title: Risk of second primary cancer associated with pre-diagnostic smoking, alcohol, and obesity in women with keratinocyte carcinoma.
abstract: Keratinocyte carcinoma (KC), which includes basal-cell carcinoma (BCC) and squamous-cell cancer (SCC), has been associated with an increased risk of second primary cancers (SPCs), although the reason for this increase is unknown. We assessed the effects of smoking, alcohol, and obesity prior to the diagnosis of KC on the development of SPCs, as these are well-established risk factors for multiple cancers and may also contribute to the increased risk of SPCs among those with KC. A total of 15,628 women with self-reported KC were identified in the Nurses' Health Study. Incident SPCs were assessed throughout the follow-up until June 2012. Cox proportional hazards models were used to calculate the hazard ratios (HRs) of SPC associated with pre-diagnostic smoking, alcohol and body mass index (BMI). We also compared these risk estimates to those for first cancers in all cohort participants. During 193,695 person-years of follow-up, we recorded 2839 SPC cases. Compared with never smokers, current smokers had a significantly elevated risk for SPC overall and specifically for lung, colorectal, and bladder cancers. We also found a positive association between higher BMI and risk for SPC overall as well as for endometrial and bladder SPCs. Women with KC who consumed alcohol ≥30g/day had a marginally higher risk of SPC compared to non-drinkers. The associations between incident SPC risk among KC cases and smoking, alcohol, and obesity appeared similar to the associations between these risk factors and the incident first primary cancers in the whole cohort. Only in the heavy smoking (≥25 cigarettes/day) category was the HR for SPC after KC (2.34; 95% CI 1.98-2.76) slightly higher than that for the first cancer in the overall cohort (HR 1.86; 95% CI 1.75-1.98, Pheterogeneity=0.01). In conclusion, pre-diagnostic smoking, alcohol and obesity prior to KC diagnosis were associated with risk of SPCs.
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Department of Family Medicine & Department of Biomedical Sciences, Seoul National University College of Medicine, Republic of Korea.
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Park
authors.affiliation: Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA.
authors.forename: Tricia
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA; Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China.
authors.forename: Shaowei
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA; Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02903, USA.
authors.forename: Wen-Qing
authors.initials: WQ
authors.lastname: Li
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA; Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02903, USA.
authors.forename: Abrar A
authors.initials: AA
authors.lastname: Qureshi
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Meir
authors.initials: M
authors.lastname: Stampfer
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA; Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02903, USA. Electronic address: eunyoung_cho@brown.edu.
authors.forename: Eunyoung
authors.initials: E
authors.lastname: Cho
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects*; D015992:Body Mass Index; D002280:Basal Cell Carcinoma / Q000150:complications* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D015603:Keratinocytes / Q000473:pathology*; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000209:etiology* / Q000473:pathology; D009765:Obesity / Q000150:complications*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000150:complications* / Q000473:pathology; D012907:Smoking / Q000009:adverse effects*
keywords: Alcohol; Body mass index; Keratinocyte carcinoma; Second primary cancer; Smoking