have evaluated the risks according to the dose or duration of treatments. The aim of this doctoral project was to study the relationships between exposure to different drugs widely used in France and worldwide (statins, nonsteroidal anti-inflammatory drugs (NSAIDs), antihypertensive drugs) and the risk of skin cancer in E3N (Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale (MGEN)), a prospective cohort study including 98,995 women insured by a national health plan covering teachers and coworkers (MGEN), born between 1925 and 1950 and followed since 1990. In this cohort, healthcare reimbursement data have been provided by the MGEN since January 1, 2004. Statistical analyses were performed using Cox proportional hazards models. Our results suggest modest global associations between the use of certain drug classes and the risk of skin cancers, with in particular an inverse association between statin use and basal cell carcinoma (BCC) risk, and a positive association between NSAID use other than aspirin and melanoma risk, while no global association between antihypertensive drugs and skin cancer risk was found. However, we observed various differential associations according to residential UV exposure, pigmentary traits or classes of certain major types of drugs. These results suggest complex relationships between exposures to drugs and skin cancer risk, which may reflect antagonism of certain mechanisms involved such as photosensitivity and inflammation

Expositions médicamenteuses et risque de cancers cutanés dans la cohorte E3N

Skin cancers are the most common neoplasms in France and their incidence is constantly increasing. Solar exposure is currently the only risk factor for which prevention is possible. Several studies have suggested that exposure to certain drugs is associated with the risk of skin cancer, either by increasing this risk, for example through a photosensitizing effect, or by decreasing it, e.g. via an anti-inflammatory effect. However, pharmacoepidemiological studies evaluating the relation between drugs and the risk of skin cancers remain relatively scarce, with often contradictory results. In addition, very few included data on participants' exposure to the sun or their pigmentary phenotype, which are important risk factors that are essential to assess a possible role of the photosensitizing nature of the drugs under study. Finally, few studies have evaluated the risks according to the dose or duration of treatments. The aim of this doctoral project was to study the relationships between exposure to different drugs widely used in France and worldwide (statins, nonsteroidal anti-inflammatory drugs (NSAIDs), antihypertensive drugs) and the risk of skin cancer in E3N (Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale (MGEN)), a prospective cohort study including 98,995 women insured by a national health plan covering teachers and coworkers (MGEN), born between 1925 and 1950 and followed since 1990. In this cohort, healthcare reimbursement data have been provided by the MGEN since January 1, 2004. Statistical analyses were performed using Cox proportional hazards models. Our results suggest modest global associations between the use of certain drug classes and the risk of skin cancers, with in particular an inverse association between statin use and basal cell carcinoma (BCC) risk, and a positive association between NSAID use other than aspirin and melanoma risk, while no global association between antihypertensive drugs and skin cancer risk was found. However, we observed various differential associations according to residential UV exposure, pigmentary traits or classes of certain major types of drugs. These results suggest complex relationships between exposures to drugs and skin cancer risk, which may reflect antagonism of certain mechanisms involved such as photosensitivity and inflammation.Les cancers cutanés sont les néoplasmes les plus fréquents en France et leur incidence est en constante augmentation. L'exposition solaire est actuellement le seul facteur de risque pour lequel une prévention est possible. Plusieurs études ont suggéré que l'exposition à certains médicaments était associée au risque de cancers cutanés, soit en augmentant ce risque, via un effet photosensibilisant par exemple, soit en le diminuant, via un effet anti-inflammatoire pour certaines molécules. Cependant, les études pharmaco-épidémiologiques évaluant les liens entre médicaments et risque de cancers cutanés restent relativement peu nombreuses, avec des résultats souvent contradictoires. En outre, très peu ont inclus des données sur l'exposition solaire ou le phénotype pigmentaire des participants, qui sont pourtant des facteurs de risque importants et sont essentiels pour évaluer un éventuel rôle du caractère photosensibilisant des médicaments étudiés. Enfin, peu d'études ont évalué le risque en fonction de la dose ou la durée des traitements. L’objectif de cette thèse était d’explorer les relations entre plusieurs classes de médicaments largement utilisées en France et dans le monde (statines, anti-inflammatoires non stéroïdiens (AINS), antihypertenseurs) et le risque de cancers cutanés dans la cohorte prospective E3N (Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale (MGEN)), qui suit 98 995 femmes françaises nées entre 1925 et 1950 depuis 1990. Dans cette cohorte, les données de remboursement de médicaments ont été fournies par la MGEN depuis le 1er janvier 2004. Les analyses statistiques ont été réalisées au moyen de modèles à risques proportionnels de Cox. Nos résultats suggèrent des associations modestes entre la prise de certaines classes de médicaments et le risque de cancers cutanés, avec notamment une association inverse entre l’utilisation de statines et le risque de carcinome basocellulaire (CBC), et une association positive entre la prise d’AINS hors aspirine et le risque de mélanome, tandis qu’il n’y avait pas d’association globale entre prise d’antihypertenseurs et risque de cancers cutanés. Cependant, nous avons observé diverses associations différentielles selon l’exposition résidentielle aux UV, le phénotype pigmentaire ou les classes de certains grands types de médicaments. Ces résultats suggèrent des relations complexes entre expositions médicamenteuses et risque de cancers cutanés, qui pourraient refléter un rôle contradictoire de certains mécanismes impliqués tels que photosensibilisation et inflammation

