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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_3157"
                     title="Death Risk Widens for Blacks With Colorectal Cancer (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/tb/21885?impressionId=1283457904216"
                     
      The risk of death from colorectal cancer is greater for blacks than whites and the differences have been widening for four decades, researchers said.&lt;br&gt;
&lt;br&gt;The widening disparities have occurred in both sexes and in all stages of the disease, despite improvements in detection and treatment, according to Samir Soneji, PhD, and colleagues at the University of Pennsylvania.&lt;br&gt;
&lt;br&gt;The disparities  --  largely driven by consistent improvements among whites  --  are most likely the result of differences in access to care or the quality of care, the researchers wrote online in the&lt;em&gt; American Journal of Public Health&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;Colorectal cancer is one of the few cancers that has had advances in detection, treatment, and survival over the second half of the twentieth century,&quot; Soneji said in a statement. &quot;But despite these advancements, we observed ever-widening racial gaps in overall and stage-specific survival.&quot;&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Earlier this year, &lt;a href=&quot;http://www.medpagetoday.com/HematologyOncology/ColonCancer/19436&quot; mce_href=&quot;http://www.medpagetoday.com/HematologyOncology/ColonCancer/19436&quot; target=&quot;_blank&quot;&gt;another research team also concluded&lt;/a&gt; that healthcare use might be responsible for the observed differences by race.&lt;/p&gt;
&lt;p&gt;The current findings come from a retrospective analysis of data from the National Center for Health Statistics and the Surveillance, Epidemiology, and End Results (SEER) database between 1960 and 2005, Soneji and colleagues reported.&lt;/p&gt;
&lt;p&gt;One surprising finding was that death rates from colorectal cancer were once higher among whites, Soneji said, at about 250 deaths per million person-years for women and 275 per million for men in 1960.&lt;/p&gt;
&lt;p&gt;But since then, death rates for whites have been dropping, while they dropped more slowly among black women and actually increased among black men, the researchers found. Specifically: &lt;ul&gt; &lt;li&gt;Among white women, mortality steadily declined from 241 deaths per million person-years in 1960 to 111 deaths per million person-years in 2005  --  equivalent to a 54% relative reduction.&lt;/li&gt; &lt;li&gt;Among black women, the relative decline was 14%  --  from 203 deaths per million person-years in 1960 to 174 in 2005.&lt;/li&gt; &lt;li&gt;For white men, mortality fell from 273 deaths per million person-years in 1960 to 166 in 2005, a 39% relative decline. &lt;/li&gt; &lt;li&gt;In contrast, death rates for black men increased 28% over the same time period, to 258 deaths per million person-years in 2005 from 201 in 1960.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The researchers also found that blacks had worse rates of stage-specific survival and life expectancy than whites.&lt;/p&gt;
&lt;p&gt;For example, they reported, the life expectancy of a 60-year-old white man with localized colorectal cancer in the 1970s was 1.01 year longer than that of a black man the same age with the same disease stage. In the first decade of this century, they found, the gap was 2.7 years.&lt;/p&gt;
&lt;p&gt;Overall, when the researchers controlled for age, sex, and stage at diagnosis, the hazard of death in the 1970s was 1.11 times greater for blacks than for whites. The disparity &quot;increased consistently&quot; over the next 30 years, reaching 1.22 times greater in the1980s, 1.26 times greater in the 1990s, and 1.33 times greater in the 2000s.&lt;/p&gt;
&lt;p&gt;The researchers said it&apos;s possible that variability and biases in death certificate data may distort the results. As well, they noted, the SEER registry does not capture the entire U.S., which may mean that some trends were missed.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study had support from Robert Wood Johnson Foundation Health &amp;amp; Society Scholars and Robert Wood Johnson Clinical Scholars.&lt;/p&gt;&lt;p&gt;The researchers did not report conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3155"
