SHORT COMMUNICATION 1127
ActaDV ActaDV
Advances in dermatology and venereology Acta Dermato-Venereologica
Prevalence of Cancer in Adult Patients with Atopic Dermatitis : A Nationwide Study
Samine RUFF 1 , Alexander EGEBERG 1 , 2 , Yuki M . F . ANDERSEN 1 , 2 , Gunnar GISLASON 2 , Lone SKOV 1 and Jacob P . THYSSEN 1 *
1
Department of Dermatology and Allergy , and 2 Department of Cardiology , Herlev and Gentofte Hospital , University of Copenhagen , DK-2900 Hellerup , Denmark . * E-mail : jacob . pontoppidan . thyssen @ regionh . dk Accepted May 16 , 2017 ; Epub ahead of print May 17 , 2017
Atopic dermatitis ( AD ) is a common chronic inflammatory skin disease . To date , few studies have examined the risk of cancer in adults with AD . However , the most consistent associations have been observed for skin cancers and lymphomas ( 1 , 2 ). Potential explanatory factors for altered risk in AD include : ( i ) the use of immunosuppressant therapies ; ( ii ) exposure to ultraviolet ( UV ) irradiation ; and ( iii ) AD-related pathomechanistic factors , including impaired cell-mediated immunity . Furthermore , a compromised epithelial barrier function facilitating transcutaneous penetration of carcinogenic agents and viruses , including human papilloma virus ( HPV ), could influence the cancer risk . The aim of the present cross-sectional study was to investigate the occurrence of selected cancers among adult Danish patients with AD ( both in- and outpatient ) compared with general population controls .
MATERIALS AND METHODS
This cross-sectional study was based on data from Danish administrative registries , which contain nationwide information on social and healthcare-related data , such as morbidity , medication use , hospitalizations , and personal income . A detailed description of the data source and methodology of this study is given in Appendix S1 1 .
1 https :// www . medicaljournals . se / acta / content / abstract / 10.2340 / 00015555-2703
Table I . Association between atopic dermatitis ( AD ) and cancers
Controls n (%)
AD |
|
|
|
n (%) |
OR |
95 % CI |
p-value |
RESULTS
A total of 8,112 adult patients with a diagnosis of AD between 1 January 1997 and 31 December 2012 , were included and matched based on age and sex with 40,560 control subjects . Baseline characteristics of the study populations are shown in Table SI 1 . A significant association was found between AD and non-melanoma skin cancer ( NMSC ) compared with controls ( 2.0 % and 0.8 %; adjusted odds ratios ( aOR ) 2.07 ; 95 % confidence interval ( 95 % CI ) 1.67 – 2.55 ) ( Table I ). Similar associations were found for cervical cancer , which occurred in 0.6 % and 0.3 % of patients with and without AD , respectively ( aOR 1.77 ; 95 % CI 1.10 – 2.84 ), although the p-value did not reach Bonferroni corrected level of significance which was set at < 0.003 . Further adjustment for a proxy variable for smoking did not significantly change the estimates ( aOR 1.76 ; 95 % CI 1.09 – 2.83 ). The prevalence of lymphoma was 1.2 % and 0.5 %, respectively ( aOR 1.86 ; 95 % CI 1.43 – 2.40 ). Similarly , pancreatic cancer had a higher prevalence in patients with AD ( 0.3 %) compared with controls ( 0.1 %) ( aOR 2.91 ; 95 % CI 1.50 – 5.66 ). The model was further adjusted for alcohol abuse and a proxy variable for smoking , and the estimates were virtually unchanged ( aOR 2.85 ; 95 % CI 1.46 – 5.56 ). No significant associations were found between AD and malignant melanoma ( MM ), or between AD and hepatic , oesophageal , thyroid , lung , colorectal , kidney , lower urinary tract , breast , ovarian , endometrial , or prostate cancer .