Expositions médicamenteuses et risque de cancers cutanés dans la cohorte E3N

Skin cancers are the most common neoplasms in France and their incidence is constantly increasing. Solar exposure is currently the only risk factor for which prevention is possible. Several studies have suggested that exposure to certain drugs is associated with the risk of skin cancer, either by increasing this risk, for example through a photosensitizing effect, or by decreasing it, e.g. via an anti-inflammatory effect. However, pharmacoepidemiological studies evaluating the relation between drugs and the risk of skin cancers remain relatively scarce, with often contradictory results. In addition, very few included data on participants' exposure to the sun or their pigmentary phenotype, which are important risk factors that are essential to assess a possible role of the photosensitizing nature of the drugs under study. Finally, few studies have evaluated the risks according to the dose or duration of treatments. The aim of this doctoral project was to study the relationships between exposure to different drugs widely used in France and worldwide (statins, nonsteroidal anti-inflammatory drugs (NSAIDs), antihypertensive drugs) and the risk of skin cancer in E3N (Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale (MGEN)), a prospective cohort study including 98,995 women insured by a national health plan covering teachers and coworkers (MGEN), born between 1925 and 1950 and followed since 1990. In this cohort, healthcare reimbursement data have been provided by the MGEN since January 1, 2004. Statistical analyses were performed using Cox proportional hazards models. Our results suggest modest global associations between the use of certain drug classes and the risk of skin cancers, with in particular an inverse association between statin use and basal cell carcinoma (BCC) risk, and a positive association between NSAID use other than aspirin and melanoma risk, while no global association between antihypertensive drugs and skin cancer risk was found. However, we observed various differential associations according to residential UV exposure, pigmentary traits or classes of certain major types of drugs. These results suggest complex relationships between exposures to drugs and skin cancer risk, which may reflect antagonism of certain mechanisms involved such as photosensitivity and inflammation.Les cancers cutanés sont les néoplasmes les plus fréquents en France et leur incidence est en constante augmentation. L'exposition solaire est actuellement le seul facteur de risque pour lequel une prévention est possible. Plusieurs études ont suggéré que l'exposition à certains médicaments était associée au risque de cancers cutanés, soit en augmentant ce risque, via un effet photosensibilisant par exemple, soit en le diminuant, via un effet anti-inflammatoire pour certaines molécules. Cependant, les études pharmaco-épidémiologiques évaluant les liens entre médicaments et risque de cancers cutanés restent relativement peu nombreuses, avec des résultats souvent contradictoires. En outre, très peu ont inclus des données sur l'exposition solaire ou le phénotype pigmentaire des participants, qui sont pourtant des facteurs de risque importants et sont essentiels pour évaluer un éventuel rôle du caractère photosensibilisant des médicaments étudiés. Enfin, peu d'études ont évalué le risque en fonction de la dose ou la durée des traitements. L’objectif de cette thèse était d’explorer les relations entre plusieurs classes de médicaments largement utilisées en France et dans le monde (statines, anti-inflammatoires non stéroïdiens (AINS), antihypertenseurs) et le risque de cancers cutanés dans la cohorte prospective E3N (Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale (MGEN)), qui suit 98 995 femmes françaises nées entre 1925 et 1950 depuis 1990. Dans cette cohorte, les données de remboursement de médicaments ont été fournies par la MGEN depuis le 1er janvier 2004. Les analyses statistiques ont été réalisées au moyen de modèles à risques proportionnels de Cox. Nos résultats suggèrent des associations modestes entre la prise de certaines classes de médicaments et le risque de cancers cutanés, avec notamment une association inverse entre l’utilisation de statines et le risque de carcinome basocellulaire (CBC), et une association positive entre la prise d’AINS hors aspirine et le risque de mélanome, tandis qu’il n’y avait pas d’association globale entre prise d’antihypertenseurs et risque de cancers cutanés. Cependant, nous avons observé diverses associations différentielles selon l’exposition résidentielle aux UV, le phénotype pigmentaire ou les classes de certains grands types de médicaments. Ces résultats suggèrent des relations complexes entre expositions médicamenteuses et risque de cancers cutanés, qui pourraient refléter un rôle contradictoire de certains mécanismes impliqués tels que photosensibilisation et inflammation

