Trends in incidence and survival analysis in non-melanoma skin cancer from 1994 to 2012 in Girona, Spain: A population-based study
Introduction
Non-melanoma skin cancers (NMSCs) are tumors that have been widely disregarded in population-based cancer registries (CRs). This is probably due to their low lethality and the fact that they are usually managed in outpatient settings. In the past, histological confirmation was not always performed.
Many CRs do not record these tumors, or their recording lacks completeness. In the latest edition of Cancer Incidence in Five Continents [1], the number of annual cases between different CRs in Spain ranged from 1 to 2995, reflecting the fact that some CRs did not registered squamous- and basal-cell carcinomas of the skin.
Despite this, some publications have appeared in the past decade concerning the increasing incidence of squamous- and basal-cell carcinomas of the skin; this could potentially be the result of increased exposure to sunlight, changes in clothing style, or increased longevity. Few publications have focused on the epidemiology of Merkel-cell carcinoma (MCC) or other rare malignant tumors of the skin, or on patient survival.
Since its founding in 1994, the Girona Cancer Registry (GCR) has collected data on non-melanoma skin cancer, including squamous-cell carcinoma (SCC) and basal-cell carcinoma (BCC) of skin, MCC, dermatofibrosarcoma protuberans (DFSP), and adnexal and skin appendages neoplasm (ASAN).
This study presents our results in descriptive epidemiology of these tumors, with a special focus on trends in incidence and observed and relative survival of these tumors.
Section snippets
Material and methods
We analyzed the database belonging to the GCR, a population-based cancer registry for the province of Girona in the north-east of Spain, which began its activity in 1994. According to census estimate data from the Catalan Institute of Statistics (available at URL: www.idescat.cat) for 2012, it covers a population of 761,627 inhabitants. It records all cancer sites according to International Agency for Research on Cancer (IARC) guidelines, and has a completeness of 96.3%. The information sources
Descriptive epidemiology
We identified 14,389 cases of NMSC in the GCR database during the period 1994–2012. Three cases of undifferentiated carcinoma and five cases of sarcomatoid carcinoma, all registered as primary skin cancers, were excluded from the analysis. Thirteen cases encoded as carcinoma NOS (not otherwise specified) or neoplasm NOS, with codes 8000 or 8010, were also excluded from the analysis due to a lack of information. Finally, 14,368 cases were suitable for analysis. Of these, 3474 were SCC, 10,729
Discussion
Registration of NMSC in population databases varies between regions and countries and can be under-registered in some places, as happens in Spain [4]. Despite this, epidemiological information has been provided for the white population in the USA, Canada, Australia and Europe, and an increasing incidence of both types of cancer has been reported [5], [6], [7], [8], [9].
Incidence of BCC and SCC of skin is expected to increase as life expectancy rises, although an increased incidence in younger
Conclusion
Our study confirms the significant increase in incidence of SCC and BCC, which could be explained by changes in sun exposure habits and/or increased life expectancy of the population covered by the CR, and/or also by an increased registration of these tumors. This increasing incidence is not observed for MCC, DFS or ASAN. The results in RS, which corrects mortality by causes other than cancer, especially in aged populations, also confirms the fact that these tumors (with the exception of MCC)
Authors’ contributions
JR-C conceived, designed and coordinated the study and wrote the manuscript. AM H-P, MC F-S and G M-E performed the statistical analysis.
L V collected all cases data at GCR.
G O-G, N V-C and RM-G contributed to the design of the study and analysis and interpretation of data.
All authors drafted the article, revised it critically and approved its final version.
Conflict of interest statement
The authors declare that they have no conflicts of interest.
Acknowledgement
We thank Barney Griffiths for reviewing the English language of the manuscript.
References (20)
- et al.
Incidencia y mortalidad del cáncer cutáneo en España: revisión sistemática y metaanálisis
Actas Dermosifiliogr.
(2016) - et al.
Epidemiology and survival of Merkel cell carcinoma in the Netherlands: a population based study of 808 cases in 1993–2007
Eur. J. Cancer
(2011) - et al.
Merkel cell carcinoma-a population-based epidemiological study in Finland with a clinical series of 181 cases
Eur. J. Cancer
(2012) - et al.
Descriptive epidemiology of malignant mucosal and uveal melanomas and adnexal skin carcinomas in Europe
Eur. J. Cancer
(2012) - et al.
Cancer Incidence In Five Continents Volume X. IARC Scientific Publications Number 164
(2014) - et al.
Permutation tests for joinpoint regression with applications to cancer rates
Stat. Med.
(2000) - et al.
Relative survival and the estimation of net survival.Elements for further discussion
Stat. Med.
(1990) - et al.
A systematic review of worldwide incidence of nonmelanoma skin cancer
Br. J. Dermatol.
(2012) - et al.
Trends in the incidence of nonmelanoma skin cancer in Denmark 1978–2007: rapid incidence increase among young Danish women
Int. J. Cancer
(2010) - et al.
Increase in basal cell carcinoma incidence steepest in individuals with high socioeconomic status: results of a cancer registry study in the Netherlands
Br. J. Dermatol.
(2009)
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