Trends in incidence of nonmelanoma skin cancers in Alberta, Canada, 1988–2007
G.W. Jung
Division of Dermatology and Cutaneous Sciences, Department of Medicine, University Dermatology Centre, 2-125 Clinical Sciences Building, Edmonton, AB T6G 2G3, Canada
Search for more papers by this authorA.I. Metelitsa
Division of Dermatology and Cutaneous Sciences, Department of Medicine, University Dermatology Centre, 2-125 Clinical Sciences Building, Edmonton, AB T6G 2G3, Canada
Search for more papers by this authorD.C. Dover
Alberta Health and Wellness, Public Health Division, Surveillance and Environmental Health, Edmonton, AB, Canada
Search for more papers by this authorT.G. Salopek
Division of Dermatology and Cutaneous Sciences, Department of Medicine, University Dermatology Centre, 2-125 Clinical Sciences Building, Edmonton, AB T6G 2G3, Canada
Search for more papers by this authorG.W. Jung
Division of Dermatology and Cutaneous Sciences, Department of Medicine, University Dermatology Centre, 2-125 Clinical Sciences Building, Edmonton, AB T6G 2G3, Canada
Search for more papers by this authorA.I. Metelitsa
Division of Dermatology and Cutaneous Sciences, Department of Medicine, University Dermatology Centre, 2-125 Clinical Sciences Building, Edmonton, AB T6G 2G3, Canada
Search for more papers by this authorD.C. Dover
Alberta Health and Wellness, Public Health Division, Surveillance and Environmental Health, Edmonton, AB, Canada
Search for more papers by this authorT.G. Salopek
Division of Dermatology and Cutaneous Sciences, Department of Medicine, University Dermatology Centre, 2-125 Clinical Sciences Building, Edmonton, AB T6G 2G3, Canada
Search for more papers by this authorConflicts of interestNone declared.
Summary
Background Nonmelanoma skin cancer (NMSC) is the most common malignancy affecting caucasian populations and has been seeing global increases in incidence for decades.
Objectives The objective of this study was to determine trends in incidence of NMSC in Alberta, Canada from 1988 to 2007.
Methods A retrospective analysis of patients from Alberta diagnosed with NMSC from 1988 to 2007 inclusive was conducted with data retrieved from the Alberta Cancer Registry (ACR). Sex-, age- and anatomical location-specific incidence rates and trends were examined.
Results From 1988 to 2007, there were 66 192 basal cell carcinomas, 19 959 invasive squamous cell carcinomas (SCC) and 12 494 in situ SCC. ACR coding for the 2007 data was not completed at the time of this study; hence, data from this year were not included in the trend analyses. Incidence of NMSC in women has been stable since 2000 [annual percentage change (APC) 0·08, P = 0·88] and has declined in men since 2001 (APC −1·28, P = 0·026). BCC incidence has been stable since 2000 (APC −0·80, P = 0·09). In situ and invasive SCC also showed a trend towards stabilization in 2000 (APC 0·36, P = 0·77) and 1995 (APC 0·01, P = 0·98), respectively. NMSC primarily affects the elderly and is rarely seen in individuals before the age of 40 years. Although the head and neck region was the location most often involved with NMSC (71·1%), it revealed a stabilizing trend, whereas most other anatomical regions demonstrated an increasing NMSC incidence rate.
Conclusions NMSC incidence in Alberta has stabilized in women and declined in men. As 95–99% of NMSC occurs in patients aged 40 years or older, and with its increased frequency in traditionally clothed areas, the authors recommend regular complete skin examinations starting at 40 years of age.
References
- 1 Ishihara K, Saida T, Otsuka F et al. Statistical profiles of malignant melanoma and other skin cancers in Japan: 2007 update. Int J Clin Oncol 2008; 13: 33–41.
- 2
Buettner PG,
Raasch BA.
Incidence rates of skin cancer in Townsville, Australia.
Int J Cancer
1998; 78: 587–93.
10.1002/(SICI)1097-0215(19981123)78:5<587::AID-IJC10>3.0.CO;2-E CAS PubMed Web of Science® Google Scholar
- 3 Katalinic A, Kunze U, Schafer T. Epidemiology of cutaneous melanoma and non-melanoma skin cancer in Schleswig-Holstein, Germany: incidence, clinical subtypes, tumour stages and localization (epidemiology of skin cancer). Br J Dermatol 2003; 149: 1200–6.
- 4 De Vries E, Van De Poll-Franse LV, Louwman WJ et al. Predictions of skin cancer incidence in the Netherlands up to 2015. Br J Dermatol 2005; 152: 481–8.
- 5 Boi S, Cristofolini M, Micciolo R et al. Epidemiology of skin tumors: data from the cutaneous cancer registry in Trentino, Italy. J Cutan Med Surg 2003; 7: 300–5.
- 6 K Wolff, LA Goldsmith, SI Katz et al. (eds). Fitzpatrick’s Dermatology in General Medicine, 7th edn. New York City: McGraw-Hill Professional, Inc., 2007.
