Differential cancer registration again seems unlikely to explain these differences, as cancer registries would have had to have differentially recorded site-specific cutaneous cancers in current smokers. The most striking findings of this study are the opposite smoking-associated RRs by tumour type, with SCCs positively associated and BCCs negatively associated with smoking, and the substantial variation between anatomical sites in the magnitudes of these two associations.
All calculations used Stata version Relevant publications from prospective studies were identified by reviewing articles and by a literature search using PubMed, up to June 30, The systematic search strategy and findings from it are given in Supplementary Information. We found that current smokers were at slightly increased overall risk of cutaneous SCC but at slightly reduced overall risk of cutaneous BCC. About a third of the cutaneous SCCs and two thirds of the cutaneous BCCs with a specified site were on the face, and smoking appeared to have little association with either RRs 0.
Information Alison doody smoking data access for the Million Women Study is available at www.
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It is possible, however, that health-seeking never-smokers may be more likely than current smokers to have their skin checked, which would result in lower incidence of BCC in smokers, particularly for less visible anatomical sites where the tumour may have otherwise have gone unnoticed, 19 but this would not explain the increased incidence for SCC of the limbs in smokers compared to never-smokers. Published findings on the associations between smoking and the incidence of cutaneous squamous cell carcinoma SCC and basal cell carcinoma BCC are inconsistent.
Relative risk RR of squamous cell and basal cell carcinoma of the skin by smoking status reported at recruitment. Although rarely fatal, cutaneous squamous cell and basal cell carcinomas SCC and BCC, respectively are among the most common types of cancer in sun-exposed white populations. The distributions of SCCs and of BCCs on different parts of the body in women in this study are similar to those reported in national cancer registry statistics for all women aged 45—74 years in England Supplementary Table 2. Among women who completed the resurvey questionnaires asking about sun exposure and sensitivity to the sun, current smokers were more likely than never-smokers to report that they tanned easily and to have ever regularly used a sunbed, whereas there was little difference by eye or hair colour.
Materials and methods In —, participants were recruited into the Million Women Study through the National Health Service NHS Breast Screening Programme and gave ed consent for follow-up when completing a questionnaire about lifestyle, medical and socio-demographic factors. Only 1 current smoker and 1 never-smoker had a basal cell carcinoma coded to ICD C Smoking is associated with an increased risk of SCC registered as C As there were relatively few cases of lip cancer, the RRs for all SCCs and for all BCCs remain essentially unchanged if cancers of the lip are excluded 1.
Relative risk of squamous cell Alison doody smoking and basal cell carcinoma of the skin for current smokers versus never-smokers as reported at the year survey, with various adjustments. Learn More.
RRs varied substantially by anatomical site; for the limbs, current smoking was associated with an increased incidence of SCC 1. Their characteristics are compared in Table 1. of amount smoked were defined using information reported at recruitment. Women were followed for an average of Alison doody smoking The mean time from recruitment to diagnosis was 10 SD 5 years. Statistical analysis The effects of smoking were assessed for each anatomic site, and for any site, for the first incident SCC and first incident BCC.
Meta-analysis of prospective studies Relevant publications from prospective studies were identified by reviewing articles and by a literature search using PubMed, up to June 30, The systematic search strategy and findings from it are given in Supplementary Information. After additional adjustment for hair colour, eye colour, moles, freckles, tendency to burn or tan, regular sunbed use and of recent holidays in sunny places, the excess of SCC and ificant deficit of BCC both remained, but the non-ificant RR for SCC was slightly increased from 1.
Only two other reports gave for BCC by anatomical site and their findings are consistent with those reported here. Published online Jun Heath1 Jane Green1 Gillian K. Green 3, 5.
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For each variable, missing values formed a separate category. Questionnaire information about smoking and other factors was recorded at recruitment — and every 3—5 years subsequently. To assess the effect of potential confounding by changes in smoking and by hair colour, eye colour, freckles, moles, tendency to tan or burn, regular sunbed use and recent sun exposure, analyses were repeated among thestudy participants who responded to the year resurvey and had known smoking status and no prior cancer including SCC or BCC.
All adjustment variables were based on responses to the year survey, apart from hair colour which used information from the 8-year survey.
In our systematic review, we identified seven other prospective studies 4 — 6891617 that had reported on the risk of incident cutaneous SCC or BCC separately in current smokers and in ex-smokers versus never-smokers Supplementary Figure 3. Conclusions Smoking-associated risks for cutaneous SCC and BCC are in the opposite direction to each other and appear to vary by anatomical site.
Residual confounding thus seems unlikely to for these strongly divergent smoking-associated risks, particularly for lesions of the limbs, where there are substantial excesses for SCC and substantial deficits for BCC RRs of 1. Corresponding author. We aimed to generate prospective evidence on these relationships overall and by anatomical site. For the main analyses, Cox proportional hazards models with time in the study as the underlying time variable yielded adjusted incidence rate ratios RRs, also referred to as relative risks that compare various of smokers or ex-smokers to never-smokers, using smoking status reported at recruitment.
Tests for interaction between smoking and each variable listed above were done using likelihood ratio tests, comparing models with and without an interaction term. For example, smoking has a ificantly greater effect for SCCs than adenocarcinomas of the lung, 20 of Alison doody smoking cervix 21 and of the anus. The effects of smoking were assessed for each anatomic site, and for any site, for the first incident SCC and first incident BCC.
