Modifiable Risk-factors for Keratinocyte Cancers in Australia: A Case-control Study
Lina Maria Serna-Higuita, Simone L. Harrison, Petra Buttner, Margaret Glasby, Beverly A. Raasch, Angelika Iftner, Claus Garbe, Peter Martus, Thomas Iftner
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Keratinocyte cancer (KC) is the most common malignancy in Caucasians. The incidence of KC has increased over the past 40 years. This case-control study investigated the environmental and host risk-factors responsible for development of KC in Australia’s high-risk population. Cases were immune-competent adults from Townsville, Australia (19.3°S) who had a new basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) histologically-confirmed during 2004 to 2009. Cases were age-matched (±5 years) to immunocompetent, community-based controls from Townsville with no prior history of KC. Binary logistic regression was performed to evaluate correlation between KC, sun exposure and other potential risk-factors. A total of 112 cases of SCC, 95 cases of BCC and 122 controls were analysed. Freckling during adolescence (SCC: odds ratio (OR) = 1.04, p < 0.01; BCC: OR = 1.05, p < 0.01), propensity to sunburn (SCC: OR = 2.75, p = 0.01, BCC: OR = 2.68 p = 0.01) and high cumulative sun-exposure (SCC: OR = 2.43, p = 0.04; BCC: OR = 2.36 p = 0.04) were independent risk-factors for both SCC and BCC. Solar lentigines (SCC: OR = 1.02, p = 0.01), and lower academic qualifications (OR = 2.35, p = 0.01) were also risk factors for SCC. No significant differences were found for gender [AQ1], history of internal cancers, smoking, alcohol consumption, diet or sun-protective practices. This study provides further evidence that a sun-sensitive phenotype and excessive sun-exposure during adulthood contribute to the risk of developing KC. Wearing a hat, long-sleeved shirts, and sunscreen did not significantly reduce the risk of KC in this study.