Adalsteinsson J A, Ratner D, Olafsdóttir E, Grant-Kels J, Ungar J, Silverberg J I, Kristjansson A K, Jonasson J G, Tryggvadottir L
University of Iceland, Saemundargata 2, 101 Reykjavik, Iceland.
University of Connecticut Department of Dermatology, 263 Farmington Ave, Farmington, CT, 06003, USA.
Br J Dermatol. 2020 Nov;183(5):847-856. doi: 10.1111/bjd.18937. Epub 2020 Mar 13.
An epidemic of basal cell carcinoma (BCC) has led to a significant healthcare burden in white populations.
To provide an update on incidence rates and tumour burden in an unselected, geographically isolated population that is exposed to a low level of ultraviolet radiation.
This was a whole-population study using a cancer registry containing records of all cases of BCC in 1981-2017. We assessed BCC incidence according to age, residence and multiplicity and assessed trends using join-point analysis. Age-standardized and age-specific incidence rates were calculated along with cumulative and lifetime risks.
During the study period, the age-standardized incidence rates increased from 25·7 to 59·9 for men, and from 22·2 to 83·1 for women (per 100 000). Compared with the single-tumour burden, the total tumour burden in the population was 1·72 times higher when accounting for multiplicity. At the beginning of the study period, the world-standardized rates in men and women were similar, but by the end of the study period the rates were 39% higher in women (83·1 per 100 000, 95% confidence interval 77·9-88·3) than in men (59·9 per 100 000, 95% confidence interval 55·6-64·2). This increase was most prominent in women on sites that are normally not exposed to ultraviolet radiation in Iceland: the trunk and legs.
This is the only reported population in which the incidence of BCC is significantly higher in women than in men. The period of notable increase in BCC lesions correlates with the period of an increase in tanning beds and travel popularity. The high multiplicity rates suggest that the total tumour burden worldwide might be higher than previously thought. What is already known about this topic? Basal cell carcinoma (BCC) is becoming an increasing healthcare burden worldwide, especially in white populations. Recent population studies have reported a rapid increase in incidence among younger individuals, especially women. What does this study add? Iceland is the only reported population in which the incidence of BCC is significantly higher in women than in men, and there does not seem to be a clear relationship between latitude and BCC incidence in Europe. Men might be comparatively protected in the northern low-ultraviolet environment, with tanning beds and travel abroad likely playing important roles in the observed incidence increase, especially in women. The high multiplicity rates suggest that the total tumour burden worldwide might be higher than previously thought. Linked Comment: Pandeya. Br J Dermatol 2020; 183:799-800.
基底细胞癌（BCC）的流行给白人人群带来了巨大的医疗负担。
提供关于一个未经过筛选、地理上孤立且紫外线辐射水平较低的人群中基底细胞癌发病率和肿瘤负担的最新情况。
这是一项全人群研究，使用了一个癌症登记处，其中包含1981 - 2017年所有基底细胞癌病例的记录。我们根据年龄、居住地和肿瘤多发性评估基底细胞癌发病率，并使用连接点分析评估趋势。计算了年龄标准化发病率和年龄特异性发病率以及累积风险和终生风险。
在研究期间，男性的年龄标准化发病率从每10万人25.7例增至59.9例，女性从每10万人22.2例增至83.1例。与单肿瘤负担相比，考虑到多发性时人群中的总肿瘤负担高出1.72倍。在研究期开始时，男性和女性的世界标准化发病率相似，但到研究期结束时，女性发病率（每10万人83.1例，95%置信区间77.9 - 88.3）比男性（每10万人59.9例，95%置信区间55.6 - 64.2）高39%。这种增加在冰岛通常不暴露于紫外线辐射的部位（躯干和腿部）的女性中最为显著。
这是唯一报告的基底细胞癌发病率女性显著高于男性的人群。基底细胞癌皮损显著增加的时期与日光浴床使用增加和旅游流行的时期相关。高多发性率表明全球的总肿瘤负担可能比之前认为的更高。关于该主题已知的信息有哪些？基底细胞癌在全球范围内正成为日益沉重的医疗负担，尤其是在白人人群中。近期的人群研究报告称，年轻个体尤其是女性的发病率迅速上升。本研究补充了什么？冰岛是唯一报告的基底细胞癌发病率女性显著高于男性的人群，而且在欧洲纬度与基底细胞癌发病率之间似乎没有明确关系。在北部低紫外线环境中男性可能相对受到保护，日光浴床的使用和出国旅行可能在观察到的发病率增加中起重要作用，尤其是在女性中。高多发性率表明全球的总肿瘤负担可能比之前认为的更高。相关评论：Pandeya。《英国皮肤病学杂志》2020年；18（3）：799 - 800。
