Nonmelanoma skin cancer and risk for subsequent malignancy.
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.
Chen
Jiping
J
Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA.
Ruczinski
Ingo
I
Jorgensen
Timothy J
TJ
Yenokyan
Gayane
G
Yao
Yin
Y
Alani
Rhoda
R
Liégeois
Nanette J
NJ
Hoffman
Sandra C
SC
Hoffman-Bolton
Judith
J
Strickland
Paul T
PT
Helzlsouer
Kathy J
KJ
Alberg
Anthony J
AJ
D000328:Adult; D000368:Aged; D002280:Basal Cell Carcinoma / Q000175:diagnosis*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000453:epidemiology*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012878:Skin Neoplasms / Q000175:diagnosis*; D011795:Surveys and Questionnaires