Yang Wu1, Simon Ghaly2, Stephen Kerr3, Bryce Jackson4, Katherine Hanigan5, Deborah Martins5,6, Krupa Krishnaprasad5, Reme E Mountifield7, David C Whiteman8, Peter A Bampton7, Richard B Gearry4, Graham L Radford-Smith5,9,10, Ian C Lawrance11,12. 1. Department of Gastroenterology, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia. yangwu_22@hotmail.com. 2. Department of Gastroenterology, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia. 3. Kirby Institute, Sydney, NSW, Australia. 4. Department of Gastroenterology, Christchurch Hospital, Christchurch, New Zealand. 5. IBD Research Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. 6. Division of Plastic and Reconstructive Surgery, University of California San Francisco, 505 Parnassus Ave, Suite M-593, San Francisco, CA, 94143-0932, USA. 7. Department of Gastroenterology, Flinders Medical Centre, Adelaide, SA, Australia. 8. Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. 9. Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. 10. University of Queensland School of Medicine, Brisbane, QLD, Australia. 11. Centre of Inflammatory Bowel Diseases, St John of God Hospital, Subiaco, WA, Australia. 12. School of Medicine and Pharmacology, Harry Perkins Institute of Medical Research, University of Western Australia, Murdoch, WA, Australia.
Abstract
BACKGROUND: Retrospective studies observe an increased risk of keratinocyte carcinomas (KCs) in patients with inflammatory bowel disease (IBD) on thiopurine (TP) medication. The role of traditional risk factors such as skin type and sun protection behavior has not been studied in this population. This study aimed to examine traditional KC risk factors and thiopurine use on skin cancer development in an IBD cohort. METHODS: Consecutive IBD patients were recruited from four specialist centers in Australia and New Zealand, each with varying UV exposure indices. Data pertaining to race, skin color, freckling and sun protection behavior, dose of TP therapy, and skin cancer development were elicited through a self-reported questionnaire. RESULTS: A total of 691 IBD patients were included with 62 reporting KC development. Thiopurine usage was similar among patients who developed skin cancer compared with those who did not (92% vs. 89%, p = 0.3). There was no statistically significant association between KC development and TP dose or 6-thioguanine nucleotide levels. In multivariate modeling, four factors were independently and significantly associated with KC: age over 61 years old versus less than 30 years old (OR 6.76; 95% CI 2.38-19.18), residing in Brisbane versus Christchurch (OR 3.3; 95% CI 1.6-6.8), never staying in the shade versus staying in the shade ≥ 50% of the time (OR 3.8; 95% CI 1.4-10.5), and having a skin type that never tanned versus other skin types (OR 6.9; 95% CI 2.9-16.0). CONCLUSION: Skin type, age, and sun protection behavior are more important risk factors for KC development than thiopurine medication use in this IBD population.
BACKGROUND: Retrospective studies observe an increased risk of keratinocyte carcinomas (KCs) in patients with inflammatory bowel disease (IBD) on thiopurine (TP) medication. The role of traditional risk factors such as skin type and sun protection behavior has not been studied in this population. This study aimed to examine traditional KC risk factors and thiopurine use on skin cancer development in an IBD cohort. METHODS: Consecutive IBDpatients were recruited from four specialist centers in Australia and New Zealand, each with varying UV exposure indices. Data pertaining to race, skin color, freckling and sun protection behavior, dose of TP therapy, and skin cancer development were elicited through a self-reported questionnaire. RESULTS: A total of 691 IBDpatients were included with 62 reporting KC development. Thiopurine usage was similar among patients who developed skin cancer compared with those who did not (92% vs. 89%, p = 0.3). There was no statistically significant association between KC development and TP dose or 6-thioguanine nucleotide levels. In multivariate modeling, four factors were independently and significantly associated with KC: age over 61 years old versus less than 30 years old (OR 6.76; 95% CI 2.38-19.18), residing in Brisbane versus Christchurch (OR 3.3; 95% CI 1.6-6.8), never staying in the shade versus staying in the shade ≥ 50% of the time (OR 3.8; 95% CI 1.4-10.5), and having a skin type that never tanned versus other skin types (OR 6.9; 95% CI 2.9-16.0). CONCLUSION: Skin type, age, and sun protection behavior are more important risk factors for KC development than thiopurine medication use in this IBD population.
Entities:
Keywords:
Immunosuppression; Inflammatory bowel disease; Skin cancer
Authors: Peter O'Donovan; Conal M Perrett; Xiaohong Zhang; Beatriz Montaner; Yao-Zhong Xu; Catherine A Harwood; Jane M McGregor; Susan L Walker; Fumio Hanaoka; Peter Karran Journal: Science Date: 2005-09-16 Impact factor: 47.728