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Why are cases of non-melanoma skin cancer increasing in Wales: an agile scope of the literature

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Authors: Evidence Service, Salina Khatoon, Hannah Shaw

Published on: 1st July 2024

Next update: Update not planned

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Introduction

Non-melanoma skin cancers (NMSC) are the most common type of cancer in Wales, making up 94% of all skin cancers during 2019. Age-standardised incidence rates of NMSC have risen by 7.1% between 2016 and 2019 to 469.8 per 100,000 in Wales. The reason for this increase within Wales remains largely unclear. We sought to identify why rates of NMSC might be rising in Wales.

Main points

What we found

No systematic reviews were identified examining the association between the trend in historic risk factor exposure with a trend in NMSC rates. However, seven systematic reviews examining the association between specific risk factors and NMSC were included. Long term exposure to UV radiation, antihypertensive medication use, menopausal hormone therapy use, topical corticosteroids use, sunscreen use, and smoking were key risk factors identified as having a potential relationship with NMSC and may contribute to the increased incidence rates seen in Wales. The relationship between risk factors and NMSC appears to be extremely complex and may vary according to the type of skin cancer. For example, some primary studies identified smoking as protective among men, but not women. Also, the relationship appears to differ across different skin cancer sub-types. There was a lack of good quality systematic reviews investigating sunburn, foreign travel, and the use of indoor tanning exposure and the potential dose response relationship with NMSC. Findings identified are likely to be generalisable to the UK population, as most included studies were conducted across Europe and USA. However, it is important to highlight that trends associated with the identified risk factors are likely to vary across countries, for example sun exposure.

What this means

It was not possible to draw firm conclusions about the relationship between a dose-response or duration of exposure to certain factors and the risk of NMSC due to the limited evidence base and lack of longitudinal data at systematic review level.  However, evidence suggests that the relationship between risk factors and NMSC is complex, and this review highlights several potential risk factors that may warrant further investigation, at primary study level.

Technical information

Using agile scope methodology, we sought to identify if a correlation with one or more of the known risk factors exists over time. Specifically, we sought to establish why cases of non-melanoma skin cancer are increasing in Wales.

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