                     title="Targeted Therapy Shows Early Promise in Melanoma (CME/CE)"
                     score="0.009"
                     href="http://www.medpagetoday.com/HematologyOncology/SkinCancer/tb/21881?impressionId=1283457904216"
                     
      &lt;p&gt;A novel drug targeted to a common mutation behind melanoma appears effective in skin tumors that carry the mutation, according to early results.&lt;/p&gt;
&lt;p&gt;In a phase I trial, 10 of the 16 patients with melanoma tumors carrying the V600E mutation in the serine&amp;#8211;threonine protein kinase B-RAF (&lt;em&gt;BRAF&lt;/em&gt;) gene had a partial response when treated with at least 240 mg of the agent known as PLX4032, or RG7204.&lt;/p&gt;
&lt;p&gt;One of these patients had a complete response to the oral inhibitor of mutated BRAF, Keith T. Flaherty, MD, of the Massachusetts General Hospital Cancer Center in Boston, and colleagues found.&lt;/p&gt;
&lt;p&gt;The results looked even better in an extension phase of trial in BRAF-mutation metastatic melanoma, the researchers reported in the Aug. 26 issue of the &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Altogether, 81% of melanoma patients with the mutation responded, noted co-author Jeffrey A. Sosman, MD, of Vanderbilt University in Nashville, Tenn.&lt;/p&gt;
&lt;p&gt;&quot;These responses occur rapidly, in organs where we infrequently see tumor regression, and patients can actually feel better overnight with this therapy,&quot; he said in an interview.&lt;/p&gt;
&lt;p&gt;The dramatic results were &quot;much beyond&quot; that expected from such an early phase study, Vernon K. Sondak, MD, of the Moffitt Cancer Center and Research Institute in Tampa, Fla., said in an interview.&lt;/p&gt;
&lt;p&gt;Even in phase III melanoma trials with standard drugs the typical response rate might be only 6% to 12%, he explained.&lt;/p&gt;
&lt;p&gt;&quot;Overall, I think this is quite significant,&quot; he said in the interview, particularly since about half of melanoma cases are associated with the mutation targeted by the drug in the study.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial with Keiran S.M. Smalley, PhD, also of the Moffitt Cancer Center and Research Institute, he called the results a major breakthrough that provides proof of principle for individualized treatment of a substantial proportion of metastatic melanoma.&lt;/p&gt;
&lt;p&gt;A similar strategy of imatinib (Gleevec) has some evidence of efficacy against melanoma in which mutations in the &lt;em&gt;KIT&lt;/em&gt; gene are culprit, but these are found in only a small minority of melanomas, the editorialists pointed out.&lt;/p&gt;
&lt;p&gt;Pretreatment screening for mutations in &lt;em&gt;BRAF&lt;/em&gt;, &lt;em&gt;KIT&lt;/em&gt;, and probably other key genes is likely on the horizon, they suggested.&lt;/p&gt;
&lt;p&gt;In the case of BRAF, they recommended confirmation of mutation before giving an inhibitor of this pathway since these drugs paradoxically stimulate cell proliferation via another route in cell lines without the mutations.&lt;/p&gt;
&lt;p&gt;Indeed, the study showed an unexpectedly high rate of cutaneous squamous cell carcinomas, nearly all of the keratoacanthoma type, in patients treated with PLX4032  --  eight (15%) in the dose-escalation cohort and 10 (31%) in the extension cohort.&lt;/p&gt;
&lt;p&gt;All of these cancers were resected with none leading to treatment discontinuation.&lt;/p&gt;
&lt;p&gt;The multicenter study included 55 patients in the dose-escalation phase who had a variety of solid-tumor types refractory to therapy or for which standard or curative therapy was not available. Among them, 49 had melanoma.&lt;/p&gt;
&lt;p&gt;Patients received PLX4032 twice daily until disease progression. Doses started at 160 mg twice daily and escalated to 1,120 mg twice daily with progressive enrollment.&lt;/p&gt;
&lt;p&gt;The recommended dose going forward was 960 mg twice daily. Beyond that dose, grade 2 or 3 rash, fatigue, and arthralgia limited escalation.&lt;/p&gt;
&lt;p&gt;In the extension phase, 32 additional patients with metastatic melanoma with confirmed V600E &lt;em&gt;BRAF&lt;/em&gt; mutation got this recommended dose.&lt;/p&gt;
