Known and potential new risk factors for skin cancer in European populations: a multicentre case-control study

Drug-induced photosensitivity

Drug-induced photosensitivity is common. The principal mechanism of systemic drug photosensitivity is phototoxicity and the principal mechanism of topical drug photosensitivity is photoallergy. Photopatch testing is helpful to determine suspected topical agent photoallergies (eg, from ultraviolet filters in sunscreens) but generally not helpful in detecting systemic drug photosensitivity. Drug-induced photosensitivity is usually best managed by stopping the suspected drug. Other measures, including phototherapy using wavelengths that do not elicit the response, are sometimes necessary.

Nonsteroidal anti-inflammatory drugs and the risk of nonmelanoma skin cancer

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been assigned a promising role in the chemoprevention of various malignancies. However, epidemiological data on the association between NSAID use and nonmelanoma skin cancer (NMSC) are limited. To explore whether patients regularly exposed to systemic NSAIDs are at a reduced risk of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC), we conducted a population-based case-control analysis using the Clinical Practice Research Datalink, a United Kingdom primary care database. We identified 65,398 patients with incident BCC and 7,864 patients with incident SCC diagnosed between 1995 and 2013 and matched 1 and 4 NMSC-free controls to each BCC and SCC case, respectively, on age, sex, general practice, calendar time and years of history in the database. We compared prior NSAID exposure between cases and controls using multivariate conditional logistic regression analyses controlling for several potential confounders. Overall, we found no association between NSAID use and BCC, but when looking exclusively at users of single NSAID substances there was a suggestion of a reduced BCC risk in regular users of aspirin and ibuprofen (adjusted odds ratio [adj. OR]: 0.92, 95% confidence interval [CI]: 0.85-0.99 and adj. OR: 0.61, 95% CI: 0.48-0.78, respectively). The risk of SCC was slightly decreased in regular users of any NSAIDs (adj. OR: 0.89, 95% CI: 0.82-0.97), with the strongest risk reduction observed in current users of coxibs (adj. OR: 0.77, 95% CI: 0.62-0.95). These findings provide evidence that patients predisposed to NMSC might benefit from chemoprevention with NSAIDs.

Social correlates of total cancer in adults and the very old: UK Understanding Society Cohort, 2009-2010

OBJECTIVE

Understanding of the social determinants of cancer in adults and the very old is still limited. The aim of this study was to provide recent evidence on the social correlates of adult total cancer in a national and population-based setting.

STUDY DESIGN

A cross-sectional study in the recent years between 2009 and 2010.

METHOD

Data was retrieved and analysed from the UK Longitudinal Household Survey. Information on demographics, living and work conditions, self-reported cancer and age of onset was obtained by household interview. Analyses included Chi-squared test, t-test, and multilevel logistic regression modelling.

RESULTS

Of 50,994 people included in the cohort, 1623 (3.5%) had ever cancer. Of these, 1592 (98.0%) occurred in adulthood (16y+) and only 109 people had their first cancer (incident cancer) at the age when they were interviewed. In the middle-aged and young adults, being female (OR 1.57, 95%CI 1.20-2.06, P = 0.001 and OR 2.04, 95%CI 1.07-3.87, P = 0.03, respectively), not born in the UK (OR 0.54, 95%CI 0.34-0.88, P = 0.01 and OR 0.31, 95%CI 0.09-1.02, P = 0.05, respectively), and being obese/overweight (OR 1.49, 95%CI 1.07-2.07, P = 0.02 and OR 2.34, 95%CI 1.17-4.66, P = 0.02, respectively) were associated with total cancer. However, no associated social factors of cancer in the very old were found. Moreover, prevalence was higher in East Midlands (OR 1.73, 95%CI 1.00-3.00, P = 0.05) but not other regions, compared to London region.

CONCLUSION

Social environment seems to continue playing a role in the aetiology of cancer in adults, although novel and/or pooled investigation for the very old would be warranted.

