The multicentre south European study 'Helios'. I: Skin characteristics and sunburns in basal cell and squamous cell carcinomas of the skin

R Zanetti,S Franceschi,R Laurent,Mj Tormo,J Wechsler,E Perea,H Sancho-Garnier,C Schrameck,C Navarro,R Tumino,M Cristofolini,L Gafà,S Rosso,C Martinez,S Schraub

doi:10.1038/bjc.1996.274

Abstract

The aim of this study was to investigate constitutional and environmental determinants of non-melanocytic skin cancer among different populations from south Europe. Between 1989 and 1993 we interviewed incident cases and a random population sample of controls from five centres where a cancer registry was operating, whereas we selected a sample of hospital-based cases and controls from three other centres. Controls were stratified according to the age and sex distribution of cases. In all, 1549 cases of basal cell carcinoma (BCC), 228 of squamous cell carcinoma (SCC) and 1795 controls were interviewed. Both cancers affected primarily sun-exposed sites such as face, head and neck, but the prevalence of BCC on the trunk was higher than for SCC. Pigmentary traits such as hair and eye colour as well as tendency to sunburn were strong and independent indicators of risk for both BCC and SCC. In SCC, adjusted odds ratios (ORs) ranged from 1.6 for fair hair colour to 12.5 for red hair. Light-blonde hair entailed a risk of about 2 for BCC. Pale eye colour was associated with a risk of 1.8 for SCC and 1.4 for BCC. Subjects who always burn and never tan showed an adjusted OR of 2.7 for BCC and 2.0 for SCC. A history of sunburns and a young age at first sunburn were associated with an increased risk for BCC only (OR 1.7). Pigmentary traits and sun sensitivity of the skin confirmed their role as risk indicators. The effect of sunburns, as an indicator of both exposure and sun sensitivity of the skin, is less clear. Nevertheless, its association with BCC suggests, by analogy with melanoma, a relationship with intense sun exposure. Conversely, SCC would require prolonged exposure to sunlight.

Highlights

Non-melanocytic skin cancer is one of the commonest tumours in white populations
Between 1989 and 1993 we interviewed incident cases and a random population sample of controls from five centres where a cancer registry was operating, whereas we selected a sample of hospital-based cases and controls from three other centres
Controls were stratified according to the age and sex distribution of cases

Summary

Introduction

Non-melanocytic skin cancer is one of the commonest tumours in white populations. Standardised incidence rates in men, as measured by cancer registries in the late 1980s, ranged from about 40 cases per 100 000 in various European countries, to 100 and 200 cases per 100 000 respectively in North America and Australia (Parkin et al, 1992). It is generally believed that incidence rates, as reported by cancer registries, are underestimated, because current notification systems miss some cases diagnosed and treated only as outpatients. Two surveys carried out in Australia, the highest risk area worldwide, found annual incidence rates to be over 1000 cases for 100 000 inhabitants (Kricker et al, 1990; Stenbeck et al, 1990)

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