&lt;p&gt;Among them, 24 had a partial response and two had a complete response. These responses occurred in visceral organs and bone metastases as well as sites where responses are common with other drugs, such as the lungs and lymph nodes.&lt;/p&gt;
&lt;p&gt;Symptom improvement occurred within one to two weeks, including reduced need for narcotics in three patients.&lt;/p&gt;
&lt;p&gt;In the entire treated cohort, the estimated median progression-free survival extended more than seven months with a substantial proportion still on study.&lt;/p&gt;
&lt;p&gt;So the novel agent isn&apos;t a cure for melanoma, Sosman noted.&lt;/p&gt;
&lt;p&gt;But there are good prospects for combining this targeted therapy with others, such as the novel immune-stimulating drug &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ASCO/20490&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ASCO/20490&quot; target=&quot;_blank&quot;&gt;ipilimumab&lt;/a&gt; which recently showed the first ever overall survival impact in metastatic melanoma, Sosman and the editorialists agreed.&lt;/p&gt;
&lt;p&gt;The mechanisms for the primary and secondary resistance seen to PLX4032 aren&apos;t known but warrant study, the researchers concluded.&lt;/p&gt;
&lt;p&gt;A phase III trial with the BRAF inhibitor is underway to determine whether it can improve overall survival similar to ipilimumab.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by Plexxikon and Roche Pharmaceuticals.&lt;/p&gt;&lt;p&gt;Flaherty, Sosman, and several co-authors report the receipt by their institutions of grant support from Plexxikon to conduct this clinical trial. Flaherty, Sosman, and several co-authors also reported receiving consulting fees or reimbursement for travel expenses from Roche Pharmaceuticals.&lt;/p&gt;&lt;p&gt;Sosman reported pending receipt of grant support from Roche Pharmaceuticals.&lt;/p&gt;&lt;p&gt;Two co-authors reported being employees of Roche Pharmaceuticals; one reported being an employee of Plexxikon, holding equity in the company, and receiving reimbursement for travel expenses from the company.&lt;/p&gt;&lt;p&gt;Sondak reported having received honoraria and travel expenses from Hoffman-LaRoche, Genentech/Hoffman-LaRoche, and GlaxoSmithKline.&lt;/p&gt;&lt;p&gt;Smalley reported having received grants from the Melanoma Research Foundation, the State of Florida, the Harry Lloyd Trust, and the National Cancer Institute.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3144"
                     title="ESC: Statins Cleared of Causing Cancer (CME/CE)"
                     score="0.009"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21866?impressionId=1283457904216"
                     
      &lt;p&gt;STOCKHOLM  --  In what may be the final word on the issue, an international team of researchers report that statins neither cause nor prevent cancer.&lt;/p&gt;
&lt;p&gt;The finding comes from a meta-analysis of 25 randomized controlled trials of the lipid-lowering medications, according to Jonathan Emberson, PhD, of the University of Oxford, and colleagues in the international Cholesterol Treatment Trialists&apos; Collaboration.&lt;/p&gt;
&lt;p&gt;In those trials, which included more than 166,000 participants, there were no differences between treatment and control arms in terms of the incidence of cancer or the rate of cancer mortality, Emberson said in a telephone interview.&lt;/p&gt;
&lt;p&gt;He will report the results next week in a presentation at the annual congress of the European Society of Cardiology here.&lt;/p&gt;
&lt;p&gt;&quot;Randomization to statin therapy for at least five years had no effect on the incidence of cancer or of cancer mortality in any group of individuals,&quot; Emberson told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The main goal of the trials was to establish the effect of statins on lipid levels, and especially how changes in lipids affected the risk of major cardiovascular events. But Emberson said the collaborative group planned from the beginning to get data on cancer mortality, based on individual patient-level data from all the studies.&lt;/p&gt;
&lt;p&gt;&quot;Because we have individual patient data, we can really look at particular hypotheses and test them,&quot; he said  --  something that many meta-analyses can&apos;t do.&lt;/p&gt;
