Skin Cancer In Women Research Articles

An observational and genetic investigation into the association between psoriasis and risk of malignancy

The relationship between psoriasis and site-specific cancers remains unclear. Here, we aim to investigate whether psoriasis is causally associated with site-specific cancers. We use observational and genetic data from the UK Biobank, obtaining GWAS summary data, eQTL analysis data, TCGA data, and GTEx data from public datasets. We perform PheWAS, polygenic risk score analysis, and one-sample and two-sample Mendelian randomization analyses to investigate the potential causal associations between psoriasis and cancers. In the unselected PheWAS analysis, psoriasis is associated with higher risks of 16 types of cancer. Using one-sample Mendelian randomization analyses, it is found that genetically predicted psoriasis is associated with higher risks of anal canal cancer, breast cancer, follicular non-Hodgkin’s lymphoma and nonmelanoma skin cancer in women; and lung cancer and kidney cancer in men. Our two-sample Mendelian randomization analysis indicates that psoriasis is causally associated with breast cancer and lung cancer. Gene annotation shows that psoriasis-related genes, such as ERAP1, are significantly different in lung and breast cancer tissues. Taken together, clinical attention to lung cancer and breast cancer may be warranted among patients with psoriasis.

The risk of skin cancer in women who carry BRCA1 or BRCA2 mutations

BackgroundIt has not been clearly established if skin cancer or melanoma are manifestations of BRCA1 or BRCA2 mutation carrier status. Estimating the risk of skin cancer is an important step towards developing screening recommendations.MethodsWe report the findings of a prospective cohort study of 6,207 women from North America who carry BRCA1 or BRCA2 mutations. Women were followed from the date of baseline questionnaire to the diagnosis of skin cancer, to age 80 years, death from any cause, or the date of last follow-up.ResultsDuring the mean follow-up period of eight years, 3.7% of women with a BRCA1 mutation (133 of 3,623) and 3.8% of women with a BRCA2 mutation (99 of 2,584) reported a diagnosis of skin cancer (including both keratinocyte carcinomas and melanoma). The cumulative risk of all types of skin cancer from age 20 to 80 years was 14.1% for BRCA1 carriers and 10.7% for BRCA2 carriers. The cumulative risk of melanoma was 2.5% for BRCA1 carriers and 2.3% for BRCA2 carriers, compared to 1.5% for women in the general population in the United States. The strongest risk factor for skin cancer was a prior diagnosis of skin cancer.ConclusionThe risk of non-melanoma skin cancer in women who carry a mutation in BRCA1 or BRCA2 is similar to that of non-carrier women. The risk of melanoma appears to be slightly elevated. We suggest that a referral to a dermatologist or primary care provider for BRCA mutation carriers for annual skin examination and counselling regarding limiting UV exposure, the use of sunscreen and recognizing the early signs of melanoma might be warranted, but further studies are necessary.

Skin cancer in women of color: Epidemiology, pathogenesis and clinical manifestations.

Malignant melanoma and nonmelanoma skin cancers (NMSC), which include basal cell carcinoma and squamous cell carcinoma, account for 40% of all neoplasms in white patients, making these cancers the most common malignancy in the United States. Given the large number of NMSC cases in white patients, there is a correspondingly large body of literature addressing various aspects of epidemiology, pathogenesis, and treatment. The incidence of both malignant melanoma and NMSC is well established and remains significantly lower in patients with skin of color (SoC) when compared with white patients. Although there is a lower incidence of skin cancer in SoC, there is often a poorer prognosis among this group. There is even more limited data focusing on women of color, making an accurate determination of incidence and mortality difficult. This gender disparity causes decreased skin cancer awareness and index of suspicion among patients and providers, hindering appropriate evaluation and care. Therefore, there is a need for an increased understanding of skin cancer in women of color. In the traditional sense, SoC refers to people of African, Asian, Native American, Middle Eastern, and Hispanic backgrounds. Patients in these ethnic groups have richly pigmented skin that is usually categorized as Fitzpatrick types III through VI and thus have notable differences in skin disease and presentation compared with fair-skinned individuals. We present this review of skin cancer in women of color to give a reasonably comprehensive representation of the literature to advance our understanding and knowledge in this unique population.