Premenopausal Use of Progestogens and Cutaneous Melanoma Risk: A French Prospective Cohort Study

International audienceAbstract We investigated the influence of premenopausal use of progestogens on melanoma using data from E3N (Etude Epidémiologique Auprès de Femmes de l’Education Nationale), a prospective cohort of 98,995 French women, aged 40–65 years at inclusion. We used Cox models to adjust for age and melanoma risk factors. Over 1992–2008, 540 melanoma cases were ascertained among 79,558 women. We found a modest association between self-reported progestogen use and melanoma risk (hazard ratio (HR) = 1.23, 95% confidence interval (CI) = 1.02, 1.47), which was reduced after adjustment for melanoma risk factors (HR = 1.15, 95% CI: 0.95, 1.39). There was no heterogeneity across types of progestogens (P = 0.22), and use of multiple progestogens was positively associated with melanoma risk (HR = 1.33, 95% CI: 1.04, 1.70). Among users, we found no relationship with duration of progestogen use, age at start and last use, and time since first and last use. Although our results did not show evidence of a confounding effect of sun exposure, progestogen users had lower levels of residential sun exposure and were more likely to report sunscreen use, suggesting specific sun exposure profiles in users. Our findings do not support a strong influence of progestogens on melanoma risk. Further research is needed to confirm these results

Antiplatelet drug use and breast cancer risk in a prospective cohort of postmenopausal women

