Nonmelanoma Skin Cancer Mortality Research Articles

A prospective cohort analysis of residential radon and UV exposures and malignant melanoma mortality in the Swiss population.

Radon is a radioactive noble gas naturally found in the earth crust that can accumulate in buildings. In addition to lung cancer, alpha particles emitted by radon may contribute to the risk of skin cancer. We evaluated the association between residential radon exposure and skin cancer mortality, over a fifteen year period, taking residential ultra-violet (UV) exposure into account. We included 4.9 million adults from the Swiss National Cohort. Hazard ratios for melanoma mortality were estimated using Cox proportional hazard models (20+ years old; follow-up 2001-2015). Long-term modelled residential radon and ambient UV exposures were assigned at baseline, and included together in the Cox models. With age as a time scale, models were adjusted for calendar time, sex, marital status, education, mother tongue, socioeconomic position, and occupational environment with potential for UV exposure. Age specific hazard ratios were derived. Effect modification, sensitivity analyses and the shape of the exposure response, as well as secondary analysis using other outcome definitions, were investigated. During follow-up (average of 13.6 years), 3,979 melanoma deaths were observed. Associations declined with age, with an adjusted hazard ratio per 100 Bq/m3 radon at age 60 of 1.10 (95% CI: 0.99, 1.23). The dose-response showed an approximate linear trend between the minimum and mean radon exposure of 75 Bq/m3. Having outdoor occupation significantly increased the risk of melanoma mortality associated with UV exposure compared to indoor jobs. Analysis restricted to the last five years of follow-up showed similar results compared to the main analysis. Similar associations were found for mortality from melanoma and non-melanoma skin cancer combined. With double the follow-up time, this study confirmed the previously observed association between residential radon exposure and melanoma and non-melanoma skin cancer mortality in Switzerland. Accumulation of radon indoors is preventable and of public health importance.

Trends in non-Melanoma Skin Cancer Mortality in Brazil and its Macroregions

Introduction: Non-melanoma skin cancer (NMSC) is the most common among all malignancies. Objective: To describe trends in NMSC mortality rates in Brazil and its macroregions from 2001 to 2018. Method: Adjusted mortality rates stratified by sex were estimated and presented per 100,000 person-years. An autoregressive analysis was implemented to assess temporal trends, annual percent change (APC) and 95% Confidence Intervals (95% CI). Results: There were 27,550 NMSC deaths in Brazil with higher frequency in males (58.1%) and among individuals aged ≥70 years (64.3%). The overall rates were 2.25 (males) and 1.22 (females) per 100,000 person-years. The trends followed an upward direction in Brazil for males (APC: 2.91%; 95% CI: 1.96%; 3.86%) and females (APC: 3.51%; 95% CI: 2.68%; 4.34%). The same occurred in the North Region, in males (APC: 9.75%; 95% CI: 7.68%; 11.86%) and in females (APC: 10.38; 95% CI: 5.77%; 15.21%), as well as in Northeast Region, in males (APC: 9.98%; 95% CI: 5.59%; 14.57%) and in females (APC: 8.34%; 95% CI: 3.29%; 13.64%). Conclusion: NMSC deaths are not rare in Brazil. Upward mortality trends were observed for the whole country and in the North and Northeast regions, which are the closest to the Equator line and also the least developed socioeconomically. A synergism between different types of inequalities and environmental exposure in these macroregions may be promoting an increase in the number of NMSC deaths, a type of cancer which is considered completely preventable.

Non-Melanoma Skin Cancer Mortality in Spain: A Predictive Model up to 2044.

Non-melanoma skin cancers (NMSC) are the most common malignancies worldwide and are, worryingly, increasing in incidence. However, data in the literature on NMSC specific mortality are scarce, because these tumors are excluded from most mortality registries. The main objective of this study is to analyze NMSC’s mortality rates and use them to generate a predictive model for the coming years in Spain. Data on mid-year population and death certificates for the period 1979–2019 were obtained from the Spanish National Statistics Institute. The Nordpred program (Cancer Registry of Norway, Oslo, Norway) within statistical program R was used to calculate mortality adjusted rates, as well as the mortality projection with an age-period-cohort model. This is the first study to report a prediction about NMSC mortality in the next years. According to our findings, the number of NMSC deaths in older people will grow in both sexes, especially in those older than >85 years old (y.o.). The age-specific mortality rates of NMSC will tend to stabilize or gradually decrease, with the exception of women between 75–79 y.o., who will present a slight increase at the end of the period. Early prevention and screening of NMSC specifically oriented to this population might change this tendency.