- 7 Gallagher RP, Ma B, McLean DI et al. Trends in basal cell carcinoma, squamous cell carcinoma, and melanoma of the skin from 1973 through 1987. J Am Acad Dermatol 1990; 23: 413–21.
- 8 Kricker A, Armstrong BK, English DR, Heenan PJ. Does intermittent sun exposure cause basal cell carcinoma? A case–control study in western Australia. Int J Cancer 1995; 60: 489–94.
- 9 Kricker A, Armstrong BK, English DR, Heenan PJ. A dose–response curve for sun exposure and basal cell carcinoma. Int J Cancer 1995; 60: 482–8.
- 10 Gallagher RP, Hill GB, Bajdik CD et al. Sunlight exposure, pigmentation factors, and risk of nonmelanocytic skin cancer. II. Squamous cell carcinoma. Arch Dermatol 1995; 131: 164–9.
- 11 Gallagher RP, Hill GB, Bajdik CD et al. Sunlight exposure, pigmentary factors, and risk of nonmelanocytic skin cancer I. Basal cell carcinoma. Arch Dermatol 1995; 131: 157–63.
- 12 Marcil I, Stern RS. Risk of developing a subsequent nonmelanoma skin cancer in patients with a history of nonmelanoma skin cancer: a critical review of the literature and meta-analysis. Arch Dermatol 2000; 136: 1524–30.
- 13 Kricker A, Armstrong BK, English DR, Heenan PJ. Pigmentary and cutaneous risk factors for non-melanocytic skin cancer – a case–control study. Int J Cancer 1991; 48: 650–62.
- 14 Hogan DJ, To T, Gran L et al. Risk factors for basal cell carcinoma. Int J Dermatol 1989; 28: 591–4.
- 15 Herity B, O’Loughlin G, Moriarty MJ, Conroy R. Risk factors for non-melanoma skin cancer. Ir Med J 1989; 82: 151–2.
- 16 Imai S. The prognosis of skin carcinoma and malignant melanoma with special reference to their extents as represented in terms of T, N, and M of union internationale contre le cancer (UICC). J Dermatol 1976; 3: 147–54.
- 17 Staples MP, Elwood M, Burton RC et al. Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985. Med J Aust 2006; 184: 6–10.
- 18 Stang A, Stausberg J, Boedeker W et al. Nationwide hospitalization costs of skin melanoma and non-melanoma skin cancer in Germany. J Eur Acad Dermatol Venereol 2008; 22: 65–72.
- 19 Chen JG, Fleischer AB Jr, Smith ED et al. Cost of nonmelanoma skin cancer treatment in the United States. Dermatol Surg 2001; 27: 1035–8.
- 20 Koh D, Wang H, Lee J et al. Basal cell carcinoma, squamous cell carcinoma and melanoma of the skin: analysis of the Singapore Cancer Registry data 1968–97. Br J Dermatol 2003; 148: 1161–6.
- 21 Demers AA, Nugent Z, Mihalcioiu C et al. Trends of nonmelanoma skin cancer from 1960 through 2000 in a Canadian population. J Am Acad Dermatol 2005; 53: 320–8.
- 22 Hayes RC, Leonfellner S, Pilgrim W et al. Incidence of nonmelanoma skin cancer in New Brunswick, Canada, 1992–2001. J Cutan Med Surg 2007; 11: 45–52.
- 23
Karagas MR,
Greenberg ER,
Spencer SK
et al.
Increase in incidence rates of basal cell and squamous cell skin cancer in New Hampshire, USA. New Hampshire Skin Cancer Study Group.
Int J Cancer
1999; 81: 555–9.
10.1002/(SICI)1097-0215(19990517)81:4<555::AID-IJC9>3.0.CO;2-R CAS PubMed Web of Science® Google Scholar
- 24
Dahl E,
Aberg M,
Rausing A,
Rausing EL.
Basal cell carcinoma. An epidemiologic study in a defined population.
Cancer
1992; 70: 104–8.
10.1002/1097-0142(19920701)70:1<104::AID-CNCR2820700117>3.0.CO;2-0 PubMed Web of Science® Google Scholar
- 25 Wassberg C, Thorn M, Johansson AM et al. Increasing incidence rates of squamous cell carcinoma of the skin in Sweden. Acta Derm Venereol 2001; 81: 268–72.
- 26 Brewster DH, Bhatti LA, Inglis JH et al. Recent trends in incidence of nonmelanoma skin cancers in the East of Scotland, 1992–2003. Br J Dermatol 2007; 156: 1295–300.
- 27 Hannuksela-Svahn A, Pukkala E, Karvonen J. Basal cell skin carcinoma and other nonmelanoma skin cancers in Finland from 1956 through 1995. Arch Dermatol 1999; 135: 781–6.
- 28 Health Statistics Division. Cancer Incidence in Canada – 2004 to 2005. Ottawa: Statistics Canada, 2005. Available at: http://dsp-psd.pwgsc.gc.ca/Collection/Statcan/82-231-X/82-231-XIE.html (last accessed 21 April 2010).