Influence on longevity of blueberry, cinnamon, green and black tea, pomegranate, sesame, curcumin, morin, pycnogenol, quercetin, and taxifolin fed iso-calorically to long-lived, F1 hybrid mice

Phytonutrients reportedly extend the life span of Caenorhabditis elegans, Drosophila, and mice. We tested extracts of blueberry, pomegranate, green and black tea, cinnamon, sesame, and French maritime pine bark (Pycnogenol and taxifolin), as well as curcumin, morin, and quercetin for their effects on the life span of mice. While many of these phytonutrients reportedly extend the life span of model organisms, we found no significant effect on the life span of male F1 hybrid mice, even though the dosages used reportedly produce defined therapeutic end points in mice. The compounds were fed beginning at 12 months of age. The control and treatment groups were iso-caloric with respect to one another. A 40% calorically restricted and other groups not reported here did experience life span extension. Body weights were un-changed relative to controls for all but two supplemented groups, indicating most supplements did not change energy absorption or utilization. Tea extracts with morin decreased weight, whereas quercetin, taxifolin, and Pycnogenol together increased weight. These changes may be due to altered locomotion or fatty acid biosynthesis. Published reports of murine life span extension using curcumin or tea components may have resulted from induced caloric restriction. Together, our results do not support the idea that isolated phytonutrient anti-oxidants and anti-inflammatories are potential longevity therapeutics, even though consumption of whole fruits and vegetables is associated with enhanced health span and life span.

Occupational UV exposure of environmental agents in Valencia, Spain

Excessive exposure to ultraviolet radiation (UVR) is considered the most important environmental risk factor in the development of melanoma and skin cancer. Outdoor workers are among those with the highest risk from exposure to solar UVR, as their daily activities constantly expose them to this radiation source. A study was carried out in Valencia, Spain, in summer 2012 and involved a group of 11 workers for a period of six 2-day recordings. Sensitive spore-film filter-type personal dosimeters (VioSpor) were used to measure erythemal UVR received by environmental agents in the course of their daily work. Median 2-day UV exposure was 6.2 standard erythema dose (SED), with 1 SED defined as effective 100 J m(-2) when weighted with the Commission Internationale de L'Eclairage's (CIE) erythemal response function. These workers were found to receive a median of 8.3% total daily ambient ultraviolet erythemal radiation. Comparison with the occupational UV exposure limit showed that the subjects had received an erythemal UV dose in excess of occupational guidelines, indicating that protective measures against this risk are highly advisable.

Emerging trends in the epidemiology of melanoma

Cutaneous melanoma (CM) is one of the most rapidly growing cancers worldwide, with a consistent increase in incidence among white populations over the past four decades. Despite the early detection of primarily thin melanomas and the improved survival rates observed in several countries, the rate of thick melanomas has remained constant or continues to increase, especially in the older age group. Current considerations in the epidemiology of melanoma focus on the observed survival benefit of females vs. males, the contributing role of indoor tanning in melanoma risk and the diverse effect of sun exposure in the development of different types of melanoma with respect to their clinical and mutational profile. Certain well-known risk factors, such as skin, hair and eye pigmentation and melanocytic naevi have been validated in large-scale association studies, while additional lifestyle factors and iatrogenic exposures, such as immunosuppressive agents and nonsteroidal anti-inflammatory drugs are being investigated. In addition, genome-wide association studies have revealed genetic loci that underlie the genetic susceptibility of melanoma, some of which are related to known risk factors. Recently, an interesting association of melanoma with Parkinson disease has been noted, with a higher than expected frequency of melanoma in patients with Parkinson disease and vice versa. This review article provides an update in the epidemiology of cutaneous melanoma and discusses recent developments in the field.

Photosensitizing agents and the risk of non-melanoma skin cancer: a population-based case-control study

Robinson et al. report a population-based case-control study to examine the association between a history of photosensitizing medication use and non-melanoma skin cancer. They report an increased risk of basal cell carcinoma with tetracycline use and of squamous cell carcinoma with diuretic use. Appropriate counseling regarding sun exposure may reduce skin cancer in patients exposed to these medications.

Potential impact of interventions resulting in reduced exposure to ultraviolet (UV) radiation (UVA and UVB) on skin cancer incidence in four European countries, 2010-2050

BACKGROUND

Behavioural interventions to reduce exposure to ultraviolet radiation (UVR) can reduce risk of skin cancer.

OBJECTIVES

To integrate the data and to evaluate the impact of interventions to limit exposure to UVR on skin cancer incidence in four selected countries.

METHODS

Using PREVENT, a dynamic simulation model, we modelled the potential for skin cancer prevention in four European countries under various scenarios to avoid damage by UVR.

RESULTS

In general, the most effective interventions were those aimed at protecting people during outdoor work and outdoor hobbies against the harmful effects of UVR, and combinations of several interventions. These could in theory lead to reductions of up to 45% in skin cancer cases projected for the year 2050.

CONCLUSIONS

The scope for prevention depends on the prevalence of the risk factors in the different countries, as well as the associated risk factors and time lags modelled.