Nonmelanoma skin cancer in women.

Men continue to develop nonmelanoma skin cancer (NMSC) at higher rates than women, but the epidemiologic pattern of NMSC development is evolving. We present a selective, narrative review of the literature showing that there is a trend toward a development of basal cell carcinomas in women at younger ages, and highlight potential causes of this trend. We review evidence that indoor tanning is associated with the development of NMSC and show that young women use indoor tanning more than any other age-sex group. We discuss societal factors that relate to the tanning behavior of young women. Finally, we argue that facial NMSCs may have more of a negative impact on quality of life in women than in men.

Mediterranean dietary pattern and skin cancer risk: a prospective cohort study in French women

Background and aims Skin cancers are the most common cancers in Caucasian populations worldwide and their incidence is rising. Ultraviolet radiation (UV) exposure is currently the sole environmental factor on which skin cancer prevention can be based. Given the oxidant effects of UV leading to skin carcinogenesis, dietary consumption of antioxidants has been proposed to reduce skin cancer risk. However, previous findings were inconsistent. The Mediterranean diet (MD) has long been reported to reduce the risk of several diseases including cancers. While previous studies explored the relationships between major food groups or individual dietary components of the MD and skin cancer risk, no previous study has investigated adherence to a MD pattern in relation to skin cancer risk to date. Methods E3 N is an ongoing prospective cohort of 98,995 French women aged 40–65 years at inclusion in 1990. Participants completed self-administered questionnaires sent biennially. Skin cancer cases were confirmed through pathology reports. Dietary data were collected via a validated food frequency questionnaire in 1993. Adherence to a MD pattern was assessed using the 9-unit dietary score proposed by Trichopoulou et al. in 2005, which takes values from 0 to 9 points (minimum to maximum adherence) according to the combined intake of fruits, vegetables, legumes, cereals, lipids, fish, dairy products, meat products, and alcohol. In this revised version of the MD score, lipid intake was assessed by calculating the ratio of unsaturated (i.e. mono- and polyunsaturated) to saturated fatty acids. We used Cox proportional hazards regression models to compute hazard ratios (HR) and 95% confidence intervals (CI) adjusted for age, birth cohort, pigmentary traits, residential UV exposure at birth and at inclusion, family history of skin cancer, total energy intake, body mass index, physical activity, smoking status, education and coffee intake. Results Between 1993 and 2008, 404 melanoma, 232 squamous-cell carcinoma (SCC), and 1367 basal-cell carcinoma (BCC) cases were ascertained among the 67,332 included women. The MD score distribution was as follows: Tertile 1: 0–3 (29.4%), Tertile 2: 4–5 (45.2%) and Tertile 3: 6–9 (25.4%). Adherence to the MD was associated with an overall reduction in skin cancer risk (HR = 0.87, 95% CI = 0.77–0.97 for T3 vs.T1, P-trend = 0.01; HR = 0.96, 95% CI = 0.94–0.99 per unit increase in the MD score). When considering skin cancer type, there was a linear inverse association between MD score and risk of non-melanoma skin cancers (HR = 0.87, 95% CI = 0.76–0.99, P-trend = 0.04), particularly BCC (HR = 0.84, 95% CI = 0.72–0.97, P-trend = 0.01). However, while we found no evidence of a linear association with melanoma (P-trend = 0.08), we observed that high MD scores were associated with a borderline reduced risk of melanoma (HR = 0.76, 95% CI = 0.57–1.00) compared with the lowest scores. Moreover, there was no heterogeneity detected across skin cancer types (Pheterogenity = 0.23). Conclusion In this large prospective cohort study, adherence to the MD was linearly associated with a reduction in overall skin cancer risk, mostly driven by an inverse association with BCC; in addition, a high MD score was associated with a decreased melanoma risk. These results suggest that a high level of adherence to the MD pattern may confer protection against skin cancer in women. If confirmed in future research, these findings may ultimately provide additional knowledge for skin cancer prevention.

