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BMC Cancer

, 14:210

Epidemiology, prevention and public health


BackgroundSkin cancer survivors experience an increased risk for subsequent malignancies but the associated risk factors are poorly understood. This study examined the risk of a new primary cancer following an initial skin cancer and assessed risk factors associated with second primary cancers.

MethodsAll invasive cutaneous malignant melanomas CMM, N = 28 069 and squamous cell carcinomas SCC, N = 24 620 diagnosed in Norway during 1955–2008 were included. Rates of new primary cancers in skin cancer survivors were compared to rates of primary malignancies in the general population using standardized incidence ratios SIR. Discrete-time logistic regression models were applied to individual-level data to estimate cancer risk among those with and without a prior skin cancer, accounting for residential region, education, income, parenthood, marital status and parental cancer status, using a 20% random sample of the entire Norwegian population as reference. Further analyses of the skin cancer cohort were undertaken to determine risk factors related to subsequent cancers.

ResultsDuring follow-up, 9608 new primary cancers occurred after an initial skin cancer. SIR analyses showed 50% and 90% increased risks for any cancer after CMM and SCC, respectively p < 0.01. The logistic regression model suggested even stronger increase after SCC 130%. The highest risk was seen for subsequent skin cancers, but several non-skin cancers were also diagnosed in excess: oral, lung, colon, breast, prostate, thyroid, leukemia, lymphoma and central nervous system. Factors that were associated with increased risk of subsequent cancers include male sex, older age, lower residential latitude, being married and low education and income. Parental cancer did not increase the risk of a subsequent cancer after SCC, but was a significant predictor among younger CMM survivors.

ConclusionsOur results provide information on shared environmental and genetic risk factors for first and later cancers and may help to identify individuals at high risk for subsequent cancers, which will be important as skin cancer incidence continues to rise.

KeywordsMalignant Melanoma Squamous Cell Carcinoma Second cancer Population-based Sociodemographic factors Family AbbreviationsCMMCutaneous malignant melanoma

SCCSquamous cell carcinoma

UVRUltraviolet radiation

CNSCentral nervous system

CIConfidence interval

OROdds ratio


SIRStandardized incidence ratio

OObserved number of cancer cases

N-ANot applicable


BMIBody mass index kg-m.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-14-210 contains supplementary material, which is available to authorized users.

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Autor: Trude E Robsahm - Margaret R Karagas - Judy R Rees - Astri Syse


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