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Baibergenova A.T.,University of Toronto | Weinstock M.A.,Dermatoepidemiology Unit | Weinstock M.A.,Brown University
Journal of the European Academy of Dermatology and Venereology | Year: 2012

Background Glucorticosteroids (GC) are potent anti-inflammatory medications with immunosuppressive property. Few retrospective studies have reported the increased risk of development of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) associated with GC use. Objective We aimed to assess the effect of oral GC use on the risk of BCC and SCC using prospective data. Methods We analysed data from the Veterans Affairs Topical Tretinoin Chemoprevention Trial, which followed up patients from 1998 to 2004. Exposure to oral GCs was defined as (1) use of any oral GCs at any point during follow-up and (2) use of GCs for a month or longer. Outcome was occurrence of new BCC or SCC. Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Results Among the 1051 study participants, 148 patients (14%) had prednisone prescription filled during study period, and 63 (6%) used prednisone for over a month. A total of 472 patients (45%) developed at least one BCC during study: 394 (44%) among non-users of prednisone and 78 (53%) among any time users. The total number of new SCC was 309 (29%): 258 (29%) among non-users of prednisone and 51 (34%) among users. Among any time prednisone users, the adjusted HR was 1.11 (95% CI, 0.87-1.42) for BCC, and 1.05 (95% CI, 0.76-1.45) for SCC. Among those who used prednisone for 30 or more days, the HR was 1.26 (95% CI, 0.90-1.78) for BCC, and 1.03 (95% CI, 0.66-1.60) for SCC. Conclusion This study does not support the existence of association between use of oral GCs and risk of BCC or SCC. © 2011 European Academy of Dermatology and Venereology. Source

Eisemann N.,University of Lubeck | Waldmann A.,University of Lubeck | Geller A.C.,Harvard University | Weinstock M.A.,Dermatoepidemiology Unit | And 3 more authors.
Journal of Investigative Dermatology | Year: 2014

Non-melanoma skin cancer (NMSC) is the most common malignancy, whose public health significance is often unrecognized. This analysis has two objectives: first, to provide up-to-date incidence estimates by sex, age group, histological type, and body site; and second, to study the impact of skin cancer screening. The impact of screening on NMSC incidence in Schleswig-Holstein, Germany, is analyzed by comparing four time periods of different screening settings (no screening (1998-2000), pilot project (Skin Cancer Research to Provide Evidence for Effectiveness of Screening in Northern Germany, SCREEN, 2003-2004), after SCREEN (2004-2008), and nation-wide skin cancer screening (2008-2010)) to a reference region (Saarland, Germany). Age-standardized (Europe) NMSC incidence was 119/100,000 for women and 145/100,000 for men in the most recent screening period in Schleswig-Holstein (2008-2010). During implementation of SCREEN (2003-2004), incidence increased from 81.5/100,000 to 111.5/100,000 (1998-2000) by 47% for women and 34% for men. All age groups in women were affected by the increase, but increases for men were mostly limited to the older age groups. Incidence in Saarland first increased slowly, but increased steeply with the introduction of the nation-wide skin cancer screening in 2008 (+47% for women and +40% for men, reference 2004-2008). Observed changes are most likely attributed to screening activities. © 2014 The Society for Investigative Dermatology. Source

Lazovich D.,University of Minnesota | Vogel R.I.,University of Minnesota | Berwick M.,University of New Mexico | Weinstock M.A.,Dermatoepidemiology Unit | And 4 more authors.
Cancer Epidemiology Biomarkers and Prevention | Year: 2010