Antioxidant supplement use and risk of non-melanoma skin cancer in women: a prospective cohort study

Background and aims Experimental studies suggest that antioxidants could protect against skin carcinomas. However, epidemiological studies on dietary antioxidant supplement use in relation to risk of basal-cell carcinoma (BCC) and squamous-cell carcinoma (SCC) yielded inconsistent findings, and very few prospective studies with available sun exposure data have been conducted to date. Our objective was to investigate the relationships between the use of dietary supplements in beta-carotene, and vitamins A, C, and E, and risk of non-melanoma skin cancers (NMSC). Methods E3 N is an ongoing prospective cohort involving 98,995 French women aged 40–65 years at inclusion in 1990. Data on the occurrence of BCC and SCC were collected every 2–3 years through self-administered questionnaires, with skin cancer cases confirmed through pathology reports. Intake of specific antioxidant supplements was collected in 1995. Dietary antioxidant intakes from foods were calculated using data collected via a validated food frequency questionnaire in 1993. We used Cox proportional hazards regression models with age as the time scale to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the risks of BCC and SCC associated with antioxidant supplement use. Models were adjusted for age, birth cohort, pigmentary traits, residential UV exposure at birth and at inclusion, family history of skin cancer, body mass index, physical activity, smoking status, and education. Results Over a mean follow-up of 11.6 years, 1245 BCC and 219 SCC cases were diagnosed among the 63,077 included women. We observed a positive association between vitamin A supplement use and risk of NMSCs (HR = 1.30, 95% CI: 1.02–1.67), particularly BCC (HR = 1.32, 95% CI: 1.01–1.72). There was also a positive association between vitamin E supplement use and NMSC risk (HR = 1.28; 95% CI: 1.05–1.56). Moreover, we found an interaction between vitamin A supplement use and dietary intake of retinol (Pinteraction = 0.04) on the risk of NSMCs: vitamin A supplement use was associated with an increased risk of NMSCs only in women in the highest tertile of dietary retinol intake (HR = 1.89; 95% CI: 1.29–2.75), but not in those in the middle (HR = 1.05, 95% CI: 0.64–1.74) or lowest tertiles of intake (HR = 1.10; 95% CI: 0.70–1.73). However, use of beta-carotene or vitamin C supplements was not associated with NMSC risk. Conclusion Our study suggests an increased risk of NMSCs associated with vitamin A (particularly for BCC) and vitamin E supplement use. The increased risk associated with vitamin A supplement use was restricted to women with high intakes of retinol from foods. These findings suggest that high supplementary intakes of some antioxidants could confer a higher risk of NMSCs in women, particularly in the context of high antioxidant intakes in the diet in the case of retinol. More research is warranted in order to replicate these findings and investigate their underlying mechanisms.

Living Healthy Versus Looking Attractive: The Multimodal Portrayal of Skin Cancer in Women's Magazines in the United States

Through a multimodal discourse analysis, this study examines the portrayal of skin cancer in six highly circulated women's magazines in the United States. The findings of this study revealed a competing relationship between the verbal and visual discourses surrounding skin cancer. Overall, the verbal messages were health-oriented, promoting the importance of physical health. However, the images focused on intentional sun exposure behaviors, accentuating the physical attractiveness of a tanned appearance. The divergence of the verbal and visual messages may indicate a tendency to impose the pro-tan norms on the female body. In addition, consumerism was also prominent in the multimodal portrayal of skin cancer, blurring the line between information and advertising. Theoretical and practical implications these findings are discussed.

