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Prevalence and Risk Factors for Skin Cancer Revealed

Markus Schober / Elaine Fuchs, Rockefeller University

Information from a new population-based nationwide English dataset has revealed insights concerning the prevalence and risk factors for cutaneous squamous cell carcinoma (cSCC), the second most common form of skin cancer.

Prior to this point, due to a high diagnosis rate and the challenges associated with accurately accounting for multiple tumors per patient, keratinocyte cancers were seldom recorded in cancer registries. Changes made in 2013 to England's National Cancer Registration and Analysis Service (NCRAS) have enabled more accurate data analysis for primary and metastatic cSCC.

"This database is an important national milestone in the treatment of skin cancer, the UK's most common cancer," commented Nina Goad of the British Association of Dermatologists. "Previously, researchers and policy makers have been working on a puzzle without all the pieces. Now [that] they know how many cases are being treated every year, better decisions can be made about treatment, prevention, and screening. This is a real step forward."

For the study, published in JAMA Dermatology, researchers used diagnostic codes derived from pathology reports in the NCRAS to identify English patients diagnosed with their first primary cSCC between 2013 and 2015. The results revealed a total of 76,977 patients.

Data analysis showed that 62.7% of these patients were male and the median age for new cSCC patients was 80. The age-standardized rates of first primary cSCC were 77.3 per 100,000 person-years in men and 34.1 per 100,000 person-years in women.

The risk of primary cSCC was increased by a number of factors. Age played a role, with those aged 80 to 89 experiencing a 1.23 times increased risk and those aged 90 or older experiencing a 1.35 times higher risk. Men experienced a 1.79 times greater risk, individuals who were immunosuppressed had a 1.99 times increased risk, and individuals residing in areas with the greatest degree of socioeconomic deprivation experienced a 1.64 times higher risk. However, the rate of primary cSCC was also greater in older, white male patients residing in areas with less socioeconomic deprivation.

During a follow-up period lasting a maximum of 36 months, 2.4% of men and 1.1% of women with cSCC developed metastasis. The researchers found that primary cSCCs located on the ear and lip were at highest risk of metastasis, with 1.7 times and 1.85 times increased risks, respectively.

"Due to their frequency, the healthcare burden of squamous cell carcinoma is substantial, with high-risk patients requiring at least two to five years clinical follow-up after treatment and patients often developing multiple tumors," stated Irene Leigh, MD, DSc, Professor Emeritus at the University of Dundee School of Medicine and senior author of the study. "With poor three-year survival once cSCC has metastasized, earlier identification of these high-risk patients and improved treatment options are vital."

This dataset concerning the incidence of cSCC cases in England is the first from the NCRAS skin cancer database. More results will be published soon.

For More Information

Venables ZC, Autier P, Nijsten T, et al (2018). Nationwide incidence of metastatic cutaneous squamous cell carcinoma in England. JAMA Dermatol. [Epub ahead of print] DOI:10.1001/jamadermatol.2018.4219

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