&lt;p&gt;The researchers conducting the trials were asked to track cancer, he said, because of observational studies that had suggested that lower cholesterol was linked to a higher risk of cancer. It now seems likely that those results arose from residual confounding or perhaps reverse causality, since it is known that the early stages of cancer can have the effect of lowering cholesterol, he said.&lt;/p&gt;
&lt;p&gt;There have also been observational studies suggesting the opposite effect  --  that statins prevent cancer.&lt;/p&gt;
&lt;p&gt;The 25 studies included 20 in which a statin was compared to placebo, involving 126,753 participants, and five in which higher and lower doses were compared, involving 39,612 participants. All the trials had at least 1,000 participants and lasted at least five years, Emberson said.&lt;/p&gt;
&lt;p&gt;The investigators calculated rate ratios for the effect on cancer incidence and cancer mortality of each 1.0 millimole per liter reduction in low-density lipoprotein cholesterol.&lt;/p&gt;
&lt;p&gt;All told, they reported, 9,954 participants developed cancer and 3,498 died from it.&lt;/p&gt;
&lt;p&gt;But reducing LDL cholesterol with a statin had no effect on the risk of developing cancer or on the risk of cancer death: &lt;ul&gt; &lt;li&gt;In the 20 statin versus control trials, cancer incidence in the treatment arms was 3,502 (or 1.4% a year) versus 3,514 cases in the control arms (also 1.4% a year), for a rate ratio of 0.99.&lt;/li&gt; &lt;li&gt;In those trials, there were 1,289 deaths among those taking statins versus 1,281 in those getting the placebo  --  0.5% a year for both  --  leading to a rate ratio of 1.00.&lt;/li&gt; &lt;li&gt;In the five trials of more versus less statin, cancer incidence was 1,466 versus 1,472 (1.6% a year for both arms) yielding a rate ratio of 1.02, while cancer mortality was 447 deaths versus 481 (0.5% a year for both arms) for a rate ratio of 0.88 and a 95% confidence interval from 0.67 to 1.15. &lt;/li&gt; &lt;li&gt;There was no evidence of any effect of statin therapy on cancer incidence or mortality at any particular site, with increasing years of treatment, or in any particular subgroup.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The only gap, Emberson said, is that the study only covers five years of treatment and it remains possible that an effect might be seen after longer therapy. But he said that some of the studies now have a decade of data and no evidence of a long-term effect has emerged.&lt;/p&gt;
&lt;p&gt;While statins are widely used, there has been &quot;an ongoing background worry&quot; among physicians that they might cause harm, according to Chris Cannon, MD, of Brigham and Women&apos;s Hospital in Boston.&lt;/p&gt;
&lt;p&gt;That fear has now been laid to rest, he told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;The key message is that statins are safe and there&apos;s no issue of increasing cancer,&quot; he said. &quot;And there&apos;s also no effect of reducing cancer, at least in a five-year time frame.&quot;&lt;/p&gt;
&lt;p&gt;The data, he said, meet the &quot;gold standard&quot; of randomized trials and &quot;trump the many observational analyses that have come out on both sides of the equation.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Emberson said he had no financial conflicts.&lt;/p&gt;
&lt;p&gt;Cannon reported research funding from Accumetrics, AstraZeneca, GlaxoSmithKline, InteKrin Therapeutics, Merck, Takeda; an advisory and ownership relationship with Bristol-Myers Squibb/Sanofi Partnership,  Novartis, and Alnylam; Honorarium for development of independent educational symposium from Pfizer; and clinical advisor and equity in Automedics Medical Systems.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3104"
                     title="CT Colonography Boosts High-Risk Yield (CME/CE)"
                     score="0.005"
                     href="http://www.medpagetoday.com/Oncology/ColonCancer/tb/21810?impressionId=1283457904216"
                     
      &lt;p&gt;CT colonography identified almost 80% more high-risk lesions compared with optical screening by adding extracolonic findings, a review of more than 2,000 cases showed.&lt;/p&gt;
