Non Melanoma Skin Cancer and Subsequent Cancer Risk

Introduction: Several studies have shown an increased risk of cancer after non melanoma skin cancers (NMSC) but the individual risk factors underlying this risk have not been elucidated, especially in relation to sun exposure and skin sensitivity to sunlight. Purpose: The aim of this study was to examine the individual risk factors associated with the development of subsequent cancers after non melanoma skin cancer. Methods: Participants in the population-based New Hampshire Skin Cancer Study provided detailed risk factor data, and subsequent cancers were identified via linkage with the state cancer registry. Deaths were identified via state and national death records. A Cox proportional hazard model was used to estimate risk of subsequent malignancies in NMSC patients versus controls and to assess the potential confounding effects of multiple risk factors on this risk. Results: Among 3584 participants, risk of a subsequent cancer (other than NMSC) was higher after basal cell carcinoma (BCC) (adjusted HR 1.40 [95% CI 1.15, 1.71]) than squamous cell carcinoma (SCC) (adjusted HR 1.18 [95% CI 0.95, 1.46]) compared to controls (adjusted for age, sex and current cigarette smoking). After SCC, risk was higher among those diagnosed before age 60 (HR 1.96 [95% CI 1.24, 3.12]). An over 3-fold risk of melanoma after SCC (HR 3.62; 95% CI 1.85, 7.11) and BCC (HR 3.28; 95% CI 1.66, 6.51) was observed, even after further adjustment for sun exposure-related factors and family history of skin cancer. In men, prostate cancer incidence was higher after BCC compared to controls (HR 1.64; 95% CI 1.10, 2.46). Conclusions: Our population-based study indicates an increased cancer risk after NMSC that cannot be fully explained by known cancer risk factors

Site-specific cancers risk after basal cell and squamous cell skin cancers versus controls.

<p>Hazard ratios refer to NMSC status (vs controls), adjusted for age at reference date, sex and smoking.</p>1<p>The melanoma models for BCC are adjusted for age at reference date, sex, smoking, skin reaction to chronic sun exposure and family history of NMSC.</p>2<p>The melanoma models for SCC are adjusted for age at reference date, sex, smoking, skin reaction to chronic sun exposure.</p><p>Stratified models are similarly adjusted except for the stratification variable.</p

Follow-up of participants and their subsequent cancers after non melanoma skin cancer.

1<p>Of 2,725 cases, 82 (3%) had both a BCC and SCC diagnosed within 30 days of the reference date. Of these, oversampling for SCC cases led 79 to an SCC classification.</p>2<p>Participants with cancer of any organ except the skin, diagnosed before the reference date, were excluded from the main analyses. Relative to controls, the odds ratio for a history of non-skin cancer in those with BCC was, adjusted for age, sex and smoking: odds ratio 1.74 (95% CI 1.40, 2.18) and for SCC, OR 1.99 (95% CI 1.59, 2.89).</p>3<p>Total exceeds number of participants with subsequent cancer because a participant may be diagnosed with multiple primary tumors.</p

Hazard ratios (95% confidence intervals) for subsequent cancers (all, and invasive cancers only) following basal cell and squamous cell skin cancers compared to controls.

<p>Hazard ratios are based on time to subsequent cancer compared to controls, adjusted for age at reference date, sex and smoking; stratified models are similarly adjusted except for the stratification variable. Where shown in bold, HR is statistically significant (alpha = 0.05).</p>1<p>All cancers: invasive plus in situ cancers of sites other than cervix and prostate.</p>2<p>Invasive cancers: stage 1–4 cancers and stage 0 bladder.</p>3<p>The HR associated with BCC did not vary significantly by sex or by age group.</p>4<p>The HR associated with SCC did not vary significantly by sex, but was significantly higher in those aged <60 than those aged ≥60 (p<0.003).</p

Oncology Care in Rural Northern New England

This study coordinates data analysis among central cancer registries in multiple states to examine differences in care between rural and urban areas

Non Melanoma Skin Cancer and Subsequent Cancer Risk

<div><p>Introduction</p><p>Several studies have shown an increased risk of cancer after non melanoma skin cancers (NMSC) but the individual risk factors underlying this risk have not been elucidated, especially in relation to sun exposure and skin sensitivity to sunlight.</p><p>Purpose</p><p>The aim of this study was to examine the individual risk factors associated with the development of subsequent cancers after non melanoma skin cancer.</p><p>Methods</p><p>Participants in the population-based New Hampshire Skin Cancer Study provided detailed risk factor data, and subsequent cancers were identified via linkage with the state cancer registry. Deaths were identified via state and national death records. A Cox proportional hazard model was used to estimate risk of subsequent malignancies in NMSC patients versus controls and to assess the potential confounding effects of multiple risk factors on this risk.</p><p>Results</p><p>Among 3584 participants, risk of a subsequent cancer (other than NMSC) was higher after basal cell carcinoma (BCC) (adjusted HR 1.40 [95% CI 1.15, 1.71]) than squamous cell carcinoma (SCC) (adjusted HR 1.18 [95% CI 0.95, 1.46]) compared to controls (adjusted for age, sex and current cigarette smoking). After SCC, risk was higher among those diagnosed before age 60 (HR 1.96 [95% CI 1.24, 3.12]). An over 3-fold risk of melanoma after SCC (HR 3.62; 95% CI 1.85, 7.11) and BCC (HR 3.28; 95% CI 1.66, 6.51) was observed, even after further adjustment for sun exposure-related factors and family history of skin cancer. In men, prostate cancer incidence was higher after BCC compared to controls (HR 1.64; 95% CI 1.10, 2.46).</p><p>Conclusions</p><p>Our population-based study indicates an increased cancer risk after NMSC that cannot be fully explained by known cancer risk factors.</p></div