Study Identifies Risk Factors for Skin Cancer in Older Adults, Highlights Utility of Screening and Prevention

Skin cancer is becoming more common and it is already known that certain risk factors, such as skin type and sun exposure, increase the chance of developing skin cancer. But research on skin cancer risk in older populations is lacking, according to a recent study that aimed to provide insight into risk factors in a cohort between the ages of 70 and 93.

The study, published in BMC Geriatrics, examined associations between new skin cancers and past skin cancer history, gender, age, skin type, outdoor work history and socioeconomic status (SES). The potential clinical utility of regular whole body skin examination (TBSE) for earlier detection and prevention in these elderly patients was also assessed.

The retrospective cross-sectional study included data from 552 participants (346 women and 206 men) who were parents of children in the Northern Finland Birth Cohort 1966 (NFBC1966)

study. The NFBC1966 is an epidemiological and longitudinal research project that identified all pregnant women expected to give birth in 1966 in the provinces of Oulu and Lapland in Finland, and followed them and their children.

In 2018, authors of the current study sent health questionnaires to 12,027 people who were part of the parent cohort in the NFBC1966. Of the 5158 who responded, 1256 were invited to participate in a clinical trial, 684 agreed, and 552 were part of the final analysis population that received a TBSE. Data from registries and patient self-reports were also used to determine risk factors for lifelong skin cancer versus first skin cancer in the cohort.

Based on TBSE, 25.5% of patients had skin cancer or a precursor to skin cancer. Men were more likely to have skin cancer or its precursors than women (34.5% vs. 20.2%, respectively), and patients diagnosed with skin cancer in the current study were more likely to have a history of it compared to those who did not have skin cancer. skin cancer (46.2% vs. 20.2%, respectively). Patients with a previous diagnosis of skin cancer were more than twice as likely to develop skin cancer later in life (odds ratio [OR], 2.56; 95% CI, 1.43-4.55).

Advanced age and SES were both associated with lifelong skin cancer ([OR, 1.05; 95% CI, 1.01-1.11] and [OR, 1.70; 95% CI, 1.00-2.95]respectively). Working outside was also associated with lifelong skin cancer in this cohort (OR 1.92; 95% CI 1.10-3.37). Fitzpatrick’s skin type was used to measure associations between skin type and cancer incidence, but no association was found in this cohort, despite skin type being a known factor in skin cancer risk. This may be due to a lack of variability in skin types in the cohort, the authors noted.

In patients in whom TBSE revealed skin cancer for the first time, more men than women had skin cancer for the first time (27.8% versus 15.4%). Working outside was also a risk factor (OR 2.31; 95% CI 1.16-4.52) in the first skin cancer cohort.

Overall, the findings suggest that in older patients, previous skin cancer is a significant risk factor for new skin cancer cases, as are male gender, advanced age, higher SES, and working outside the home. Men and participants who worked outside the home showed a higher initial incidence of cancer at the time of the TSBE.

“In line with previous studies, we found that older age was associated with a greater risk of skin cancer. While best practices for skin cancer screening have yet to be determined, many studies have emphasized the importance of TBSE in the elderly,” the authors wrote.

They also noted that skin cancer treatment costs are highest in late-onset disease, and patients who are diagnosed later have a poorer chance of survival.

“Physicians treating older individuals are encouraged to perform a skin exam to detect skin cancers and their precursors,” the authors wrote.

“A previous history of skin cancer – which can be easily induced in the patient – may indicate that the patient is at higher risk for new skin cancers. Since we found that skin cancers and precursors mainly affect men, we especially ask for caution in the treatment of older men,” they concluded.

Reference

Sinikumpu S, Jokelainen J, Keinänen-Kiukaanniemi S, Huilaja L. Skin cancer and their risk factors in the elderly: a population-based study. BMC Geriatr. Published online April 1, 2022. doi: 10.1186/s12877-022-02964-1