Cumulative ultraviolet radiation flux in adulthood and risk of incident skin cancers in women

Background:Solar ultraviolet (UV) exposure estimated based on residential history has been used as a sun exposure indicator in previous case–control and descriptive studies. However, the associations of cumulative UV exposure based on residential history with different skin cancers, including melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC), have not been evaluated simultaneously in prospective studies.Methods:We conducted a cohort study among 108 578 women in the Nurses' Health Study (1976–2006) to evaluate the relative risks of skin cancers with cumulative UV flux based on residential history in adulthood.Results:Risk of SCC and BCC was significantly lower for women in lower quintiles vs the highest quintile of cumulative UV flux (both P for trend <0.0001). The association between cumulative UV flux and risk of melanoma did not reach statistical significance. However, risk of melanoma appeared to be lower among women in lower quintiles vs the highest quintile of cumulative UV flux in lag analyses with 2–10 years between exposure and outcome. The multivariable-adjusted hazard ratios per 200 × 10−4 Robertson–Berger units increase in cumulative UV flux were 0.979 (95% confidence interval (CI): 0.933, 1.028) for melanoma, 1.072 (95% CI: 1.041, 1.103) for SCC, and 1.043 (95% CI: 1.034, 1.052) for BCC.Conclusions:Associations with cumulative UV exposure in adulthood among women differed for melanoma, SCC, and BCC, suggesting a potential variable role of UV radiation in adulthood in the carcinogenesis of the three major skin cancers.

著明な貧血と血小板減少と末梢血の異常細胞で発見された転移性乳癌の１例

Worldwide, breast cancer accounts for 22.9% of all cancers excluding non-melanoma skin cancers in women. More than 80% of breast cancer cases are discovered when a woman discovers a lump that feels different from the rest of the breast tissue. We report the case of a 60-year-old woman who had been treated for one year at a psychiatric hospital for suspected schizophrenia, and was referred to our hospital on March 23, 2011 for consultation regarding complete blood count abnormalities: hemoglobin, 4.8g/dl ; Plt, 1.9×104/μl ; WBC, 12,700/μl with 18.5% abnormal cells. Computed tomography revealed an enhanced, irregular mass in her right breast as well as right axillary lymph node swelling, suggestive of breast cancer. BM biopsy confirmed the presence of abnormal, keratin-positive cells, suggesting metastasis to the bone. CA15-3 was 300U/ml (normal range ＜25). The patient died on April 11, 2011, post-admission day 20. We found a rare case of terminal breast cancer that presented with peripheral blood abnormality. Breast cancer in patients who do not notice breast abnormality can present with peripheral blood abnormality.

Inorganic phosphate and the risk of cancer in the Swedish AMORIS study

BackgroundBoth dietary and serum levels of inorganic phosphate (Pi) have been linked to development of cancer in experimental studies. This is the first population-based study investigating the relation between serum Pi and risk of cancer in humans.MethodsFrom the Swedish Apolipoprotein Mortality Risk (AMORIS) study, we selected all participants (> 20 years old) with baseline measurements of serum Pi, calcium, alkaline phosphatase, glucose, and creatinine (n = 397,292). Multivariable Cox proportional hazards regression analyses were used to assess serum Pi in relation to overall cancer risk. Similar analyses were performed for specific cancer sites.ResultsWe found a higher overall cancer risk with increasing Pi levels in men ( HR: 1.02 (95% CI: 1.00-1.04) for every SD increase in Pi), and a negative association in women (HR: 0.97 (95% CI: 0.96-0.99) for every SD increase in Pi). Further analyses for specific cancer sites showed a positive link between Pi quartiles and the risk of cancer of the pancreas, lung, thyroid gland and bone in men, and cancer of the oesophagus, lung, and nonmelanoma skin cancer in women. Conversely, the risks for developing breast and endometrial cancer as well as other endocrine cancer in both men and women were lower in those with higher Pi levels.ConclusionsAbnormal Pi levels are related to development of cancer. Furthermore, the in verse association between Pi levels and risk of breast, endometrial and other endocrine cancers may indicate the role of hormonal factors in the relation between Pi metabolism and cancer.

