Sex hormones and the risk of keratinocyte cancers among women in the United States: A population‐based case–control study

• Published in: International journal of cancer 2016-07, Vol.139 (2), p.300-309
• Main Authors: Kuklinski, Lawrence F., Zens, Michael S., Perry, Ann E., Gossai, Anala, Nelson, Heather H., Karagas, Margaret R.
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Aged, 80 and over; Basal cell carcinoma; Cancer; Carcinoma, Basal Cell - epidemiology; Carcinoma, Basal Cell - etiology; Carcinoma, Basal Cell - pathology; Carcinoma, Squamous Cell - epidemiology; Carcinoma, Squamous Cell - etiology; Carcinoma, Squamous Cell - pathology; Case-Control Studies; Contraception; Contraceptives, Oral, Hormonal - adverse effects; Estrogens; Female; Gonadal Steroid Hormones - adverse effects; Gonadal Steroid Hormones - metabolism; Health risk assessment; Health risks; Hormone replacement therapy; Humans; Incidence; keratinocyte cancer; Keratinocytes - metabolism; Keratinocytes - pathology; Lesions; Medical research; Menstruation; Middle Aged; New Hampshire; Odds Ratio; oral contraception; Population studies; Population Surveillance; Population-based studies; Progestin; Risk; Risk factors; Sex hormones; Skin cancer; Skin diseases; Skin Neoplasms - epidemiology; Skin Neoplasms - etiology; Squamous cell carcinoma; Steroid hormones; Steroids; United States - epidemiology; Womens health
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.30072

Men are at a higher risk of developing both squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) than women, but there is emerging evidence that women may be experiencing greater increases in the incidence rates of these malignancies than men. One possible explanation is the expanding use of sex steroids among women, although only a few studies have examined this hypothesis. As part of a population‐based, case–control study of women in New Hampshire, USA, we sought to evaluate the risk of SCC, BCC, and early‐onset BCC in relation to exogenous and endogenous sex hormones. We found that oral contraceptive (OC) use was associated with an increased risk of SCC (OR = 1.4, 95% CI = 1.1–1.8) and BCC (OR = 1.4, 95% CI = 1.0‐1.8), particularly high estrogen dose (>50 mg) OC use. Hormone replacement therapy (HRT) use also related to SCC, with an elevated OR largely for progestin use (OR = 1.4, 95% CI = 1.1–1.8). Additionally, both OC use and combination HRT use were associated with more aggressive BCC subtypes. In contrast, menstrual and reproductive history did not appear to influence keratinocyte cancer risk in our data. Our findings provide evidence that use of sex steroids may enhance risk of keratinocyte cancer. What's new? Rates of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) appear to be rising faster in women than in men. The question is, why? In this study, the authors found that both oral contraception (OC) and hormone replacement therapy (HRT) were associated with an increased risk of these keratinocyte cancers, as well as with more aggressive subtypes of BCC. These results suggest that careful surveillance and early identification of skin lesions is especially important among women who have used synthetic sex steroids