title: Sex hormones and the risk of keratinocyte cancers among women in the United States: A population-based case-control study.
abstract: 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.
authors.affiliation: Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Lawrence F
authors.initials: LF
authors.lastname: Kuklinski
authors.affiliation: Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Zens
authors.affiliation: Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Perry
authors.affiliation: Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Anala
authors.initials: A
authors.lastname: Gossai
authors.affiliation: Division of Epidemiology and Community Health, Masonic Cancer Center, University of Minnesota, Minneapolis, MN.
authors.forename: Heather H
authors.initials: HH
authors.lastname: Nelson
authors.affiliation: Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Karagas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D016022:Case-Control Studies; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects; D005260:Female; D012739:Gonadal Steroid Hormones / Q000009:adverse effects* / Q000378:metabolism; D006801:Humans; D015994:Incidence; D015603:Keratinocytes / Q000378:metabolism / Q000473:pathology*; D008875:Middle Aged; D009513:New Hampshire; D016017:Odds Ratio; D011159:Population Surveillance; D012306:Risk; D012878:Skin Neoplasms / Q000453:epidemiology / Q000209:etiology; D014481:United States / Q000453:epidemiology
chemical_list: D003278:Contraceptives, Oral, Hormonal; D012739:Gonadal Steroid Hormones
keywords: hormone replacement therapy; keratinocyte cancer; oral contraception; sex hormones