Skip to main content
  • AACR Publications
    • Blood Cancer Discovery
    • Cancer Discovery
    • Cancer Epidemiology, Biomarkers & Prevention
    • Cancer Immunology Research
    • Cancer Prevention Research
    • Cancer Research
    • Clinical Cancer Research
    • Molecular Cancer Research
    • Molecular Cancer Therapeutics

AACR logo

  • Register
  • Log in
  • My Cart
Advertisement

Main menu

  • Home
  • About
    • The Journal
    • AACR Journals
    • Subscriptions
    • Permissions and Reprints
    • Reviewing
  • Articles
    • OnlineFirst
    • Current Issue
    • Past Issues
    • CEBP Focus Archive
    • Meeting Abstracts
    • Progress and Priorities
    • Collections
      • COVID-19 & Cancer Resource Center
      • Disparities Collection
      • Editors' Picks
      • "Best of" Collection
  • For Authors
    • Information for Authors
    • Author Services
    • Best of: Author Profiles
    • Informing Public Health Policy
    • Submit
  • Alerts
    • Table of Contents
    • Editors' Picks
    • OnlineFirst
    • Citation
    • Author/Keyword
    • RSS Feeds
    • My Alert Summary & Preferences
  • News
    • Cancer Discovery News
  • COVID-19
  • Webinars
  • Search More

    Advanced Search

  • AACR Publications
    • Blood Cancer Discovery
    • Cancer Discovery
    • Cancer Epidemiology, Biomarkers & Prevention
    • Cancer Immunology Research
    • Cancer Prevention Research
    • Cancer Research
    • Clinical Cancer Research
    • Molecular Cancer Research
    • Molecular Cancer Therapeutics

User menu

  • Register
  • Log in
  • My Cart

Search

  • Advanced search
Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
  • Home
  • About
    • The Journal
    • AACR Journals
    • Subscriptions
    • Permissions and Reprints
    • Reviewing
  • Articles
    • OnlineFirst
    • Current Issue
    • Past Issues
    • CEBP Focus Archive
    • Meeting Abstracts
    • Progress and Priorities
    • Collections
      • COVID-19 & Cancer Resource Center
      • Disparities Collection
      • Editors' Picks
      • "Best of" Collection
  • For Authors
    • Information for Authors
    • Author Services
    • Best of: Author Profiles
    • Informing Public Health Policy
    • Submit
  • Alerts
    • Table of Contents
    • Editors' Picks
    • OnlineFirst
    • Citation
    • Author/Keyword
    • RSS Feeds
    • My Alert Summary & Preferences
  • News
    • Cancer Discovery News
  • COVID-19
  • Webinars
  • Search More

    Advanced Search

Letters to the Editor

Primary Malignancy in Patients with Nonmelanoma Skin Cancer—Response

Eugene Liat Hui Ong, Raph Goldacre and Michael Goldacre
Eugene Liat Hui Ong
Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: Eugene@tutemate.com
Raph Goldacre
Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael Goldacre
Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
DOI: 10.1158/1055-9965.EPI-14-0355 Published July 2014
  • Article
  • Info & Metrics
  • PDF
Loading

Our recent study (1) is the largest of many of different designs aimed at investigating the relationship between Nonmelanoma skin cancer (NMSC) and subsequent primary malignancies. Our results are in line with the most comprehensive systematic review on this relationship: it reported significantly increased overall relative risks in 15 of its 21 studies (2).

It is true that we were unable to adjust for smoking, BMI (as a marker of dietary fat intake), alcohol intake and UV exposure. However, cohort studies adjusting for individual level data on smoking, alcohol, BMI, skin color, and a number of other risk factors (3, 4) also show an increased cancer risk after NMSC.

In his own meta-analysis (5), Grant adjusts for the relative risk of lung cancer as a crude proxy for smoking, despite the lack of definitive evidence linking smoking with NMSC. He states that the decreased risks he finds for four cancers after NMSC are “nearly direct evidence that solar UVB reduces the risk of many internal cancers” with, he postulates, the likely mechanism being increased production of vitamin D. There is, however, a lack of high-quality evidence showing a low risk of other cancers after NMSC. A more robust methodology than that in Grant's study, and greater consistency of results showing low cancer rates associated with NMSC, would be needed to support his claim about UBV and the risk of cancer.