Non-Melanoma Skin Cancer Distribution in the Russian Federation

Background: Non-melanoma skin cancer (NMSC) incidence has been increasing steadily around the world. The aim of the study is to describe geographic trends in incidence and mortality of NMSC in Russia between 2007 and 2017 and compare findings to other European countries. Methods: We used geospatial analysis to map the incident cases and descriptive statistical analysis to analyze trends. Additionally, we assessed the relationship between ethnicity, geographic latitude/longitude, and NMSC incidence/mortality rates. We retrospectively analyzed the data from the Moscow Oncology Research Institute, Ministry of Health of the Russian Federation, for 2007–2017. Routine methods of descriptive epidemiology were used to study incidence and mortality rates by age groups, years, and jurisdictions (i.e., Federal Districts and Federal Subjects). Results: In total, 733,723 patients were diagnosed with NMSC in Russia over the period 2007–2017, of whom 63% were women. The overall age-standardized incidence and mortality rates were 29.64/100,000 and 0.70/100,000, respectively. There was a consistent increase in age-standardized incidence rates over the study period, with a decreasing mortality rate. Geographic mapping revealed north-to-south and east-to-west gradients for NMSC. Conclusions: This study demonstrated longitudinal trends for NMSC incidence in Russia documenting that skin phototype, latitude/longitude, climate zones, and cultural practices remain dominant risk factors defining the epidemiology of NMSC. Moreover, this work identified several regions in the country (i.e., Republic of Adygea, Samara, Krasnodar Krai, etc.), where patient education/sun awareness campaigns will be useful to help reduce the risk of this malignancy.

Solar ultraviolet A radiation and nonmelanoma skin cancer in Arica, Chile

In this work, we present the maximum daily values of solar ultraviolet A radiation (UV-A) as a function of time. The results indicated that such values reached a maximum of 93.9 W/m2 in 2010 and a minimum of 16.5 W/m2 in 2012. The annual averages of both UV-A and solar ultraviolet B radiation (UV-B) from 2007 to 2013 were recorded. UV-A was always higher than UV-B. However, UV-B is more energetic due to its intrinsic wavelength. The nonmelanoma skin cancer mortality incidences per 100,000 inhabitants in Arica and in Chile as a function of time between 2007 and 2013 indicated that these mortality rates varied from 3.12 (Arica) to 0.88 (Chile) in 2007 and 2.71 (Arica) to 0.88 (Chile) in 2013. The nonmelanoma skin cancer prevalence rates per 100,000 inhabitants in Arica were 22.2 in 2007 and 19.5 in 2013. The relationship between NMSC and exposure to UV-A is given. In Arica, we report high levels of UV-A and the highest NMSC rates compared with other regions in our country.

Accuracy of death certification in cutaneous squamous cell carcinoma: A retrospective case review

Accuracy of death certification in cutaneous squamous cell carcinoma: A retrospective case review

Incidence, Mortality, and Trends of Nonmelanoma Skin Cancer in Germany

Increasing incidence rates (IRs) of nonmelanoma skin cancer (NMSC) in white populations have been described worldwide. Cancer registry data from the Saarland and Schleswig-Holstein federal states were used to analyze incidence and mortality trends in Germany. Age-standardized rates were compared with crude rates to assess disease burden. Joinpoint regression models were used to estimate annual percentage changes and 95% confidence intervals, allowing us to assess temporal trends between 1970 and 2012. Incidence predictions until 2030 were based on age-period-cohort models and linear extrapolation techniques. In the Saarland federal state, between 1970 and 2012, NMSC age-standardized and crude IRs increased 10- to 22-fold, respectively. In Schleswig-Holstein, between 1999 and 2012 crude IRs doubled, reaching 250 cases/100,000 persons per year in 2012, with age-standardized IRs increasing 1.5-fold. During this period, NMSC mortality remained stable or decreased. For 2030, the predicted age-standardized IRs are as follows: males, 230 cases; females, 180-200 cases. The predicted crude IRs for the same year are males, 450-500 cases; females, 380-430 cases. There is a continuous long-term increase of NMSC incidence with no tendency for leveling off. By 2030, the current NMSC IR in Germany is expected to double.