Nonsteroidal anti‐inflammatory drugs and the risk of keratinocyte skin cancer among women

We read with great interest the study by Johannesdottir and coworkers,1 who report that a high-intensity and long-term use of nonsteroidal anti-inflammatory drugs (NSAID) is associated with a decreased risk of squamous cell carcinoma. Their observation is highly intriguing in the light of the reported higher frequency of keratinocyte skin cancer (ie, actinic keratoses and squamous cell carcinoma) among men compared with women.2 To date, the sex-related different frequency of keratinocyte skin cancer has been solely attributed to a higher occupational sun exposure of men compared with women.3 The study by Johannesdottir et al1 provides the first evidence for an alternative explanation, which could be linked to the chronic use of painkillers and menstrual cycle–related symptoms. It has been estimated that as many as 2.5 million women each year are affected by menstrual disorders such as primary dysmenorrhea, which often cause excessive pain shortly before or during the menstruation.4 The use of NSAIDs have been shown to effectively reduce the pain and represents first-line treatment.4 Given that approximately 25% of women5 will presumably use NSAIDs on a monthly basis for several years, if not decades, the observation made Johannesdottir et al1 supports the hypothesis that NSAIDs may represent a currently unrecognized factor associated with a lower incidence of keratinocyte skin cancer in women compared with men. Although the authors did not investigate such correlation, their data strongly emphasize the need to look closer at the potential role of NSAIDs in the prevention of keratinocyte skin cancer in the future. No specific funding was disclosed. CONFLICT OF INTEREST DISCLOSURE The authors made no disclosure. Iris Zalaudek MD* , Giuseppe Argenziano MD*, * Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Instituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy, Department of Dermatology, Medical University of Graz, Austria

Non-steroidal anti-inflammatory drugs, acetaminophen, and risk of skin cancer in the Nurses’ Health Study

Non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with lower risk of certain cancers, but data on the effect on skin cancer risk have been limited and contradictory. We prospectively examined whether use of NSAIDS or acetaminophen was associated with a lower risk of skin cancer in women. The 92,125 Caucasian women in the Nurses' Health Study provided information on aspirin use in 1980. Other NSAIDs and acetaminophen were added in 1990. Medication use, frequency, and quantity were reassessed on biennial questionnaires. Through 2008, we confirmed 658 melanoma cases, 1,337 squamous cell carcinoma (SCC) cases, and had 15,079 self-reports of basal cell carcinoma (BCC). We used COX proportional hazards models to compute relative risks (RR) adjusted for known skin cancer risk factors. Neither aspirin nor non-aspirin NSAID use was associated with a lower risk of melanoma, SCC, or BCC, even for women with high quantity, frequency, or duration of use. Instead, we observed an increased risk of melanoma among current aspirin users (RR=1.32, 95% CI 1.03-1.70), though an increase of similar magnitude among past users and lack of a dose-response effect did not support a pharmacologic mechanism. We observed a mild reduction in SCC risk in current acetaminophen users (RR=0.88, 95% CI 0.75-1.02), with a linear decrease in risk with greater frequency of use (p=0.04). Aspirin and other NSAIDs were not associated with a lower risk of melanoma, SCC, or BCC in women. Our large, prospective study does not support a chemoprotective effect of NSAIDs against skin cancers.

Measuring Socioeconomic Disparities in Cancer Incidence in Tehran, 2008

Health disparities exist among and within countries, while developing and low income countries suffer more. The aim of this study was to quantify cancer disparities with regard to socioeconomic position (SEP) in 22 districts of Tehran, Iran. According to the national cancer registry, 7599 new cancer cases were recorded within 22 districts of Tehran in 2008. Based on combined data from census and a population-based health equity study (Urban HEART), socioeconomic position (SEP) was calculated for each district. Index of disparity, absolute and relative concentration indices (ACI and RCI) were used for measuring disparities in cancer incidence. The overall cancer age standardised rate (ASR) was 117.2 per 100,000 individuals (120.4 for men and 113.5 for women). Maximum ASR in both genders was seen in districts 6, 3, 1 and 2. Breast, colorectal, stomach, skin and prostate were the most common cancers. Districts with higher SEP had higher ASR (r=0.9, p<0.001). Positive ACI and RCI indicated that cancer cases accumulated in districts with high SEP. Female disparity was greater than for men in all measures. Breast, colorectal, prostate and bladder ASR ascended across SEP groups. Negative ACI and RCI in cervical and skin cancers in women indicate their aggregation in lower SEP groups. Breast cancer had the highest absolute disparities measure. This report provides an appropriate guide and new evidence on disparities across geographical, demographic and particular SEP groups. Higher ASR in specific districts warrants further research to investigate the background predisposing factors.