- 29 Metelitsa AI, Dover DC, Smylie M et al. A population-based study of cutaneous melanoma in Alberta (1993–2002). J Am Acad Dermatol 2010; 62: 227–32.
- 30 Statistics Canada. Population by Sex and Age Group, by Province and Territory. Ottawa: Statistics Canada, 2009. Available at: http://www40.statcan.gc.ca/l01/cst01/demo31a-eng.htm (last accessed 21 April 2010).
- 31 Alberta Cancer Board and Foundation. (2008) What is the Alberta Cancer Registry? Edmonton: Alberta Cancer Board Foundation, 2008. Available at: http://www.cancerboard.ab.ca/CancerAlberta/AlbertaCancerRegistry/ (last accessed 21 April 2010).
- 32
Kim HJ,
Fay MP,
Feuer EJ,
Midthune DN.
Permutation tests for joinpoint regression with applications to cancer rates.
Stat Med
2000; 19: 335–51.
10.1002/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z CAS PubMed Web of Science® Google Scholar
- 33 Wun LM, Merrill RM, Feuer EJ. Estimating lifetime and age-conditional probabilities of developing cancer. Lifetime Data Anal 1998; 4: 186–96.
- 34 Harris RB, Griffith K, Moon TE. Trends in the incidence of nonmelanoma skin cancers in Southeastern Arizona, 1985–1996. J Am Acad Dermatol 2001; 45: 528–36.
- 35 Hoey SE, Devereux CE, Murray L et al. Skin cancer trends in Northern Ireland and consequences for provision of dermatology services. Br J Dermatol 2007; 156: 1301–7.
- 36 Miller DL, Weinstock MA. Nonmelanoma skin cancer in the United States: incidence. J Am Acad Dermatol 1994; 30: 774–8.
- 37 Statistics Canada. Proportion of Foreign-Born Population, by Province and Territory (1991 to 2001 Censuses). Ottawa: Statistics Canada, 2005. Available at: http://www40.statcan.ca/l01/cst01/demo46a-eng.htm (last accessed 21 April 2010).
- 38 Statistics Canada. 2006 Census: Immigration in Canada: A Portrait of the Foreign-Born Population, 2006 Census: Highlights. Ottawa: Statistics Canada, 2009. Available at: http://www12.statcan.ca/census-recensement/2006/as-sa/97-557/p1-eng.cfm (last accessed 21 April 2010).
- 39 Montague M, Borland R, Sinclair C. Slip! slop! slap! and SunSmart, 1980–2000: skin cancer control and 20 years of population-based campaigning. Health Educ Behav 2001; 28: 290–305.
- 40
Rivers JK,
Gallagher RP.
Public education projects in skin cancer. Experience of the Canadian Dermatology Association.
Cancer
1995; 75: 661–6.
10.1002/1097-0142(19950115)75:2+<661::AID-CNCR2820751408>3.0.CO;2-2 CAS PubMed Web of Science® Google Scholar
- 41 Mogensen M, Jemec GB. Diagnosis of nonmelanoma skin cancer/keratinocyte carcinoma: a review of diagnostic accuracy of nonmelanoma skin cancer diagnostic tests and technologies. Dermatol Surg 2007; 33: 1158–74.
- 42 Holme SA, Malinovszky K, Roberts DL. Changing trends in non-melanoma skin cancer in South Wales, 1988–98. Br J Dermatol 2000; 143: 1224–9.
- 43 Leiter U, Garbe C. Epidemiology of melanoma and nonmelanoma skin cancer – the role of sunlight. Adv Exp Med Biol 2008; 624: 89–103.
- 44 Rosso S, Zanetti R, Martinez C et al. The multicentre South European study ‘Helios’ II: different sun exposure patterns in the aetiology of basal cell and squamous cell carcinomas of the skin. Br J Cancer 1996; 73: 1447–54.
- 45 Jorgensen CM, Wayman J, Green C, Gelb CA. Using health communications for primary prevention of skin cancer: CDC’s choose your cover campaign. J Womens Health Gend Based Med 2000; 9: 471–5.
- 46 Boldeman C, Branstrom R, Dal H et al. Tanning habits and sunburn in a Swedish population age 13–50 years. Eur J Cancer 2001; 37: 2441–8.
- 47 Demko CA, Borawski EA, Debanne SM et al. Use of indoor tanning facilities by white adolescents in the United States. Arch Pediatr Adolesc Med 2003; 157: 854–60.
- 48 Statistics Canada. Employment by Industry and Sex. Ottawa: Statistics Canada, 2009. Available at: http://www40.statcan.gc.ca/l01/cst01/labor10a-eng.htm (last accessed 21 April 2010).
- 49 Edlich RF, Winters KL, Cox MJ et al. National health strategies to reduce sun exposure in Australia and the United States. J Long Term Eff Med Implants 2004; 14: 215–24.
- 50 Christenson LJ, Borrowman TA, Vachon CM et al. Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA 2005; 294: 681–90.
- 51 Robinson JK, Rigel DS, Amonette RA. Trends in sun exposure knowledge, attitudes, and behaviors: 1986 to 1996. J Am Acad Dermatol 1997; 37: 179–86.
