title: Relation of statin use with non-melanoma skin cancer: prospective results from the Women's Health Initiative.
abstract: BACKGROUND
  The relationship between statin use and non-melanoma skin cancer (NMSC) is unclear with conflicting findings in literature. Data from the Women's Health Initiative (WHI) Observational Study and WHI Clinical Trial were used to investigate the prospective relationship between statin use and NMSC in non-Hispanic white (NHW) postmenopausal women.
  
  
  METHODS
  The WHI study enrolled women aged 50-79 years at 40 US centres. Among 133,541 NHW participants, 118,357 with no cancer history at baseline and complete medication/covariate data comprised the analytic cohort. The association of statin use (baseline, overall as a time-varying variable, duration, type, potency, lipophilicity) and NMSC incidence was determined using random-effects logistic regression models.
  
  
  RESULTS
  Over a mean of 10.5 years of follow-up, we identified 11,555 NMSC cases. Compared with participants with no statin use, use of any statin at baseline was associated with significantly increased NMSC incidence (adjusted odds ratio (ORadj) 1.21; 95% confidence interval (CI): 1.07-1.35)). In particular, lovastatin (OR 1.52; 95% CI: 1.08-2.16), simvastatin (OR 1.38; 95% CI: 1.12-1.69), and lipophilic statins (OR 1.39; 95% CI: 1.18-1.64) were associated with higher NMSC risk. Low and high, but not medium, potency statins were associated with higher NMSC risk. No significant effect modification of the statin-NMSC relationship was found for age, BMI, smoking, solar irradiation, vitamin D use, and skin cancer history.
  
  
  CONCLUSIONS
  Use of statins, particularly lipophilic statins, was associated with increased NMSC risk in postmenopausal white women in the WHI cohort. The lack of duration-effect relationship points to possible residual confounding. Additional prospective research should further investigate this relationship.
authors.affiliation: Department of Dermatology, Stanford University School of Medicine, 450 Broadway Street, Pavilion B, 4th Floor MC 5338, Redwood City, CA 94063, USA.
authors.forename: Ange
authors.initials: A
authors.lastname: Wang
authors.affiliation: Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
authors.affiliation: Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Kapphahn
authors.affiliation: Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Haley
authors.initials: H
authors.lastname: Hedlin
authors.affiliation: Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Manisha
authors.initials: M
authors.lastname: Desai
authors.affiliation: Department of Epidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Jo Ann E
authors.initials: JA
authors.lastname: Manson
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Strickler
authors.affiliation: Department of Medicine, George Washington University, Washington, DC, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Martin
authors.affiliation: Department of Social and Preventive Medicine, University at Buffalo, Buffalo, NY, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
authors.affiliation: Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Simon
authors.affiliation: Department of Dermatology, Stanford University School of Medicine, 450 Broadway Street, Pavilion B, 4th Floor MC 5338, Redwood City, CA 94063, USA.
authors.forename: Jean Y
authors.initials: JY
authors.lastname: Tang
mesh_terms: D000367:Age Factors; D000368:Aged; D002280:Basal Cell Carcinoma / Q000139:chemically induced* / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000139:chemically induced* / Q000453:epidemiology; D015331:Cohort Studies; D004781:Environmental Exposure / Q000706:statistics & numerical data; D005229:Fatty Acids, Monounsaturated / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D000077340:Fluvastatin; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D007211:Indoles / Q000009:adverse effects / Q000627:therapeutic use; D016015:Logistic Models; D008137:Longitudinal Studies; D008148:Lovastatin / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology; D011446:Prospective Studies; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D019821:Simvastatin / Q000009:adverse effects / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D013472:Sunlight; D014807:Vitamin D / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D005229:Fatty Acids, Monounsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D011725:Pyridines; D014815:Vitamins; D014807:Vitamin D; D000077340:Fluvastatin; D008148:Lovastatin; D019821:Simvastatin; C086276:cerivastatin