Nonmelanoma Skin Cancer and Risk for Subsequent Malignancy

• Published in: JNCI : Journal of the National Cancer Institute 2008-09, Vol.100 (17), p.1215-1222
• Main Authors: Chen, Jiping, Ruczinski, Ingo, Jorgensen, Timothy J., Yenokyan, Gayane, Yao, Yin, Alani, Rhoda, Liégeois, Nanette J., Hoffman, Sandra C., Hoffman-Bolton, Judith, Strickland, Paul T., Helzlsouer, Kathy J., Alberg, Anthony J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Carcinoma, Basal Cell - diagnosis; Carcinoma, Squamous Cell - diagnosis; Dermatology; Epidemiology; Female; Humans; Incidence; Male; Maryland - epidemiology; Medical diagnosis; Medical research; Medical sciences; Middle Aged; Multivariate Analysis; Neoplasms, Second Primary - diagnosis; Neoplasms, Second Primary - epidemiology; Prospective Studies; Regression analysis; Risk Assessment; Risk Factors; Skin cancer; Skin Neoplasms - diagnosis; Surveys and Questionnaires; Tumors; Tumors of the skin and soft tissue. Premalignant lesions
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/djn260

Background Individuals with a personal history of nonmelanoma skin cancer (NMSC) may have an increased risk of subsequent noncutaneous malignancies. To test this hypothesis, we carried out a community-based, prospective cohort study. Methods In the CLUE (Give Us a Clue to Cancer and Heart Disease) II cohort, which was established in Washington County, MD, in 1989, the risk of new malignancies was compared among individuals with (n = 769) and without (n = 18 405) a personal history of NMSC (total n = 19 174) during a 16-year follow-up period. Pathologically confirmed NMSC (and other malignancies) were ascertained from the Washington County Cancer Registry. Cox regression analysis with time-dependent covariates was used to determine the hazard ratios (presented as multivariable-adjusted relative risks [RRs]) and 95% confidence intervals (CIs) of second primary malignancies associated with a previously confirmed NMSC diagnosis. All statistical tests were two-sided. Results The crude incidence rate (per 10 000 person-years) of subsequent cancers other than NMSC among participants with a positive personal history of NMSC was 293.5 and with a negative history was 77.8. Compared with persons with no personal history of NMSC, those with such a history had a statistically significantly increased risk of being diagnosed with a subsequent cancer other than NMSC (RR = 1.99, 95% CI = 1.70 to 2.33) after adjusting for age, sex, body mass index, smoking status, and educational level. The association was observed for both basal cell carcinoma (multivariable-adjusted RR = 2.03, 95% CI = 1.70 to 2.42) and squamous cell carcinoma (multivariable-adjusted RR = 1.97, 95% CI = 1.50 to 2.59) of the skin. NMSC was a statistically significantly stronger cancer risk factor in younger age groups than in older age groups (P for interaction = .022). Conclusions This community-based, prospective cohort study provides evidence for an association between an NMSC diagnosis and an increased risk of subsequent cancer, even after adjusting for individual-level risk factors.