Basic aspects of the pathogenesis and prevention of non‐melanoma skin cancer in solid organ transplant recipients: a review

Pérez, Hernando; Benavides, Xiomara; Reyes‐Zurita, Fernando J.; Pabón, Maria; Tschen, Jaime A.; Maradei-Anaya, Silvia Juliana; Rebolledo, Leonardo Andrés López; Lozano, E.

doi:10.1111/ijd.13409

Cited by 25 publications

(23 citation statements)

References 49 publications

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“…Risk factors for developing NMSC in OTRs include the duration and intensity of immunosuppressive therapy, advanced age, lighter Fitzpatrick phototypes, exposure to ultraviolet radiation (UVR), and human papillomavirus infections . Ongoing UVR exposure is the most important modifiable risk factor for the development of NMSC; the vast majority of NMSC develop on sun‐exposed sites, such as the head, neck, and upper extremities .…”

Section: Introductionmentioning

confidence: 99%

Skin cancer knowledge and photoprotective practices of organ transplant recipients

Traboulsi

Potok

Ruzycki

et al. 2019

Clinical Transplantation

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Background: Long-term use of immunosuppressive medications by organ transplant recipients (OTRs) leads to an increased risk of non-melanoma skin cancers (NMSCs).The objective of this study was to assess photoprotective knowledge and practices among OTRs and to identify predictors of poor sunscreen adherence and barriers to photoprotection. Methods:A written survey was administered to 300 solid OTRs attending the Southern Alberta Transplant Program. Demographics, transplant and NMSC history, ultraviolet radiation (UVR) exposure, photoprotective knowledge and practices, and barriers to implementing photoprotection were collected. Relevant statistical analyses and univariate and multivariable regression models on sunscreen use were performed. Results:One hundred and seventy-nine of the 300 respondents reported not using sunscreen most days despite 79.3% recalling have received photoprotection education. Of the surveyed OTRs, 45.7% reported no barriers to implementing photoprotective practices. On average, respondents scored 74.5% on a commonly used tool to assess photoprotective knowledge (SD 30.6%). In multivariable analyses, older age, male gender, and lack of post-secondary education were associated with lower rates of self-reported sunscreen use. The most commonly patient-reported barriers to photoprotection were "hassle/time consuming" (16.7%) and "sunscreen is uncomfortable or unpleasant" (10.0%).Conclusions: Despite OTRs self-reporting having received sufficient sun-protective knowledge and demonstrating reasonable recollection of photoprotective education on assessment, implementation of sun protection in the studied OTRs remains suboptimal. K E Y W O R D Seducation, non-melanoma skin cancer, photoprotection, sunscreen, transplantation

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Section: Introductionmentioning

confidence: 99%

Skin cancer knowledge and photoprotective practices of organ transplant recipients

Traboulsi

Potok

Ruzycki

et al. 2019

Clinical Transplantation

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“…One such scenario is if the exposure is rare and the cancer outcome is not rare among users (e.g., risk of skin cancer among immunocompromised patients [26]). Also, if outcomes other than cancer are of interest in the same study, establishing a data set structured for cohort analyses will be more efficient.…”

Section: Considerations For the Choice Of Study Designmentioning

confidence: 99%

Considerations for Pharmacoepidemiological Studies of Drug–Cancer Associations

Pottegård

Friis

Stürmer

et al. 2018

Basic Clin Pharma Tox

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In this MiniReview, we provide general considerations for the planning and conduct of pharmacoepidemiological studies of associations between drug use and cancer development. We address data sources, study design, assessment of drug exposure, ascertainment of cancer outcomes, confounder adjustment and future perspectives. Aspects of data sources include assessment of complete history of drug use and data on dose and duration of drug use, allowing estimates of cumulative exposure. Outcome data from formal cancer registries are preferable, but cancer data from other sources, for example, patient or pathology registries, medical records or claims are also suitable. The two principal designs for observational studies evaluating drug-cancer associations are the cohort and case-control designs. A key challenge in studies of drug-cancer associations is the exposure assessment due to the typically long period of cancer development. We present methods to examine early and late effects of drug use on cancer development and discuss the need for employing 'lag-time' in order to avoid reverse causation. We emphasize that a new-user study design should always be considered. We also underline the need for 'dose-response' analyses, as drug-cancer associations are likely to be dose-dependent. Generally, studies of drug-cancer associations should explore risk of site-specific cancer, rather than cancer overall. Additional differentiation may also be crucial for organ-specific cancer with various distinct histological subtypes (e.g., lung or ovary cancer). We also highlight the influence of confounding factors and discuss various methods to address confounding, while emphasizing that the choices of methods depend on the design and specific objectives of the individual study. In some studies, use of active comparator(s) may be preferable. Pharmacoepidemiological studies of drug-cancer associations are expected to evolve considerably in the coming years, due to the increasing availability of long-term data on drug exposures and cancer outcomes, the increasing conduct of multinational studies, allowing studies of rare cancers and subtypes of cancer, and methodological improvements specifically addressing cancer and other long-term outcomes.Use of prescription and over-the-counter drugs represents exogenous exposures that may result in either increase or reduction in cancer risk. Clear associations have been established for a number of drugs, for example, the preventive effect of aspirin use against colorectal cancer [1,2] or the increased risk of renal cancer with use of phenacetin [3,4]. Further, new hypotheses often arise, such as the recent concerns about carcinogenic effects of lithium [5][6][7] and pioglitazone [8][9][10][11][12]. A significant challenge in the elucidation of drug effects on cancer development is that the effects typically first become manifest several years after drug initiation. The long period of cancer development and the relatively low incidence of most individual cancer types impede the ability o...

