Human papillomavirus (HPV), a group
of viruses commonly linked to the sexually transmitted disease known as
genital HPV infection, has long been associated with the development of
certain types of cancers -- specifically cervical cancer. However, in some
cases, HPV can lead to a type of skin cancer known as squamous cell
carcinoma. While squamous cell carcinoma has a 95 percent five-year cure
rate when detected and treated early, genital skin cancers can be difficult
to diagnose since they are not always readily visible and may not exhibit
any noticeable symptoms. As studies show, this can lead to a fatal outcome.
Speaking today at the 65th Annual Meeting of the American Academy of
Dermatology, dermatologist Martin A. Weinstock, MD, PhD, FAAD, professor of
dermatology and community health at Brown University in Providence, RI, and
chief dermatologist at Veterans Affairs Medical Center in Providence,
presented key findings from a population-based study of nonmelanoma skin
cancer mortality in the United States from 1969 to 2000. The data shows a
large number of fatal nonmelanoma skin cancers that occurred in the
genitalia of men and women age 65 and older, which may have been caused by
HPV.
Skin cancers are divided into one of two classes -- nonmelanoma and
melanoma. Nonmelanoma skin cancers (NMSCs) are the most common forms of
skin cancer, which include basal cell carcinoma and squamous cell
carcinoma. While basal cell carcinomas rarely spread to other parts of the
body, squamous cell carcinomas can spread to other organs if not treated
early. Melanoma can rapidly spread to the lymph system and internal organs,
making it the most serious and deadly form of skin cancer.
Dr. Weinstock and his colleague Kevan G. Lewis, MD, a resident in the
department of dermatology at Brown University, reviewed records from the
U.S. National Center for Health Statistics and the Centers for Disease
Control and Prevention mortality database. They found that of the 74,000
deaths that occurred over a 32-year period from NMSCs, genital NMSCs
claimed the lives of nearly 30,000 men and women. Of the nearly 30,000
deaths attributed to genital NMSC, women were three times more likely to
die of this type of cancer than men -- with 22,000 deaths occurring in
women compared to 8,000 deaths in men.
"As dermatologists, we expect to see skin cancers induced by
ultraviolet light, because sunlight is one of the primary risk factors for
the disease," said Dr. Weinstock. "But some of the most dangerous types of
skin cancers are those that are not sun-induced, such as skin cancers that
occur on genital skin - a place that is not exposed to intense sun and is
not routinely examined by dermatologists. That's why there needs to be an
increased awareness of this issue, so patients and physicians can be better
prepared to detect these cancers early before they become fatal."
Dr. Weinstock reports that the number of deaths from genital NMSCs
increased with age, when mortality rates were age-adjusted to the 2000 U.S.
standard population based on the number of deaths per 100,000 people per
year. Specifically, the number of women under age 65 who died of genital
NMSCs were less than one death per 100,000 people per year. For a city of 1
million people, one death per 100,000 means that 10 people die per year.
For women between the ages of 65-74, 1.8 deaths per 100,000 people per
year were reported; for women between the ages of 75-84, the number rose to
4.1 deaths per 100,000 people per year; and for women age 85 and older, the
number jumped to 8.8 deaths per 100,000 people per year.
For men under age 65, less than 0.5 deaths per 100,000 people per year
were reported; for men between the ages of 65-74, 1.0 death per 100,000
people per year was reported; for men between the ages of 75-84, the number
rose to 1.9 deaths per 100,000 people per year; and for men age 85 and
older, the number jumped to 4.1 deaths per 100,000 people per year.
"The number of deaths attributed to genital NMSCs was higher than
expected, and we believe HPV was the major cause of these cancers," noted
Dr. Weinstock. "The availability of the new HPV vaccine offers the
potential for a substantial reduction in the development of these skin
cancers for future generations. Since HPV is a sexually transmitted
disease, both men and women can practice preventive measures that could
lead to a decline in mortality rates from genital NMSCs, and heed the
warning signs of the disease -- including new growths or sores that don't
heal -- to detect it early."
When the death rates from non-genital NMSCs were examined, Dr.
Weinstock found that men were twice as likely as women to die from these
typically sun-induced skin cancers that commonly occurred on the face, head
or neck. Specifically, approximately 45,000 deaths were attributed to
non-genital NMSC -- roughly 27,000 deaths in men and 18,000 deaths in
women.
Similar to the mortality rates for genital NMSCs, the number of deaths
from non-genital NMSC also increased sharply with age for both genders.
Overall, the combined number of men and women under age 65 who died from
non-genital NMSC was less than one death per 100,000 people per year; for
adults between the ages of 65-74, 1.9 deaths per 100,000 people per year
was reported; for adults between the ages of 75-84, the number rose to 4.4
deaths per 100,000 people per year; and for adults age 85 and older, the
number increased dramatically to 11.9 deaths per 100,000 people per year.
"The one bit of good news from our study is that overall the death
rates from genital and non-genital nonmelanoma skin cancers have been
declining over the years," added Dr. Weinstock. "Even as the number of
older adults increase each year, we are finding that the overall death
rates are decreasing -- which could be attributed to a greater early
detection and prevention of skin cancer. We are hopeful that this trend
will continue and expect that the HPV vaccine will play a pivotal role in
reducing the overall death rate of genital skin cancers in the future."
Headquartered in Schaumburg, Ill., the American Academy of Dermatology
(Academy), founded in 1938, is the largest, most influential, and most
representative of all dermatologic associations. With a membership of more
than 15,000 physicians worldwide, the Academy is committed to: advancing
the diagnosis and medical, surgical and cosmetic treatment of the skin,
hair and nails; advocating high standards in clinical practice, education,
and research in dermatology; and supporting and enhancing patient care for
a lifetime of healthier skin, hair and nails.
American Academy of Dermatology
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