Dusingize Jean Claude, Olsen Catherine M, Pandeya Nirmala P, Subramaniam Padmini, Thompson Bridie S, Neale Rachel E, Green Adèle C, Whiteman David C
Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia; School of Public Health, University of Queensland, Queensland, Australia.
Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia.
J Invest Dermatol. 2017 Aug;137(8):1700-1708. doi: 10.1016/j.jid.2017.03.027. Epub 2017 Apr 13.
Sunlight is the principal environmental risk factor for keratinocyte cancers, but other carcinogens have also been implicated, including tobacco smoke. Findings have been conflicting, however. We investigated associations between cigarette smoking and incidence of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) in QSkin, a prospective study of skin cancer (N = 43,794). Smoking history was self-reported at baseline; newly diagnosed BCCs and SCCs were ascertained through data linkage and verified by histopathology reports. We restricted analyses to white participants who at baseline reported no past history of skin cancer excisions and no more than five destructively treated actinic skin lesions. We fitted Cox proportional hazards models, adjusted for known confounders. Compared with never smokers, current smokers had significantly lower risks of BCC (hazard ratio = 0.6; 95% confidence interval = 0.4-0.9) but significantly higher risks of SCC (hazard ratio = 2.3; 95% confidence interval = 1.5-3.6). Former smokers had similar risks for BCC and SCC as never smokers. Among smokers, we observed no dose-response trends with duration of smoking, intensity, or time since quitting. On further analysis, current smokers had fewer skin examinations and procedures than never smokers, suggesting greater opportunities for detection among never smokers. Strengths include large sample size, prospective design, and virtually complete follow-up; however, histologic details were missing for a proportion of excised tumors. In conclusion, current smokers had a lower incidence of BCC (possibly because of detection bias) but higher rates of SCC.
阳光是导致角质形成细胞癌的主要环境风险因素，但其他致癌物也被认为与之有关，包括烟草烟雾。然而，研究结果一直存在矛盾。我们在一项皮肤癌前瞻性研究QSkin（N = 43,794）中调查了吸烟与基底细胞癌（BCC）或鳞状细胞癌（SCC）发病率之间的关联。吸烟史在基线时通过自我报告获得；新诊断的BCC和SCC通过数据链接确定，并经组织病理学报告验证。我们将分析限制在基线时报告无皮肤癌切除史且接受过破坏性治疗的光化性皮肤病变不超过5处的白人参与者。我们拟合了Cox比例风险模型，并对已知的混杂因素进行了调整。与从不吸烟者相比，当前吸烟者患BCC的风险显著降低（风险比 = 0.6；95%置信区间 = 0.4 - 0.9），但患SCC的风险显著升高（风险比 = 2.3；95%置信区间 = 1.5 - 3.6）。既往吸烟者患BCC和SCC的风险与从不吸烟者相似。在吸烟者中，我们未观察到吸烟持续时间、强度或戒烟时间的剂量反应趋势。进一步分析发现，当前吸烟者的皮肤检查和治疗程序比从不吸烟者少，这表明从不吸烟者有更多的检测机会。研究的优势包括样本量大、前瞻性设计以及几乎完全的随访；然而，一部分切除肿瘤的组织学细节缺失。总之，当前吸烟者患BCC的发病率较低（可能是由于检测偏倚），但患SCC的发病率较高。