An ecological study of cancer mortality rates in California, 1950–64, with respect to solar UVB and smoking indices

<u>Purpose:</u> This paper addresses whether nonmelanoma skin cancer (NMSC) mortality rates can serve as a useful index of population ultraviolet-B (UVB) irradiance and vitamin D production in a manner that affects the risk of internal cancers <u>Methods:</u> This analysis uses the ecological study approach with cancer mortality rate data from 19 state economic areas in California. This paper uses age-adjusted data for those aged 40 y or older. Two additional indices for solar UVB doses were also used: latitude and surface UVB doses for July 1992 from the total ozone mapping spectrometer. Lung cancer mortality rates served as the index of the health effects of smoking<u>Results:</u> Significant inverse correlations with NMSC mortality rate in multiple linear regression analyses were found during the period 1950–64 for eight types of cancer for males: bladder, brain, colon, gastric, prostate, and rectal cancer; multiple myeloma; and non-Hodgkin lymphoma. No similar results emerged for females with respect to all three UVB indices. Their NMSC mortality rates averaged 60% lower than those for males. Lung cancer mortality rates were directly correlated with three types of cancer for males: laryngeal, oral, and renal. No significant correlations with NMSC mortality rates appeared for later periods<u>Conclusions:</u> NMSC mortality rates were found inversely correlated with internal cancers for males in the period 1950–64. After that period, no further such correlations were found. The reasons may hypothetically include reduced NMSC mortality rates, high immigration rates, movement from rural to urban locations and reduced solar UVB irradiance.

Trends of cutaneous squamous cell carcinoma in the Netherlands: Increased incidence rates, but stable relative survival and mortality 1989–2008

BackgroundIncidence rates of cutaneous squamous cell carcinoma (SCC) are increasing in many countries, though detailed information is scarce. ObjectivesTo describe detailed trends in incidence rates, relative survival and estimate mortality rates of SCC in the Netherlands. MethodsInformation on newly diagnosed SCC patients between 1989 and 2008 was obtained from the Netherlands Cancer Registry (NCR). Information of non-melanoma skin cancer (NMSC) mortality was obtained from Statistics Netherlands. European Standardised Rates (ESR) and Estimated Annual Percentage Change (EAPC) were calculated. Incidence rates were fitted to two different models and predicted by the best fitted model. Cohort-based and multivariate survival analyses were performed to assess changes over time. ResultsThe ESR increased from 22.2 to 35.4 per 100,000 inhabitants for males and from 7.8 to 20.5 for females. The EAPC was 6.9% (95% confidence interval: 5.8–8.7) for males and 9.2% (95%CI: 7.5–11.0) for females. Incidence rates increased for all body sites, except for the lips, where a decreasing trend for males was observed. The predicted ESR in 2020 is 46.9 per 100,000 inhabitants for males and 28.7 for females. The 5-year relative survival rate was 92.0% (95%CI: 91.3–92.8) for males and 94.9% (95%CI: 94.0–95.7) for females and remained stable over time. Overall relative survival was better for females, but females with advanced disease had a 30.4 relative excess risk of dying compared to those in stage I. This difference was 9.9 for men. The estimated mortality rate decreased with –1.9% (95%CI: –3.1% to –0.7%) annually. ConclusionsIncidence rates of SCC increased rapidly. Relative survival was high, as most SCCs were diagnosed in stage I. Nevertheless, the number of newly diagnosed patients may exceed 11,000 by 2020, emphasising the need to improve methods to prevent skin cancer.

Benefits Outweigh Risks

The recent review of vitamin D for cancer prevention (1) was based on the IARC review [Ref. 6 in (1)]. My critical review of the IARC review pointed out that the evidence for beneficial effects of solar UVB and vitamin D was much stronger than concluded in the review (2). Ecological studies (epidemiological studies researching disease outcome and risk-modifying factors averaged by geographical region) are better for studying the effects of UVB and vitamin D in reducing the risk of cancer than observational studies and randomized controlled trials (RCTs) for several reasons: solar UVB is the primary source of vitamin D for most people there is a long lag time between cancer initiation and detection or death RCTs and observational studies often use too little vitamin D too short a time period, and too few people. An ecological study for Spain illustrates this. The two factors used for vitamin D were nonmelanoma skin cancer (NMSC) mortality rate and latitude, for 48 provinces. NMSC was inversely correlated and/or latitude directly correlated with mortality rates for 15 types of cancer after adjustment for lung cancer mortality rates, included to account for the effect of smoking (3). Death rates were much higher for internal cancers than for NMSC.

