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