Regular Article

British Journal of Cancer (2001) 85, 683–686. doi:10.1054/bjoc.2001.1931 www.bjcancer.com
Published online 28 August 2001

Non-melanoma skin cancers and glucocorticoid therapy

M R Karagas1, G L Cushing Jr2, E R Greenberg1, L A Mott1, S K Spencer1 and D W Nierenberg1

  1. 1Departments of Community and Family Medicine, Medicine, Pharmacology and Toxicology, and the Norris Cotton Cancer Center, Dartmouth Medical School, Lebanon, New Hampshire, 03756, USA
  2. 2Mount Auburn Hospital, Cambridge, MA, 02238, USA

Received 15 March 2001; Revised 9 May 2001; Accepted 9 May 2001.

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Abstract

Non-melanoma skin cancer (NMSC) is an important cause of morbidity and long-term mortality in organ transplant recipients receiving immunosuppressive drugs such as azathioprine and cyclosporin, often combined with adrenocortical steroids (glucocorticoids). At lower doses, glucocorticoids alone are prescribed for other conditions including musculoskeletal, connective tissue and respiratory disorders. Presently, it is unknown whether patients taking glucocorticoids are at an increased risk of skin malignances. In a population-based case-control study in New Hampshire, USA, we compared use of glucocorticoids in 592 basal cell carcinoma (BCC) and 281 squamous cell carcinoma (SCC) cases and in 532 age and gender matched controls; neither cases nor controls had a history of organ transplantation. Participants underwent a structured personal interview regarding history of medication use and skin cancer risk factors. We used unconditional logistic regression analysis to compute odds ratios associated with glucocorticoid use for 1 month or longer while controlling for potential confounding factors. Risk of SCC was increased among users of oral glucocorticoids (adjusted odds ratio = 2.31; 95% CI = 1.27, 4.18), and risk of BCC was elevated modestly (adjusted odds ratio = 1.49; 95% CI = 0.90, 2.47). In contrast, risk of both SCC and BCC were unrelated to use of inhaled steroids. Our data suggest that use of oral glucocorticoids may increase risk of NMSC, and SCC in particular, among patients other than organ transplant recipients. We hypothesize that immunosuppression induced by oral glucocorticoids may allow these cancers to emerge from immunosurveillance. © 2001 Cancer Research Campaign www.bjcancer.com

Keywords:

non-melanoma skin cancer, squamous cell carcinoma, basal cell carcinoma, glucocorticoids, immunosuppressive therapy, case-control study

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