Abstract
Background
Skin cancers are known to be associated with sun exposure, whereas sunlight through
the production of vitamin D may protect against some cancers. The aim of this study
was to assess whether patients with skin cancer have an altered risk of developing
other cancers.
Methods
The study cohort consisted of 416,134 cases of skin cancer and 3,776,501 cases of
non-skin cancer as a first cancer extracted from 13 cancer registries. 10,886 melanoma
and 35,620 non-melanoma skin cancer cases had second cancers. The observed numbers
(O) of 46 types of second primary cancer after skin melanoma, basal cell carcinoma
or non-basal cell carcinoma, and of skin cancers following non-skin cancers were compared
to the expected numbers (E) derived from the age, sex and calendar period specific
cancer incidence rates in each of the cancer registries (O/E = SIR, standardised incidence ratios). Rates from cancer registries classified to sunny
countries (Australia, Singapore and Spain) and less sunny countries (Canada, Denmark,
Finland, Iceland, Norway, Scotland, Slovenia and Sweden) were compared to each other.
Results
SIR of all second solid primary cancers (except skin and lip) after skin melanoma
were significantly lower for the sunny countries (SIR(S) = 1.03; 95% CI 0.99–1.08) than in the less sunny countries (SIR(L) = 1.14; 95%CI 1.11–1.17). The difference was more obvious after non-melanoma skin cancers:
after basal cell carcinoma SIR(S)/SIR(L) = 0.65 (95%CI = 0.58–0.72); after non-basal cell carcinoma SIR(S)/SIR(L) = 0.58 (95%CI = 0.50–0.67). In sunny countries, the risk of second primary cancer after non-melanoma
skin cancers was lower for most of the cancers except for lip, mouth and non-Hodgkin
lymphoma.
Conclusions
Vitamin D production in the skin seems to decrease the risk of several solid cancers
(especially stomach, colorectal, liver and gallbladder, pancreas, lung, female breast,
prostate, bladder and kidney cancers). The apparently protective effect of sun exposure
against second primary cancer is more pronounced after non-melanoma skin cancers than
melanoma, which is consistent with earlier reports that non-melanoma skin cancers
reflect cumulative sun exposure, whereas melanoma is more related to sunburn.
Keywords
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Article info
Publication history
Published online: May 31, 2007
Accepted:
April 19,
2007
Received in revised form:
April 13,
2007
Received:
February 27,
2007
Identification
Copyright
© 2007 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