Background: Indoor tanning has been only weakly associated with melanoma risk; most reports were unable to adjust for sun exposure, confirm a dose-response, or examine specific tanning devices. A population-based case-control study was conducted to address these limitations. Methods: Cases of invasive cutaneous melanoma, diagnosed in Minnesota between 2004 and 2007 at ages 25 to 59, were ascertained from a statewide cancer registry; age-matched and gender-matched controls were randomly selected from state driver's license lists. Self-administered questionnaires and telephone interviews included information on ever use of indoor tanning, types of device used, initiation age, period of use, dose, duration, and indoor tanning-related burns. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for known melanoma risk factors. Results: Among 1,167 cases and 1,101 controls, 62.9% of cases and 51.1% of controls had tanned indoors (adjusted OR 1.74; 95% CI, 1.42-2.14). Melanoma risk was pronounced among users of UVB-enhanced (adjusted OR, 2.86; 95% CI, 2.03-4.03) and primarily UVA-emitting devices (adjusted OR, 4.44; 95% CI, 2.45-8.02). Risk increased with use: years (P < 0.006), hours (P < 0.0001), or sessions (P = 0.0002). ORs were elevated within each initiation age category; among indoor tanners, years used was more relevant for melanoma development. Conclusions: In a highly exposed population, frequent indoor tanning increased melanoma risk, regardless of age when indoor tanning began. Elevated risks were observed across devices. Impact: This study overcomes some of the limitations of earlier reports and provides strong support for the recent declaration by the IARC that tanning devices are carcinogenic in humans. ©2010 AACR. Source

Vogel R.I.,University of Minnesota | Ahmed R.L.,University of Minnesota | Nelson H.H.,University of Minnesota | Berwick M.,University of New Mexico | And 3 more authors.
Journal of the National Cancer Institute | Year: 2014

Indoor tanning is carcinogenic to humans. Individuals report that they tan indoors before planning to be in the sun to prevent sunburns, but whether skin cancer is subsequently reduced is unknown. Using a population-based case-control study, we calculated the association between melanoma and indoor tanning after excluding exposed participants reporting indoor tanning-related burns, stratified by their number of lifetime sunburns (0, 1-2, 3-5, >5). Confounding was addressed using propensity score analysis methods. All statistical tests were two-sided. We observed increased risk of melanoma across all sunburn categories for participants who had tanned indoors without burning compared with those who never tanned indoors, including those who reported zero lifetime sunburns (odds ratio = 3.87; 95% confidence interval = 1.68 to 8.91; P =. 002). These data provide evidence that indoor tanning is a risk factor for melanoma even among persons who reported never experiencing burns from indoor tanning or outdoor sun exposure. © 2014 The Author 2014. Published by Oxford University Press. All rights reserved. Source

Katalinic A.,University of Lubeck | Waldmann A.,University of Lubeck | Weinstock M.A.,Dermatoepidemiology Unit | Geller A.C.,Harvard University | And 4 more authors.
Cancer | Year: 2012

Background: From July 1, 2003 to June 30, 2004, a population-based skin cancer screening project was conducted in Schleswig-Holstein, Germany. In total, 360,288 individuals aged ≥20 years were screened by means of a whole-body examination. In this report, the authors compare trends in melanoma mortality in Schleswig-Holstein with those in all adjacent regions, none of which had population-based skin cancer screening. Methods: Trends in melanoma mortality rates for Schleswig-Holstein and the adjacent regions (Denmark and the German federal states of Mecklenburg-Vorpommern, Hamburg, and Lower Saxony) and in Germany excluding Schleswig-Holstein were compared. Log-linear regression was used to assess mortality trends. Results: In Schleswig-Holstein during the pre skin cancer screening period (1998-1999), the age-standardized melanoma mortality rate (World standard population) was 1.9 per 100,000 for men and 1.4 per 100,000 for women. Melanoma mortality declined by 47% to 1.0 per 100,000 men and by 49% to 0.7 per 100,000 women by 2008/2009. The annual percentage change in the most recent 10-year period (2000-2009) was -7.5% (95% confidence interval, -14.0, -0.5) for men and -7.1% (95% confidence interval, -10.5, -2.9) for women. In each of the 4 adjacent regions and in the rest of Germany, mortality rates were stable, and the decline in Schleswig-Holstein was significantly different from the changes observed in all of the other areas studied. Conclusions: The current data represent strong evidence, but not absolute proof, that the skin cancer screening program produced a reduction in melanoma mortality in Schleswig-Holstein. Cancer 2012. © 2012 American Cancer Society. Source

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