Adjusted |
|
|
OR * |
95 % CI |
p-value |
Any Pancreatic cancer |
41 ( 0.1 ) |
20 ( 0.3 ) |
2.44 |
1.43 – 4.17 |
0.0011 |
2.91 |
1.50 – 5.66 |
0.0016 |
Hepatic cancer |
25 ( 0.1 ) |
5 ( 0.1 ) |
1.00 |
0.38 – 2.61 |
1.0000 |
1.12 |
0.35 – 3.52 |
0.8513 |
Oesophageal cancer |
33 ( 0.1 ) |
9 ( 0.1 ) |
1.36 |
0.65 – 2.85 |
0.4093 |
1.30 |
0.57 – 2.95 |
0.5316 |
Thyroid cancer |
33 ( 0.1 ) |
7 ( 0.1 ) |
1.06 |
0.47 – 2.40 |
0.8875 |
1.25 |
0.46 – 3.40 |
0.6603 |
Lung cancer |
236 ( 0.6 ) |
68 ( 0.8 ) |
1.44 |
1.10 – 1.89 |
0.0078 |
1.27 |
0.95 – 1.71 |
0.1080 |
Colorectal cancer |
285 ( 0.7 ) |
78 ( 1.0 ) |
1.37 |
1.07 – 1.76 |
0.0137 |
1.30 |
0.98 – 1.72 |
0.0675 |
Kidney cancer |
40 ( 0.1 ) |
10 ( 0.1 ) |
1.25 |
0.63 – 2.50 |
0.5277 |
1.10 |
0.52 – 2.31 |
0.8032 |
Lower urinary tract cancer |
128 ( 0.3 ) |
31 ( 0.4 ) |
1.21 |
0.81 – 1.80 |
0.3382 |
1.20 |
0.77 – 1.88 |
0.4187 |
Melanoma |
201 ( 0.5 ) |
55 ( 0.7 ) |
1.37 |
1.02 – 1.85 |
0.0389 |
1.35 |
0.97 – 1.88 |
0.0791 |
Non-melanoma skin cancer |
334 ( 0.8 ) |
158 ( 2.0 ) |
2.39 |
1.98 – 2.90 |
< 0.0001 |
2.07 |
1.67 – 2.55 |
< 0.0001 |
Lymphoma |
215 ( 0.5 ) |
100 ( 1.2 ) |
2.34 |
1.85 – 2.97 |
< 0.0001 |
1.86 |
1.43 – 2.40 |
< 0.0001 |
Women only Breast cancer |
501 ( 2.0 ) |
120 ( 2.4 ) |
1.20 |
0.98 – 1.47 |
0.073 |
1.11 |
0.89 – 1.39 |
0.3493 |
Ovarian cancer |
89 ( 0.4 ) |
20 ( 0.4 ) |
1.12 |
0.69 – 1.83 |
0.6371 |
1.12 |
0.64 – 1.96 |
0.6862 |
Endometrial cancer |
62 ( 0.3 ) |
15 ( 0.3 ) |
1.21 |
0.69 – 2.13 |
0.5077 |
1.12 |
0.61 – 2.07 |
0.7084 |
Cervical cancer |
85 ( 0.3 ) |
30 ( 0.6 ) |
1.77 |
1.17 – 2.69 |
0.0074 |
1.77 |
1.10 – 2.84 |
0.0176 |
Men only Prostate cancer |
215 ( 1.4 ) |
44 ( 1.4 ) |
1.02 |
0.74 – 1.42 |
0.8887 |
0.95 |
0.65 – 1.39 |
0.795 |
Odds ratio ( ORs ) were estimated using univariate and multivariate logistic regression . * Adjusted for age , sex , socioeconomic status , and number of dermatology visits . CI : confidence interval . Numbers in bold represent results that reached the Bonferroni corrected level of significance ( p < 0.003 ).
This is an open access article under the CC BY-NC license . www . medicaljournals . se / acta Journal Compilation © 2017 Acta Dermato-Venereologica . doi : 10.2340 / 00015555-2703 Acta Derm Venereol 2017 ; 97 : 1127 – 1129