A Nested Case Control Study Assessing the Risk of Basal CellCarcinoma in Childhood Cancer Survivors Treated with Varying Dosesof Radiation Pubblico

Abstract

Abstract A Nested Case Control Study Assessing the Risk of Basal Cell Carcinoma in Childhood Cancer Survivors Treated with Varying Doses of Radiation By Tanya C. Watt Childhood cancer survivors are at risk for secondary malignancies due to the initial therapy they received. Skin cancer is the most common malignancy in the United States, and has a growing incidence, primarily due to increased sun exposure. Recently, ionizing radiation has been added to the list of risk factors for skin cancer, specifically basal cell carcinomas. This study serves to analyze whether there is a dose dependent increase in the risk of development of BCCs in childhood cancer survivors. 215 cases and 645 controls were sampled from the Childhood Cancer Survivor Study database in a nested case-control study. With multivariate analysis, treatment with ionizing radiation was the predominant risk factor for development of a BCC. This appeared to be dose dependent, with a plateau at the highest doses, suggesting that above 4500 cGy of radiation, the skin cells were so destroyed as to not undergo oncogenesis. Other risk factors included a history of Hodgkin disease, the likelihood to burn when exposed to the sun, skin color, and a family history of non-melanomatous skin cancers. No interactions were found between these other risk factors and radiation therapy. The results of this study will help to provide better guidelines for patients, their families, and their providers when assessing the risks of BCCs in childhood cancer survivors.

Table of Contents

Table of Contents 1. Introduction.......................................................................1 2. Background.......................................................................3 3. Methods...........................................................................13 4. Results.............................................................................20 5. Discussion........................................................................25 6. References........................................................................29 7. Figures/Tables....................................................................32

List of Figures and Tables Figure 1...............................................................................32 Clustering of tumor cases within first two month period Table 1................................................................................33 Basic demographic information comparing cases and controls Table 2................................................................................34 Genetic risk factors comparing cases and controls Table 3................................................................................35 Rates of previous sun exposure in cases compared with controls Table 4................................................................................36 Medical behavior of cases and controls Table 5................................................................................37 Location of BCC compared to radiation field Table 6................................................................................38 Univariate analysis of basic demographic risk factors Table 7................................................................................39 Univariate analysis of genetic risk factors Table 8................................................................................40 Univariate analysis of previous sun exposure Table 9................................................................................41 Univariate analysis of previous medical behavior Table 10..............................................................................42 Multivariate model of predictors of development of BCCs considering cancer-related risk factors Table 11..............................................................................43 Multivariate model of predictors of development of BCCs, restricted to survivors who completed Follow-up 2 survey Figure 2..............................................................................44 Odds ratios estimating relative risk of different doses of radiation

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School	Laney Graduate School
Department	Clinical Research Curriculum Program
Degree	MS
Submission	Dissertation
Language	English
Research Field	Health Sciences, Medicine and Surgery
Parola chiave	basal cell carcinoma
Committee Chair / Thesis Advisor	Mertens, Ann, Emory University
Committee Members	Boring, John R, Emory University Klein, Mitchel, Emory University

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