The remaining 1, women contributed person-years until 1. The few women 1. After exclusion of women with cancer and unknown smoking status 1, remained, on average born in interquartile range — and recruited in range — at age 56 SD 5 years. By contrast, current smokers have increased incidence of SCC of the limbs but reduced incidence of BCC of the limbs and trunk.
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As this study includes women only, may not be generalisable to men. Furthermore, smoking has generally been found to cause greater increases in the incidence of SCC than of other types of carcinoma, similar to the findings here for skin cancer. It is well established that smoking-related risks for cancers of other organs can vary by tumour type.
Introduction Although rarely fatal, cutaneous squamous cell and basal cell carcinomas SCC and BCC, respectively are among the most common types of cancer in sun-exposed white populations. To assess the role of confounding by hair and eye colour and by various measures of sun exposure and sensitivity to the sun, the main analyses were repeated amongwomen who provided information on these factors at the year resurvey in — and had no prior cancer at this time; Fig.
Women who completed this resurvey were aged 68 SD 5 years on average, and during 3. Meta-analysis of the Alison doody smoking this and seven other prospective studies also showed opposite associations of smoking with SCCs and with BCCs but were largely dominated by the of this study. Relative risk of squamous cell and basal cell carcinoma of the skin for the current smokers versus never-smokers by anatomical site.
Methods We followed 1, women without prior cancer by electronic linkage to national cancer registration data.
While sun exposure is an important cause of both types of cutaneous cancer, current smoking is also associated with the risk of these cancers. Meta-analysis of prospective studies for current smokers versus never-smokers. This article has been cited by other articles in PMC.
Associated Data Supplementary Materials Supplementary material. We followed 1, women without prior cancer by electronic linkage to national cancer registration data. To provide reliable epidemiological evidence about the associations between smoking and the incidence of cutaneous SCC and BCC, overall and by anatomical site, we present new data from a large prospective study of UK women, and we update meta-analyses. Cox regression yielded adjusted relative risks RRs comparing smokers versus never-smokers.
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Summary RRs, combining study-specificwere calculated as weighted averages, with each weight proportional to the inverse of the variance of the study-specific log RR. Chi-squared tests assess heterogeneity across studies. Tumour distributions by anatomical site are similar to those for women aged 45—74 years in England in — Supplementary Table 1. All analyses were routinely adjusted for the ten UK cancer registration regions that were in place when the women were recruited: one covering Scotland and 9 in England although since then two English registries have merged.
By contrast, for lesions on the limbs current smoking was associated with a ificantly increased risk for SCC and a ificantly decreased risk for BCC RRs 1. Supplementary information is available for this paper at National Center for Biotechnology InformationU. Journal List Br J Cancer v. Findings in meta-analyses of from this and seven other prospective studies were largely dominated by the findings in this study. Additional adjustments for these factors were done in sensitivity analyses among women who completed the year resurvey see below. In the subset who answered questions after recruitment about hair colour, eye colour, moles, freckles, regular Alison doody smoking use, recent holidays in sunny places and tendency to burn or tan, the associations of smoking with SCCs and with BCCs were not materially altered after additional adjustment by each factor separately and for all factors simultaneously.
Abstract Introduction Published findings on the associations between smoking and the incidence of cutaneous squamous cell carcinoma SCC and basal cell carcinoma BCC are inconsistent.
Try out PMC Labs and tell us what you think. Sponsors had no role in study de, data collection, data analysis, data interpretation or report writing. Residual confounding would generally be expected to bias smoking-related risks in a similar way for both SCC and BCC but not lead to substantial heterogeneity. In addition, women were asked at the resurvey 8 SD 3 years after recruitment their hair colour when aged 10 years, and at the resurvey 12 SD 2 years after recruitment they were asked about their eye colour, of freckles and moles, sunbed use, holidays in sunny places and tendency to tan or burn.
These are further classified by anatomical site, determined by the fourth character of the ICD code: lip C As ICD Alison doody smoking C00 is for malignant neoplasm of the lip excluding the skin of lipare also presented for cancers of the lip based on either ICD code C00 or C Study participants were resurveyed by post about every 3—5 years after recruitment, each time asking about current and past smoking.
Taking all studies together, including the present study, the combined RRs for SCCs and BCCs comparing current smokers versus never-smokers were similar to those in the current study 1.
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Limbs are often covered by clothing and are less regularly exposed to ultraviolet UV radiation than sun-exposed parts of the body like the face, and so it may be that smoking is associated with SCC only at lower levels of UV exposure. Alicia K. Gillian K. Catherine M. Author information Article notes Copyright and information Disclaimer.
Nevertheless, we took of different cancer registration rates in all analyses by routinely stratifying by the 10 cancer registries in England and Scotland that existed at time of recruitment, and the smoking-associated RRs did not vary ificantly by region or on excluding the Thames region Supplementary Figure 2. In —, participants were recruited into the Million Women Study through the National Health Service NHS Breast Screening Programme and gave ed consent for follow-up when completing a questionnaire about lifestyle, medical and socio-demographic factors.
People in the UK have unique NHS s that enable electronic linkage to the NHS Central Registers, through which researchers can be routinely notified of cancer registrations and deaths. Br J Cancer. Smoking-associated risks for cutaneous SCC and BCC are in the opposite direction to each other and appear to vary by anatomical site.
As well as stratifying by cancer registry region, all were adjusted for the information available to us on eight other potential confounders: year of birth, deprivation index, height, body mass index, alcohol consumption, strenuous exercise, year of recruitment, and time since recruitment.