On the Relation Between Non-melanoma Skin Cancer and All-cause Mortality Rates

The paper by Jensen et al. (1) reported a 9% [95% con-fidence interval (CI) 7–11%] reduction in mortality rate for patients with basal cell carcinoma (BCC), but a 54% (95% CI, 41–68%) increase for patients with cutaneous squamous cell carcinoma. Smoking is a risk factor for SCC, but not BCC [Ref. 3 in (1)]. Alcohol and tobacco consumption rates are much higher in Denmark than in Sweden. Based on death rates for categories of disease related to alcohol and tobacco, it is estimated that alcohol and smoking account for almost the entire difference between Danish and Swedish men and for 75% of the difference between Danish and Swedish women (2). The role of smoking in the risk of a second cancer after development of non-melanoma skin cancer (NMSC) has been reviewed (3).Further evidence that long-term higher serum 25- hydroxyvitamin D levels are associated with incidence of BCC is provided by a study of cancer cases listed in the Rhineland-Palatinate cancer registry in Germany (4). Those living in the winegrowing regions had a hig-her incidence of NMSC and malignant melanoma but significantly lower risk of vitamin D-sensitive cancers, including those of the stomach, colon, rectum, lung and ovary (5). A similar result was found in Spain, where mortality rates for 15 types of cancer were found to be inversely correlated with NMSC mortality rates (6). While more research is required to more fully under-stand the findings, they add to the evidence supporting the hypothesis that solar ultraviolet irradiance is more beneficial than harmful. In addition to cancer (5), vitamin D reduces the risk of cardiovascular disease and diabetes (7), as well as infectious diseases (8). It has been estimated that a doubling of solar ultraviolet-B irradiance and serum 25-hydroxyvitamin D concentrations in Denmark would reduce the all-cause mortality by 17% (9).

Increased Skin Cancer Mortality in Chile Beyond the Effect of Ageing: Temporal Analysis 1990 to 2005

Chile has a medium-to-high skin cancer mortality rate. Previous studies have shown an increasing rate of skin cancer mortality. We evaluated skin cancer mortality characteristics and their temporal evolution in Chile from 1990 to 2005 in a mixed ecological study using death certificate databases. Age, sex, year and region of residence were obtained for melanoma and non-melanoma deaths. Crude and age-sex-adjusted rates were calculated using the national projections and WHO 2000 standard population data. Descriptive and temporal analyses, using a Prais-Winsten regression, were computed. A total of 3588 deaths were registered, of which 55% were melanoma and 54% occurred in men (median age 71 years; women were older). The adjusted rate was 1.75 deaths per 100,000 inhabitants (2.22 in men vs. 1.39 in women). Melanoma skin cancer and non-melanoma skin cancer mortality had a tendency to increase. In conclusion, skin cancer mortality is rising beyond the rate predicted by ageing. An increased incidence due to changes in modifiable factors, such as exposure to ultraviolet radiation and arsenic, might explain the increase in skin cancer mortality.

Non-melanoma Skin Cancer and Ten-year All-cause Mortality: A Population-based Cohort Study

Confounding from comorbidity and socioeconomic status may have biased earlier findings of all-cause mortality among patients with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). We therefore examined all-cause mortality among 72,295 Danish patients with BCC, 11,601 with SCC, and 383,714 age- and gender-matched population control cohort subjects with extensive control for comorbidity and socioeconomic status. Data on cancer, death, and socioeconomic status were obtained from medical databases and Statistics Denmark. We analysed data using Cox regression analysis, with estimation of 10-year mortality rate ratios (MRRs) and 95% confidence intervals (CI). Mortality was reduced among patients with BCC (10-year MRR = 0.91 (95% CI: 0.89-0.92) and did not vary by age, comorbidity, or socioeconomic status. Mortality among patients with SCC was increased and varied by age, selected chronic diseases, but not socioeconomic status. The reduced mortality observed among patients with BCC and the increased mortality among patients with SCC persisted even after extensive control for comorbidity and socioeconomic status.

In defense of the sun: An estimate of changes in mortality rates in the United States if mean serum 25-hydroxyvitamin D levels were raised to 45 ng/mL by solar ultraviolet-B irradiance.

Emerging scientific evidence strongly supports the beneficial role of vitamin D in reducing the risk of incidence and death from many chronic and infectious diseases. This study estimates increases in melanoma and nonmelanoma skin cancer mortality rates and decreases in chronic and infectious disease mortality rates in the US from the standpoint of approximately doubling population doses of solar UVB to increase mean serum 25-hydroxyvitamin D levels from 16 ng/mL for black Americans and 25 ng/mL for white Americans to 45 ng/mL. The primary benefits are expected to come from reductions in cancer and cardiovascular diseases. Although a few thousand excess deaths per year might occur from melanoma and skin cancer, the avoided premature death rate could be near 400,000/ year, with most of the avoided deaths coming late in life. While oral sources of vitamin D could be used instead of UVB or when UVB irradiance is not available, public health policies do not yet recommend the 3,000-4,000 IU/day required to raise serum 25-hydroxyvitamin D levels to the levels required for optimal health, which would be required before vitamin D fortification levels in food can be raised. Until then, moderate solar UVB irradiance remains an import source, and the health benefits greatly outweigh the risks.