International audienceBackground: Epidemiologic evidence is insufficient to draw conclusions on the impact of low-dose aspirin use on breast cancer risk, and the potential impact of other antiplatelet drugs such as clopidogrel needs to be explored. Methods: We investigated the association between breast cancer risk and low-dose aspirin or clopidogrel use in the E3N cohort, which includes 98,995 women, with information on breast cancer risk factors collected from biennial questionnaires matched with drug reimbursement data available from 2004. Women with at least two reimbursements of the drug of interest in any previous 3-month period were considered "ever"exposed. Exposure was considered as time-varying and multivariable Cox regression models were used to estimate HRs of breast cancer. Results: Among 62,512 postmenopausal women followed during 9 years on average, 2,864 breast cancer cases were identified. Compared with never use, a transient higher breast cancer risk was observed during the third year of low-dose aspirin use [HR2-≤3 years of use = 1.49 (1.08.2.07)], followed by a lower risk [HR4+ years of use = 0.72 (0.52.0.99)]. Clopidogrel ever use was associated with a higher breast cancer risk [HR, 1.30 (1.02.1.68)], restricted to estrogen receptor negative (ER-) tumors [HRER+ = 1.14 (0.83.1.57), HRER- = 3.07 (1.64.5.76), Phomogeneity = 0.01]. Conclusions: Low-dose aspirin was associated with a lower breast cancer risk only after several years of use, while ever use of clopidogrel was associated with a higher ER- breast cancer risk. Impact: Antiplatelet drugs are not good pharmacologic candidates for breast cancer prevention

Use of nonsteroidal anti-inflammatory drugs and breast cancer risk in a prospective cohort of postmenopausal women

International audienceBackground: Although anti-inflammatory agents could theoretically have anticancer properties, results from cohort studies on nonsteroidal anti-inflammatory drugs (NSAIDs) and breast cancer (BC) risk are inconsistent. Methods: We investigated the association between NSAID use and BC incidence in the French E3N prospective cohort, which includes 98,995 women born between 1925 and 1950 and insured by a health insurance plan that covers mostly teachers. Self-reported information on lifestyle and medical history has been collected biennially by questionnaires and matched with data from a drug reimbursement database covering the period 2004–2014. Women who self-reported current NSAID use in the 2000 or 2002 questionnaires or with at least two reimbursements in any previous 3-month period were defined as exposed to NSAIDs. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for the association of NSAID use with BC risk. Results: In the current analysis, 62,512 postmenopausal women were followed between 2004 and 2014 (9 years on average, starting at a mean age of 63 years; 2864 incident BC). In multivariable models, there was no statistically significant association between NSAID use and BC risk [HR = 1.00 (0.92–1.08), compared with non-exposed women]. The NSAID-BC associations did not differ by NSAID types, BC subtypes, risk factors, and comorbidities, nor by duration and dose of use. However, a statistically significant interaction was observed by proton pump inhibitor (PPI) drug use (Pinteraction = 0.01) whereby a decreased risk of BC with NSAID use was only observed among women who also used PPI before. Conclusion: Only women who used NSAIDs after having used PPI had a lower risk of BC. This result is novel and requires replication in other studies

Dietary antioxidant supplements and risk of keratinocyte cancers in women: a prospective cohort study

International audiencePurpose: Experimental studies suggested that antioxidants could protect against skin carcinomas. However, epidemiological studies on antioxidant supplement use in relation to basal-cell carcinoma (BCC) and squamous-cell carcinoma (SCC) risks yielded inconsistent findings, and few prospective studies have been conducted to date. We aimed to investigate the associations between antioxidant supplement intake and keratinocyte cancer (KC) risk. Methods: E3N is an ongoing prospective cohort initiated in 1990 and involving 98,995 French women aged 40–65 years at recruitment. Intakes of dietary antioxidants were estimated via a validated dietary questionnaire in 1993 and self-reported antioxidant supplement use was collected in 1995. We used Cox models to compute hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for age and skin cancer risk factors. Results: Over 1995–2014, 2426 BCC and 451 SCC cases were diagnosed among 63,063 women. We found positive relationships between vitamin A supplement use and KC risk (HR = 1.37, 95% CI 1.15–1.62), particularly with BCC (HR = 1.40, 95% CI 1.17–1.69); and between vitamin E supplement use and risks of both BCC (HR = 1.21, 95% CI 1.03–1.52) and SCC (HR = 1.43, 95% CI 1.03–1.99). Intake of beta-carotene supplements was associated with an increased SCC risk (HR = 1.59, 95% CI 1.00–2.54). Vitamin C supplement use was not associated with KC risk. We found similar results when considering total antioxidant intake. Conclusions: Intakes of vitamin A or E supplements were associated with an increased KC risk in women. Further studies with information on doses and duration of supplement use and the ability to examine their underlying mechanisms are needed

