Exogenous sex hormones, menstrual and reproductive history, and risk of non-melanoma skin cancer among women: a systematic literature review and meta-analysis

Abstract

Non-melanoma skin cancers (NMSC) are more frequent among men, but women (especially those aged < 40 years) have experienced steeper growth in their incidence rates in recent years. Hormonal factors were hypothesized to be playing a role in modulating NMSC risk, but the studies published to date provided conflicting results. We systematically reviewed and meta-analysed the studies focusing on the association between hormone-related characteristics (use of exogenous sex hormones, and aspects of menstrual and reproductive history) and the risk of NMSC among women. We included observational and experimental studies published in PubMed and EMBASE until February 2020. We calculated summary relative risk (SRR) and 95% confidence intervals (CI) by applying random effects models with maximum likelihood estimation, and used the I2 statistics to quantify the degree of heterogeneity of risk estimates across studies. Eleven independent studies encompassing a total of over 30,000 NMSC cases were included in quantitative analyses. No evidence of an increased NMSC risk emerged among ever vs. never users of oral contraceptives (SRR 1.13, 95% CI 0.88–1.45) or hormones for menopause (SRR 1.09, 95% CI 0.87–1.37). Likewise, age at menarche or at menopause and parity were not associated with NMSC risk. Heterogeneity across studies was low, and pooled results were comparable between NMSC subtypes. We found no evidence that hormonal factors play a role in the pathogenesis of NMSC among women.

The role of pregnancy in maternal cancer risk: Epidemiologic evidence from the Nordic Countries Linked Birth and Cancer Registries Cohort Project

“…While malignant melanoma is the most common cancer arising during pregnancy, accounting for about a third of malignancies among expectant mothers, parous women are not at higher risk of subsequently developing melanoma than nulliparous women (51), or of developing non-melanoma skin cancer (52). Women have a lower incidence of leukemias and lymphomas overall than men, but there is little evidence that pregnancy factors are associated with non-Hodgkin's lymphoma (53).…”

Skin cancer incidence in transgender individuals receiving gender‐affirming hormone treatment: a nationwide cohort study in the Netherlands

“…The incidence of skin cancer is on the rise 1–5 . Sex‐dependent differences regarding skin cancer diagnoses have been reported in the literature: nonmelanoma skin cancer (NMSC) includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) and is more common in men than in women 6 . The incidence of melanoma skin cancer differs per country and is dependent on sun exposure, early cancer detection programs, and access to care 1 .…”

“…[1][2][3][4][5] Sex-dependent differences regarding skin cancer diagnoses have been reported in the literature: nonmelanoma skin cancer (NMSC) includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) and is more common in men than in women. 6 The incidence of melanoma skin cancer differs per country and is dependent on sun exposure, early cancer detection programs, and access to care. 1 In addition, sex-related differences in melanoma incidence are observed: worldwide, elderly men, in particular, are more likely to develop melanoma.…”

“…1,3 There is limited evidence suggesting that sex hormones play a direct role in the pathogenesis of NMSC. Although keratinocytes may express estrogen receptors (ER), estrogenrelated receptors (ERR), and progesterone receptors (PR), 6,8,9 hormonal changes such as contraceptive use or during menopause do not affect NMSC risk. 6 Basal cell carcinoma (BCC) is more frequent among young women compared with men.…”

“…Although keratinocytes may express estrogen receptors (ER), estrogenrelated receptors (ERR), and progesterone receptors (PR), 6,8,9 hormonal changes such as contraceptive use or during menopause do not affect NMSC risk. 6 Basal cell carcinoma (BCC) is more frequent among young women compared with men. However, it is most prevalent in older men.…”