Cigarette smoking and the risks of basal cell carcinoma and squamous cell carcinoma.
AffiliationDepartment of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia;
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AbstractSunlight is the principal environmental risk factor for keratinocyte cancers, but other carcinogens have also been implicated, including tobacco smoke. Findings have been conflicting however. We investigated associations between cigarette smoking and incidence of BCC or SCC in QSkin, a prospective study of skin cancer (n=43,794). Smoking history was self-reported at baseline; newly diagnosed BCCs and SCCs were ascertained through data linkage and verified by histopathology reports. We restricted analyses to white participants who at baseline reported no past history of skin cancer excisions and no more than 5 destructively-treated actinic skin lesions. We fitted Cox proportional hazards models, adjusted for known confounders. Compared with never smokers, current smokers had significantly lower risks of BCC (HR 0.6; 95% CI, 0.4-0.9) but significantly higher risks of SCC (HR 2.3; 95% CI, 1.5-3.6). Former smokers had similar risks for BCC and SCC as never smokers. Among smokers, we observed no dose-response trends with duration of smoking, intensity or time since quitting. On further analysis, current smokers had fewer skin examinations and procedures than never smokers, suggesting greater opportunities for detection among never smokers. Strengths include large sample size, prospective design and virtually complete follow-up, however histologic details were missing for a proportion of excised tumors. In conclusion, current smokers had lower incidence of BCC (possibly due to detection bias), but higher rates of SCC.
CitationCigarette smoking and the risks of basal cell carcinoma and squamous cell carcinoma. 2017 J. Invest. Dermatol.
JournalThe Journal of Investigative Dermatology