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“…Given the use of lifelong immunosuppressive drugs for preservation of transplanted kidney function, RTRs are at increased risk of developing cancer (Cheng et al, 2018;Garrett et al, 2017;Zamoiski et al, 2017). The most common posttransplant malignancy is keratinocyte carcinoma (KC), defined as squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) (Garrett et al, 2017;Perez et al, 2017). SCC is the most common cancer in RTRs with a 65-to 250-fold increased risk, and BCC has a 10-to 16-fold increased risk, as compared with the general population (Garrett et al, 2017;Harwood et al, 2017;O'Reilly Zwald and Brown, 2011;Perez et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…The most common posttransplant malignancy is keratinocyte carcinoma (KC), defined as squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) (Garrett et al, 2017;Perez et al, 2017). SCC is the most common cancer in RTRs with a 65-to 250-fold increased risk, and BCC has a 10-to 16-fold increased risk, as compared with the general population (Garrett et al, 2017;Harwood et al, 2017;O'Reilly Zwald and Brown, 2011;Perez et al, 2017). In addition to the increased incidence, KCs in RTRs show more aggressive clinical and histologic features, with increased risk of recurrence and metastatic disease (Barrett et al, 1993;Ducroux et al, 2017;Gogia et al, 2013;Perez et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…RTRs share some KC risk factors with the general population including older age, male sex, family history of skin cancer, light pigmentation, and chronic exposure to cumulative UVR (Didona et al, 2018;Gao et al, 2019;O'Reilly Zwald and Brown, 2011;Perez et al, 2017). Among RTRs, additional risk factors have been identified including time elapsed since transplant, age at the time of transplant, and type and duration of immunosuppression (Garrett et al, 2017;O'Reilly Zwald and Brown, 2011;Yesantharao et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Association between Human Leukocyte Antigen Type and Keratinocyte Carcinoma Risk in Renal Transplant Recipients

Kim

Wojciechowski

Pattanayak

et al. 2020

Journal of Investigative Dermatology

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Keratinocyte carcinoma (KC), defined as squamous cell carcinoma and basal cell carcinoma, is the most common malignancy among white, non-Hispanic renal transplant recipients. Although recent genome-wide association studies reported that class II HLA is associated with KC risk, epidemiologic data on HLA type and KC risk in renal transplant recipients is limited. Using an institutional cohort of white, non-Hispanic renal transplant recipients transplanted between 1993 and 2017, we examined the association between pretransplant molecular HLA types and KC risk. Posttransplant KCs were captured using the International Classification of Diseases codes and validated using pathology reports. Cox proportional hazards regression models were used to estimate hazard ratios of incident KC, squamous cell carcinoma, and basal cell carcinoma, adjusting for age, male sex, history of KC, Charlson comorbidity index, HLA mismatch, transplant type, year of transplant, and the type of immunosuppression. Among 617 subjects (mean age 53 years, 67% male), 10% developed posttransplant KC. Multivariable Cox regression analyses showed HLA-DRB1*13 was associated with KC risk (hazard ratio, 1.84; 95% confidence interval, 1.00e3.38) and squamous cell carcinoma risk (hazard ratio, 2.24; 95% confidence interval, 1.12e4.49), whereas HLA-DRB1*14 (hazard ratio, 2.81; 95% confidence interval, 1.14e6.91) was associated with basal cell carcinoma risk. Our findings suggest that a subset of renal transplant recipients with specific HLA polymorphisms may be at increased KC risk.

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Basic aspects of the pathogenesis and prevention of non‐melanoma skin cancer in solid organ transplant recipients: a review

Abstract: Patient risk factors for the development of NMSC should be reviewed during the transplant consultation. Individuals found to be at increased risk should undergo closer follow-up and preventive care counseling. This article proposes an algorithm for the prevention of NMSC.

Cited by 25 publications

References 49 publications

Skin cancer knowledge and photoprotective practices of organ transplant recipients

Skin cancer knowledge and photoprotective practices of organ transplant recipients

Considerations for Pharmacoepidemiological Studies of Drug–Cancer Associations

Association between Human Leukocyte Antigen Type and Keratinocyte Carcinoma Risk in Renal Transplant Recipients

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