Pre-Diagnostic Plasma 25-Hydroxyvitamin D Levels and Risk of Non-Melanoma Skin Cancer in Women

BackgroundRecent reports have shown that vitamin D status was inversely associated with the risk of various cancers. However, few studies examined the association between vitamin D levels and risk of skin cancer.MethodsWe prospectively evaluated the association between baseline plasma 25(OH)D levels and the risk of incident squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) among 4,641 women from the Nurses’ Health Study (NHS) and the NHS II with 510 incident BCC cases and 75 incident SCC cases. We used multivariate logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsPlasma 25(OH)D levels were positively associated with risk of BCC after adjusting for age at blood draw, season of blood draw, lab batch, hair color, burning tendency, the number of sunburns, and ultra-violet B flux of residence at blood collection. Women in the highest quartile of 25(OH)D had more than 2-fold increased risk of BCC compared with women in the lowest quartile (OR = 2.07, 95% CI = 1.52–2.80, P for trend <0.0001). We also found a significantly positive association between plasma 25(OH)D levels and SCC risk after adjusting for the same covariates (OR, highest vs. lowest quartile = 3.77, 95% CI = 1.70–8.36, P for trend = 0.0002).ConclusionIn this prospective study of women, plasma vitamin D levels were positively associated with non-melanoma skin cancer risk. Considering that most circulating vitamin D is due to sun exposure, the positive association between plasma vitamin D and non-melanoma skin cancer is confounded by sun exposure. Our data suggest that one-time measurement of plasma vitamin D levels may reasonably reflect long-term sun exposure and predict the risk of non-melanoma skin cancer.

Antioxidant Supplementation Increases the Risk of Skin Cancers in Women but Not in Men

This research aimed to test whether supplementation with a combination of antioxidant vitamins and minerals could reduce the risk of skin cancers (SC). It was performed within the framework of the Supplementation in Vitamins and Mineral Antioxidants study, a randomized, double-blinded, placebo-controlled, primary prevention trial testing the efficacy of nutritional doses of antioxidants in reducing incidence of cancer and ischemic heart disease in the general population. French adults (7876 women and 5141 men) were randomized to take an oral daily capsule of antioxidants (120 mg vitamin C, 30 mg vitamin E, 6 mg β-carotene, 100 μg selenium, and 20 mg zinc) or a matching placebo. The median time of follow-up was 7.5 y. A total of 157 cases of all types of SC were reported, from which 25 were melanomas. Because the effect of antioxidants on SC incidence varied according to gender, men and women were analyzed separately. In women, the incidence of SC was higher in the antioxidant group [adjusted hazard ratio (adjusted HR) = 1.68; P = 0.03]. Conversely, in men, incidence did not differ between the 2 treatment groups (adjusted HR = 0.69; P = 0.11). Despite the small number of events, the incidence of melanoma was also higher in the antioxidant group for women (adjusted HR = 4.31; P = 0.02). The incidence of nonmelanoma SC did not differ between the antioxidant and placebo groups (adjusted HR = 1.37; P = 0.22 for women and adjusted HR = 0.72; P = 0.19 for men). Our findings suggest that antioxidant supplementation affects the incidence of SC differentially in men and women.

Family History and Age Increase Risk of Skin Cancers in Women

Family History and Age Increase Risk of Skin Cancers in Women

Prevalence of skin and other cancers in patients with psoriasis.

The prevalence of skin and internal malignancies was estimated from the general practitioners' notes of 2247 patients with psoriasis and 4494 age- and sex-matched controls. The prevalence of skin cancer in the psoriatics was 155% that of controls, but this was not significant at the 5% level. Subgroup analysis showed an increase in skin cancers in women (P < 0.05). There was no difference in the age of onset of skin cancers between psoriatics and controls and there was no evidence of a cumulative therapeutic risk. There was no difference in the prevalence of non-skin cancers between psoriatics and controls.