&lt;p&gt;CT showed extracolonic findings in almost half of the cases, a fourth of which were considered significant. The findings led to 280 radiology procedures and 19 surgeries, adding about $50 per patient.&lt;/p&gt;
&lt;p&gt;&quot;CT colonography [CTC] not only identifies colorectal cancer [CRC] but also doubles the yield of identifying significant early extracolonic lesions, resulting in lives saved,&quot; Ganesh Veerappan, MD, of Walter Reed Army Medical Center in Washington, and co-authors reported in the September issue of the &lt;em&gt;American Journal of Roentgenology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;These results represent a compelling reason to consider CTC either as an alternative to optical colonoscopy CRC screening or as a one-time procedure to identify significant treatable intracolonic and extracolonic lesions.&quot;&lt;/p&gt;
&lt;p&gt;CT colonography, or virtual colonoscopy, does not replace a CT scan of the abdomen and pelvis for detecting significant extracolonic lesions, the authors emphasized. Because of its lack of contrast material and low radiation dose, CT colonography&apos;s sensitivity for detecting extracolonic lesions is lower than that of a conventional CT scan.&lt;/p&gt;
&lt;p&gt;Because CT colonography enables examination of the entire abdomen and pelvis, the imaging modality shows extracolonic findings in a substantial proportion of patients. Prior studies have suggested that these extracolonic findings are clinically significant in 10% to 23% of cases, the authors wrote in their introduction.&lt;/p&gt;
&lt;p&gt;The clinical and economic impact of CT colonography&apos;s extracolonic findings had not been studied carefully, and that was the objective of Veerappan and co-authors.&lt;/p&gt;
&lt;p&gt;They retrospectively reviewed records of 2,277 patients who had screening CT colonography at Walter Reed from 2003 to 2006. A CT colonography reporting and data system was used to classify findings as highly significant, likely significant, or insignificant.&lt;/p&gt;
&lt;p&gt;Screening CT colonography showed extracolonic findings in 1,037 (46%) of patients. The findings were considered insignificant (E2 by the reporting system) in 787 cases and significant in 240 (E3-4).&lt;/p&gt;
&lt;p&gt;During a mean follow-up of 19 months, evaluation of significant findings led to 280 radiology procedures and 19 surgeries, resulting in a total cost of $113,179, or about $50 per patient screened.&lt;/p&gt;
&lt;p&gt;Screening CT colonography identified six intracolonic malignancies and three adenomas with high-grade dysplasia. Additionally, the imaging studies identified six extracolonic malignancies and one abdominal aortic aneurysm.&lt;/p&gt;
&lt;p&gt;CT colonography detected 16 high-risk lesions, whereas nine would have been identified by optical colonoscopy, resulting in a 78% increase in the yield of high-risk lesions. Eleven of the 16 lesions were treated by curative surgery, and five of the 11 lesions were extracolonic.&lt;/p&gt;
&lt;p&gt;&quot;Of 2,277 patients undergoing CTC for CRC screening, extracolonic findings doubled the yield of cancer identification from six to 12,&quot; the authors noted. &quot;This is a clear advantage of this new technology that needs to be weighed into future recommendations concerning CRC screening.&quot;&lt;/p&gt;
&lt;p&gt;Limitations of the study included its retrospective design and inability to follow patients who may have been treated outside of the military health system.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported that they had no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3031"
                     title="Redheads Seem to Have Multiple BCCs (CME/CE)"
                     score="0"
                     href="http://www.medpagetoday.com/Dermatology/SkinCancer/tb/21695?impressionId=1283457904216"
                     
      &lt;p&gt;Redheads appear to be at the highest risk for developing multiple basal cell carcinomas (BCC), according to a Dutch population-based study.&lt;/p&gt;
&lt;p&gt;The prospective study of nearly 11,000 people followed for almost a decade found those with red hair who had one BCC were 40.3% more likely to have multiple subsequent lesions compared with those who had dark hair (adjusted HR 1.43, 95% CI 1.05 to 1.93), Ville Kiiski, MD, and colleagues from Erasmus Medical Center in Rotterdam, reported.&lt;/p&gt;
