High sun exposure before the age of 30 was a major predictor, as was a history of eczema. Martin Weinstock and colleagues reported their findings online July 19 in the Journal of Investigative Dermatology.
In the powerful sunlight of July, newly published results from a large study of people at high risk for basal cell carcinoma support the emerging view of the nation’s most common cancer as a chronic ailment that often repeatedly afflicts older people but for which the seeds may be planted in youth. The research also found a new association with eczema.
“Basal cell carcinoma is a chronic disease once people have had multiple instances of it, because they are always at risk of getting more,” said Dr. Martin Weinstock, professor of dermatology in the Warren Alpert Medical School of Brown University, who practices at the Providence Veterans Affairs Medical Center. “It’s not something at the moment we can cure. It’s something that we need to monitor continually so that when these cancers crop up we can minimize the damage.”
Dermatologists hold out hope for a medication that will help prevent recurrences of BCC. To test one such medicine, Weinstock chaired the six-site, six-year VA Topical Tretinoin Chemoprevential Trial, which last year found that the skin medication failed to prevent further instances of BCC in high-risk patients.
Weinstock is the corresponding author of the new study, published online July 19 in the Journal of Investigative Dermatology, which presents an analysis of the risk predictors of BCC recurrence found among the trial’s population of 1,131 people, all of whom were veterans, 97 percent of whom were men, and whose median age was 72. On average, a participant had more than three episodes of BCC or squamous cell carcinoma before entering the study.
History, eczema, and early exposure
Overall, 44 percent of study participants developed new BCCs during the study period. The biggest predictor of another bout with BCC after three to four years of follow-up was a prior history of them. The 129 participants who had more than five BCCs in the five years before the study had a hazard rate ratio that was nearly four times as high as that of the 204 people who had none or one and more than twice as high that of the 200 people who had three.
Eczema was another predictor of BCC recurrence in the study’s high-risk group. Participants who acknowledged a family history of the skin condition had a hazard rate ratio 1.54 times higher than people who did not, after statistical adjustments.
“We don’t know why this is,” Weinstock said. “The connection with eczema is something that’s new, that needs to be further explored.”
Age was another predictor, and not just in providing further confirmation that the risk people face increases with age. The study also showed that particularly intense sun exposure before the age of 30 was a strong a predictor of BCC occurrence among the high-risk study population, even though for most of them their 30s were decades ago.
“We talk about sun protection, which is important, but that’s something for basal cell that’s most important in your youth,” Weinstock said. “While we don’t exonerate UV exposure in one’s 40s, 50s, and 60s, it was particularly UV exposure before the age of 30 that was most closely related to BCC in our study.”
Awaiting a new trial
If limiting UV exposure is most crucial before the age of 30, what can doctors do for older people who may be headed for multiple bouts with BCC?
“Right now we have this wait and cut approach,” he said. “We know these people are at high risk and we know that most of them are going to get more.”
A better solution comes back to finding and testing preventive medication. Tretinoin didn’t work, but Weinstock said he and his colleagues are testing another called 5-Fluorouracil. He said he is optimistic but has not yet seen the data from a trial that began about three years ago.
Robert Dyer of the Providence VA Medical Center and Brown University was the study’s lead author. In addition to Dyer and Weinstock, other authors on the paper are Tobias Cohen, Amilcar Rizzo, Stephen Brigham and the VATTC Trial Group.
The U.S. Department of Veterans Affairs Co-operative Studies Program funded the research.
Editors: Brown University has a fiber link television studio available for domestic and international live and taped interviews, and maintains an ISDN line for radio interviews. For more information, call (401) 863-2476.
David Orenstein | EurekAlert!
A promising target for kidney fibrosis
21.04.2017 | Brigham and Women's Hospital
Stem cell transplants: activating signal paths may protect from graft-versus-host disease
20.04.2017 | Technische Universität München
The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.
Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...
The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...
Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.
Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...
Two researchers at Heidelberg University have developed a model system that enables a better understanding of the processes in a quantum-physical experiment...
Glaciers might seem rather inhospitable environments. However, they are home to a diverse and vibrant microbial community. It’s becoming increasingly clear that they play a bigger role in the carbon cycle than previously thought.
A new study, now published in the journal Nature Geoscience, shows how microbial communities in melting glaciers contribute to the Earth’s carbon cycle, a...
20.04.2017 | Event News
18.04.2017 | Event News
03.04.2017 | Event News
21.04.2017 | Physics and Astronomy
21.04.2017 | Health and Medicine
21.04.2017 | Physics and Astronomy