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Endometriosis and the risk of skin cancer: a prospective cohort study

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Abstract

Purpose

Endometriosis has been associated with an increased risk of skin melanoma. However, associations with other skin cancer types and how they compare with melanoma are unclear. Our objective was to prospectively investigate the relationships between endometriosis and risk of non-melanoma and melanoma skin cancers.

Methods

E3N is a prospective cohort of 98,995 French women aged 40–65 years in 1990. Data on surgically confirmed endometriosis and skin cancer diagnoses were collected every 2–3 years through self-report, with skin cancer cases confirmed through pathology reports. Hazard Ratios (HR) and 95% confidence intervals (CIs) were calculated using Cox regression models.

Results

Between 1990 and 2008, 535 melanoma, 247 squamous-cell carcinoma (SCC), and 1,712 basal-cell carcinoma (BCC) cases were ascertained. Endometriosis was associated with an increased overall risk of skin cancer (HR 1.28, 95% CI 1.05–1.55). When considering skin cancer type, endometriosis was associated with melanoma risk (HR 1.64, 95% CI 1.15–2.35), but not with SCC (HR 1.21, 95% CI 0.62–2.36) or BCC (HR 1.16, 95% CI 0.91–1.48) (non-melanoma skin cancers combined: HR 1.17, 95% CI 0.93–1.46), although no heterogeneity was detected across skin cancer types (Phomogeneity = 0.13).

Conclusion

These data support an association between a personal history of endometriosis and the risk of skin cancer and suggest that the association is strongest for melanoma.

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Abbreviations

BCC:

Basal cell carcinoma

BSA:

Body surface area

CI:

Confidence interval

GWAS:

Genome-Wide Association Study

HR:

Hazard ratio

NMSC:

Non-melanoma skin cancer

OC:

Oral contraceptive

OR:

Odds ratio

SCC:

Squamous cell carcinoma

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Acknowledgments

We are grateful to the study subjects for their continued participation; to Dr. Nicolas Chopin, Dr. Hervé Foulot, and Prof. Charles Chapron for reviewing endometriosis cases for the validation study; and to Dr. Jean Verdebout for providing data on mean daily ultraviolet radiation dose in French metropolitan departments. We also thank all members of the E3N-EPIC study group, particularly Marie Fangon, Pascale Gerbouin-Rérolle, Lyan Hoang, Céline Kernaleguen, Camille Laplanche, Maryvonne Niravong, and Maxime Valdenaire for their technical assistance, and we warmly thank Anne Bijon for her work on the E3N skin cancer database. The E3N cohort from the French National Institute of Health and Medical Research (Inserm) was supported by the Mutuelle Générale de l’Education Nationale (MGEN); the Gustave Roussy Institute; and the French League against Cancer (LNCC). MK was supported by a Marie Curie Fellowship within the 7th European Community Framework Programme (#PIOF-GA-2011-302078), and through the Young Researcher Prize from the Bettencourt-Schueller Foundation and the Jean Darier Prize delivered by the SVR Laboratories. LVF was supported by a T32 Grant (#HD060454) in reproductive, perinatal, and pediatric epidemiology from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Cancer Institute (3R25CA057711) National Institutes of Health.

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Author notes

  1. Marie-Christine Boutron-Ruault and Marina Kvaskoff are joint last-authors.

Authors and Affiliations

  1. Department of Epidemiology, Harvard T.H Chan School of Public Health, Boston, MA, 02115, USA

    Leslie V. Farland & Stacey A. Missmer

  2. Department of Obstetrics, Gynaecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, 02115, USA

    Leslie V. Farland

  3. Univ. Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, 33000, Bordeaux, France

    Simon Lorrain

  4. Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, 02115, Boston, MA, USA

    Stacey A. Missmer

  5. Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA

    Stacey A. Missmer

  6. CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif Cedex, France

    Laureen Dartois, Iris Cervenka, Isabelle Savoye, Sylvie Mesrine, Marie-Christine Boutron-Ruault & Marina Kvaskoff

  7. Gustave Roussy, Espace Maurice Tubiana, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France

    Laureen Dartois, Iris Cervenka, Isabelle Savoye, Sylvie Mesrine, Marie-Christine Boutron-Ruault & Marina Kvaskoff

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  1. Leslie V. Farland
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  2. Simon Lorrain
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  3. Stacey A. Missmer
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  8. Marie-Christine Boutron-Ruault
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  9. Marina Kvaskoff
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Corresponding author

Correspondence to Marina Kvaskoff.

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Farland, L.V., Lorrain, S., Missmer, S.A. et al. Endometriosis and the risk of skin cancer: a prospective cohort study. Cancer Causes Control 28, 1011–1019 (2017). https://doi.org/10.1007/s10552-017-0939-2

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  • DOI: https://doi.org/10.1007/s10552-017-0939-2

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