Use of systemic glucocorticoids and risk of breast cancer in a prospective cohort of postmenopausal women

International audienceBackground: Glucocorticoids could theoretically decrease breast cancer risk through their anti-inflammatory effects or increase risk through immunosuppression. However, epidemiological evidence is limited regarding the associations between glucocorticoid use and breast cancer risk. Methods: We investigated the association between systemic glucocorticoid use and breast cancer incidence in the E3N cohort, which includes 98,995 women with information on various characteristics collected from repeated questionnaires complemented with drug reimbursement data available from 2004. Women with at least two reimbursements of systemic glucocorticoids in any previous 3-month period since January 1, 2004, were defined as exposed. We considered exposure as a time-varying parameter, and we used multivariable Cox regression models to estimate hazard ratios (HRs) of breast cancer. We performed a competing risk analysis using a cause-specific hazard approach to study the heterogeneity by tumour subtype/stage/grade. Results: Among 62,512 postmenopausal women (median age at inclusion of 63 years old), 2864 developed breast cancer during a median follow-up of 9 years (between years 2004 and 2014). Compared with non-exposure, glucocorticoid exposure was not associated with overall breast cancer risk [HR = 0.94 (0.85-1.05)]; however, it was associated with a higher risk of in situ breast cancer and a lower risk of invasive breast cancer [HR insitu = 1.34 (1.01-1.78); HR invasive = 0.86 (0.76-0.97); P homogeneity = 0.01]. Regarding the risk of invasive breast cancer, glucocorticoid exposure was inversely associated with oestrogen receptor (ER)-positive breast cancer [HR ER+ = 0.82 (0.72-0.94); HR ER− = 1.21 (0.88-1.66); P homogeneity = 0.03]; it was also inversely associated with the risk of stage 1 or stage 2 tumours but positively associated with the risk of stage 3/4 breast cancers [HR stage1 = 0.87 (0.75-1.01); HR stage2 = 0.67 (0.52-0.86); HR stage3/4 = 1.49 (1.02-2.20); P homogeneity = 0.01]. Conclusion: This study suggests that the association between systemic glucocorticoid use and breast cancer risk may differ by tumour subtype and stage

Statin Use and Skin Cancer Risk: A Prospective Cohort Study

International audienceEpidemiological studies on statin use in relation to skin cancer risk are scarce and yielded conflicting results. We explored this association in Etude Epidémiologique auprès de femmes de l'Education Nationale, a prospective cohort of French women born in 1925–1950. Health and lifestyle data were self-reported biennially and matched with drug reimbursement data, allowing the identification of participants’ statin use since 2004. Multivariable cause-specific hazards regression models adjusted for skin cancer risk factors estimated hazard ratios with 95% confidence intervals. Over 2004–2014, 455 cutaneous melanoma, 1,741 basal cell carcinoma, and 268 squamous cell carcinoma cases were ascertained among 62,473 women. Compared with never use, there were no associations between ever use of statins and melanoma (hazard ratio = 1.16, 95% confidence interval = 0.94–1.44) or squamous cell carcinoma (hazard ratio = 0.89, 95% confidence interval = 0.66–1.19) risks and a decrease in basal cell carcinoma risk with ever use of statins (hazard ratio = 0.89, 95% confidence interval = 0.79–0.996). We found no trend of increasing or decreasing risks with dose, duration of use, time since first use, or age at first use and no statistically significant effect modification by pigmentary traits or residential UVR exposure. Because of the limited number of studies evaluating the associations between the use of statins and the risks of melanoma, basal cell carcinoma, and squamous cell carcinoma, these findings would deserve further investigation in other settings