The hypothesis that NMSC is a marker of increased vitamin D status, and that increased vitamin D status reduces the risk of internal malignancies, is not completely precluded by our results (1). However, if such hypothesized protective effects are real, their effects seem to be far outweighed by the increased risks associated with having an NMSC. The balance of available evidence points strongly in favor of the multiple primary cancers model, in which NMSC is associated with an increased risk of a range of other malignancies.

See the original Letter to the Editor, p. 1438

Disclosure of Potential Conflicts of Interest

No potential conflicts of interest were disclosed.

  • Received April 2, 2014.
  • Accepted April 3, 2014.
  • ©2014 American Association for Cancer Research.

References

  1. 1.↵
    1. Ong ELH,
    2. Goldacre R,
    3. Hoang U,
    4. Sinclair R,
    5. Goldacre M
    . Subsequent primary malignancies in patients with nonmelanoma skin cancer in England: a national record-linkage study. Cancer Epidemiol Biomarkers Prev 2014;23:490–8.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Wheless L,
    2. Black J,
    3. Alberg AJ
    . Nonmelanoma skin cancer and the risk of second primary cancers: a systematic review. Cancer Epidemiol Biomarker Prev 2010;19:1686–95.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Efird JT,
    2. Friedman GD,
    3. Habel L,
    4. Tekawa IS,
    5. Nelson LM
    . Risk of subsequent cancer following invasive or in situ squamous cell skin cancer. Ann Epidemiol 2002;12:469–75.
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Friedman GD,
    2. Tekawa IS
    . Association of basal cell skin cancers with other cancers (United States). Cancer Causes Control 2000;11:891–7.
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. Grant WB
    . A meta-analysis of second cancers after a diagnosis of nonmelanoma skin cancer: additional evidence that solar ultraviolet-B irradiance reduces the risk of internal cancers. J Steroid Biochem Mol Biol 2007;103:668–74.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top
Cancer Epidemiology Biomarkers & Prevention: 23 (7)
July 2014
Volume 23, Issue 7
  • Table of Contents
  • Table of Contents (PDF)

Sign up for alerts

View this article with LENS

Open full page PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for sharing this Cancer Epidemiology, Biomarkers & Prevention article.

NOTE: We request your email address only to inform the recipient that it was you who recommended this article, and that it is not junk mail. We do not retain these email addresses.

Enter multiple addresses on separate lines or separate them with commas.
Primary Malignancy in Patients with Nonmelanoma Skin Cancer—Response
(Your Name) has forwarded a page to you from Cancer Epidemiology, Biomarkers & Prevention
(Your Name) thought you would be interested in this article in Cancer Epidemiology, Biomarkers & Prevention.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Primary Malignancy in Patients with Nonmelanoma Skin Cancer—Response
Eugene Liat Hui Ong, Raph Goldacre and Michael Goldacre
Cancer Epidemiol Biomarkers Prev July 1 2014 (23) (7) 1439; DOI: 10.1158/1055-9965.EPI-14-0355

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Primary Malignancy in Patients with Nonmelanoma Skin Cancer—Response
Eugene Liat Hui Ong, Raph Goldacre and Michael Goldacre
Cancer Epidemiol Biomarkers Prev July 1 2014 (23) (7) 1439; DOI: 10.1158/1055-9965.EPI-14-0355
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Disclosure of Potential Conflicts of Interest
    • References
  • Info & Metrics
  • PDF
Advertisement

Related Articles

Cited By...

More in this TOC Section

  • Genome-wide Analysis of Common Copy Number Variation and Epithelial Ovarian Cancer Risk—Response
  • Copy Number Variation and Ovarian Cancer Risk—Letter
  • Shift Work, Chronotype, and Cancer Risk—Response
Show more Letters to the Editor
  • Home
  • Alerts
  • Feedback
  • Privacy Policy
Facebook   Twitter   LinkedIn   YouTube   RSS

Articles

  • Online First
  • Current Issue
  • Past Issues

Info for

  • Authors
  • Subscribers
  • Advertisers
  • Librarians

About Cancer Epidemiology, Biomarkers & Prevention

  • About the Journal
  • Editorial Board
  • Permissions
  • Submit a Manuscript
AACR logo

Copyright © 2021 by the American Association for Cancer Research.

Cancer Epidemiology, Biomarkers & Prevention
eISSN: 1538-7755
ISSN: 1055-9965

Advertisement