title: Nonmelanoma skin cancer and risk for subsequent malignancy.
abstract: 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.
authors: Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA.
authors: Jiping
authors: J
authors: Chen
authors: Ingo
authors: I
authors: Ruczinski
authors: Timothy J
authors: TJ
authors: Jorgensen
authors: Gayane
authors: G
authors: Yenokyan
authors: Yin
authors: Y
authors: Yao
authors: Rhoda
authors: R
authors: Alani
authors: Nanette J
authors: NJ
authors: Liégeois
authors: Sandra C
authors: SC
authors: Hoffman
authors: Judith
authors: J
authors: Hoffman-Bolton
authors: Paul T
authors: PT
authors: Strickland
authors: Kathy J
authors: KJ
authors: Helzlsouer
authors: Anthony J
authors: AJ
authors: Alberg
mesh_terms: 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