Skin cancer mortality in Germany before and after the post‐communist transition

Until now mortality trends of melanoma and nonmelanoma skin cancer (NMSC) in Germany have been studied only in West Germany. We were interested in comparing mortality trends of melanoma and NMSC in West and East Germany before and after the post-communist transition. By analyses of health care utilization data in West and East Germany, we explored potential reasons for mortality differences between these regions. We analyzed mortality data of skin melanoma and NMSC of West and East Germany (1980-2005). We calculated sex-specific age-standardized mortality rates using the World Standard Population. We calculated age-specific mortality rates (20-39, 40-59, 60-79, 80+ years). Age-standardized skin melanoma mortality rates tended to be lower in East Germany than West Germany before reunification. After reunification rates became very similar. Age-standardized mortality rates of NMSC were continuously higher in East than West Germany. The mortality rate differences among East and West Germans in 1996-2005 are mainly due to 2.34- and 2.24-fold higher mortality rates among men and women aged 80 years, respectively, who live in East Germany. Even 15 years after reunification, mortality of NMSC is still higher in East than West Germany, although incidence rates of squamous cell cancers of the skin are not higher in East Germany. Differences in the participation in early cancer detection and health care utilization in West and East Germany do not sufficiently explain our findings.

Nationwide hospitalization costs of skin melanoma and non‐melanoma skin cancer in Germany

Non-melanoma skin cancer (NMSC), in contrast to skin melanoma (MEL), is considered a negligible health problem because mortality of NMSC is low. The aim of this study was to provide insights into the burden of NMSC and MEL by analysing nationwide skin cancer hospitalization data and data from a dermatologist panel of Germany. We wanted to estimate hospitalization costs due to skin cancer in Germany. We analysed the most recent nationwide hospitalization data from 2003 and estimated hospitalization costs due to MEL and NMSC. We estimated the annual number of private dermatologist practice visits in Germany due to skin cancer. In 2003, 20 455 melanoma-related and 41 929 NMSC-related hospitalizations occurred in Germany. Age-standardized hospitalization rates for NMSC were 2.5-fold and 1.8-fold higher among men and women than the rates for MEL, respectively. The age-specific proportions of hospitalizations for NMSC in relation to all cancer-related hospitalizations increased within the age range of 65 years and more. Among people aged 90 years and more, 14% of all cancer-related hospitalizations were due to NMSC. Estimated annual hospitalization costs for MEL were euro50 to 60 million, and those for NMSC were euro105 to 130 million. The estimated number of private dermatologist practice visits in Germany 2003 is considerably higher for NMSC than MEL CONCLUSIONS: Analyses of hospitalizations data and data from private dermatologists give NMSC higher public health relevance than can be obtained from consideration of death statistics.

Genital and Nongenital Nonmelanoma Skin Cancer: More Epidemiological Studies Are Needed

Although black men in the United States have a lower mortality of nongenital nonmelanoma skin cancer (NMSC) than white men, they have a higher mortality of genital NMSC than white men. Mortality of NMSC has declined over time. Ethnicity-specific incidence and survival analyses of NMSC can be used to determine to what degree earlier detection and/or more efficient therapies have contributed to these observations.

Trends in Nonmelanoma Skin Cancer Mortality Rates in the United States, 1969 through 2000

The purpose of this population-based study was to assess trends in mortality rates for nonmelanoma skin cancer (NMSC) in the United States. Particular emphasis was placed on the subgroup of malignancies arising on genital skin. Nearly 75,000 deaths in the United States were attributed to NMSC from 1969 to 2000. The age-adjusted US mortality rate for NMSC arising on nongenital skin from 1969 to 2000 was 0.69/10(5)/year; the rate among men was twice that among women. Mortality rates among white men exceeded that of black men by a factor of two; the same was observed among women, but by a smaller multiple. Corresponding mortality rates for malignancies arising from genital skin (penis, scrotum, vulva) were higher in women (0.54) than in men (0.30). In contrast to nongenital NMSC, mortality rates among black men were twice that of white men; however, rates for white and black women were similar. These results suggest that greater emphasis could be placed on reducing mortality from genital NMSC while continuing to stress reduction of excess sun exposure.

Trends in nonmelanoma skin cancer mortality in the United States: 1969 through 2000

Trends in nonmelanoma skin cancer mortality in the United States: 1969 through 2000

Trends in Nonmelanoma Skin Cancer Mortality in the United States, 1969 through 2000

Trends in Nonmelanoma Skin Cancer Mortality in the United States, 1969 through 2000