Acta Dermato-Venereologica 99-10CompleteContent | Page 11
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CLINICAL REPORT
Sunbed Use Increases Cutaneous Squamous Cell Carcinoma Risk
in Women: A Large-scale, Prospective Study in Sweden
Gustav Boelsgaard CHRISTENSEN 1 , Christian INGVAR 2 , Linda Werner HARTMAN 3 , Håkan OLSSON 4 and Kari NIELSEN 5
1
Department of Dermatology, Skåne University Hospital, Department of Clinical Sciences, Dermatology and Venereology, 2 Department of
Surgery and 4 Department of Oncology and Pathology and Cancer Epidemiology, Skåne University Hospital, Department of Clinical Sciences,
Lund University, 3 Faculty of Medicine, Department of Clinical Sciences, Oncology and Pathology, and 5 Department of Dermatology, Helsingborg
Hospital, Department of Clinical Sciences, Dermatology and Venereology, Lund University, Lund, Sweden
The incidence of cutaneous squamous cell carcinoma
has increased rapidly in Sweden in the past decades.
Here, we present a prospective study of the Melanoma
in Southern Sweden (MISS)-cohort, with 29,460 parti-
cipating women in southern Sweden that investigates
the risk factors for cutaneous squamous cell carcino-
ma. Data on the host and skin cancer risk factors were
collected through questionnaires and then matched
with the National Cancer Registry. Statistical analyses
were based on uni- and multivariable Cox proportio-
nal hazards models, using age as the time-scale. We
found that sunbed use (hazard ratio (HR) 1.2, 95%
CI: 1.1–1.4), red and light blond hair (HR 1.6, 95%
CI: 1.1–2.3), freckles (HR 1.4, 95% CI: 1.1–1.8) and
immunosuppressive medications (HR 2.1, 95% CI:
1.3–4.5) were independent risk factors. Furthermore,
we observed a dose-dependent relationship between
sunbed use and the development of cutaneous squa-
mous cell carcinoma. Our findings support the idea of
integrating dermatological follow-up examinations for
immunosuppressed patients and banning the use of
sunbeds in order to prevent cutaneous squamous cell
carcinoma.
Key words: cutaneous squamous cell carcinoma; risk factors;
sunbed; prospective cohort.
Accepted Apr 16, 2019; E-published Apr 16, 2019
Acta Derm Venereol 2019; 99: 878–883.
Corr: Gustav Boelsgaard Christensen, Department of Dermatology, Skå-
ne University Hospital, Lasarettsgatan 15, SE-222 41 Lund, Sweden. E-
mail: [email protected]
O
ver the past 10 years, there was an annual increase
of 6.5% for Swedish women and 5.5% for Swe-
dish men in the incidence of cutaneous squamous cell
carcinoma (cSCC), making it the most and second most
rapidly increasing malignant tumour in Sweden (1, 2).
This trend has been observed for light-skinned people
worldwide as well (3–6). A cSCC diagnosis can be lethal
and surgical excision is the first line treatment in forms of
invasive cSCCs. A patient with the suspected diagnosis
is often referred from primary care to a dermatology
department for diagnosis and subsequent treatment. Due
to the rise in incidence, the number of patients in derma-
tology departments has been increasing, which represents
a growing economic burden on the healthcare system.
doi: 10.2340/00015555-3198
Acta Derm Venereol 2019; 99: 878–883
SIGNIFICANCE
There has been an increase in the number of skin cancers
in Sweden in the last decades. We looked closer at one skin
cancer in particular – squamous cell carcinoma. In order
to be able to prevent squamous cell carcinoma, we need
to understand which risk factors are most important. We
studied a large group of Swedish women and looked into
which risk factors play a role in getting squamous cell car-
cinoma. Having freckles and red or light blond hair, taking
medications that suppress the immune system and using
sunbeds play a part.
As with most cancers, the interaction between phenoty-
pic, genotypic, and environmental factors determines the
individual risk for developing cSCC. As such, understan-
ding these risk factors and implementing evidence-based
preventive strategies are essential to combat the rising
incidence of cSCC.
Analysing risk factors identified in prospective studies
with no recall bias, can help to achieve this goal. The
majority of the studies, examining risk factor contribu-
tion to cSCC, to date are retrospective in nature and
very little focus exclusively on women. In contrast, the
aim of the present study is to prospectively investigate a
cohort of women and thereby elucidate the influence of
both phenotypic (colour of hair and eyes, freckles and
naevi count) and environmental factors (medicine intake,
educational level, smoking habits and UV exposure) on
cSCC incidence.
MATERIALS AND METHODS
Participants
The MISS (Melanoma in Southern Sweden) cohort was established
in 1990–1992 and is still followed prospectively. Swedish-born
women (1,000 women per calendar year, born between 1925 and
1965), living in the Southern Sweden’s health care region, with
no prior diagnosis of invasive cancer were selected for the study.
The women included in the cohort were chosen through random
computerized selection from the Population/Census Registry
and were controlled to have no prior diagnosis of invasive cancer
through the Regional Cancer Registry before the final inclusion.
At baseline 40,000 women were included into the study. Non-
responders were sent a reminder letter.
The invited women were asked to answer a written questionnaire
on the possible risk factors for skin cancer and breast cancer. The
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Journal Compilation © 2019 Acta Dermato-Venereologica.