&lt;p&gt;Using Andersen-Gill multifailure survival models to analyze repeated events, Kiiski&apos;s team determined that a high educational level (reflecting higher socioeconomic status) also was associated with a greater likelihood for multiple BCCs (HR 1.42, 95% CI 1.12 to 1.81), they wrote in the August &lt;em&gt;Archives of Dermatology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Risk factors for developing a first BCC lesion include age, male sex, race, and genetic predisposition, factors that may interact with environmental exposures such as ultraviolet light, the researchers explained.&lt;/p&gt;
&lt;p&gt;However, risk factors for subsequent lesions are not well documented, so the team analyzed data from participants in the Rotterdam Study, a prospective, population-based cohort study designed to study diseases in elderly people.&lt;/p&gt;
&lt;p&gt;Data from two cohorts were examined  --  7,983 people ages 55 or older enrolled in 1990 and 3,011 participants added in 1999. The team then compared risk factors for multiple lesions with those associated with initial incident BCC lesions among a total of 10,820 participants.&lt;/p&gt;
&lt;p&gt;The mean age at study entry was 69.1 years. Two-thirds of the participants were women and almost all were white.&lt;/p&gt;
&lt;p&gt;A total of 4.8% of the cohort had at least one BCC, and there were 854 unique lesions (excluding BCC recurrences) during almost ten years of follow-up.&lt;/p&gt;
&lt;p&gt;Risk factors for a first BCC included older age (65 to 75 years) at the time of enrollment (adjusted OR 1.39, 95% CI 1.11 to 1.75) and red hair (adjusted OR 1.98, 95% CI 1.24 to 3.14), the researchers found.&lt;/p&gt;
&lt;p&gt;Among two-thirds of the cohort, the most common BCC lesion site was the head or neck; more than half were of the nodular subtype.&lt;/p&gt;
&lt;p&gt;The incidence rate for first BCC lesions was 513 per 100,000 person-years.&lt;/p&gt;
&lt;p&gt;The incidence of multiple BCC lesions was 161.5 per 100,000 person-years, and 85.9% developed their second lesion within five years after the first.&lt;/p&gt;
&lt;p&gt;In a multivariate analysis that adjusted for factors such as sex, hair color, and lesion histologic subtype, older age at the time of first BCC was associated with a lower risk for developing multiple lesions, with a hazard ratio of 0.58 (95% CI 0.47 to 0.71) for those who were 75 or older at the time of their index lesion.&lt;/p&gt;
&lt;p&gt;The investigators acknowledged that this finding might be explained in part by a shorter mean follow-up time  --  6.66 years  --  among the oldest patients, compared with 10.36 years in those ages 65 to 75, and 10.70 years for those under age 65.&lt;/p&gt;
&lt;p&gt;&quot;However, this theory does not clarify the decreased risk of developing multiple lesions in the 65.0 to 74.99 year age group,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;The hazard ratio for that intermediate age group was 0.65 (95% CI 0.53 to 0.81).&lt;/p&gt;
&lt;p&gt;After adjusting for confounders, the only lesion factor associated with high risk was site of the index lesion being on an upper extremity (HR 1.49, 95% CI 1.02 to 2.15).&lt;/p&gt;
&lt;p&gt;The study findings, that patients who were younger at the time of first diagnosis, had higher socioeconomic status, red hair at a younger age, and whose first BCC was located on an upper extremity, could allow physicians to focus most closely on these patients for more rigorous follow-up.&lt;/p&gt;
&lt;p&gt;In the Netherlands and the U.S., the usual recommendation is for annual skin examination for five years.&lt;/p&gt;
&lt;p&gt;The incidence of BCC is steadily rising  --  around one million Americans develop a BCC each year.&lt;/p&gt;
&lt;p&gt;Early-stage lesions can be easily removed and the cure rate is high with early detection and treatment. Although not the most deadly skin cancer (that distinction belongs to melanoma) the high incidence and risk of multiple lesions make it the fifth most expensive cancer to treat in the U.S., according to the authors.&lt;/p&gt;
&lt;p&gt;&quot;The risk profiles associated with incident and multiple lesions differed; this information requires physicians to alter their risk assessment after a first lesion has been diagnosed,&quot; they concluded.&lt;/p&gt;
&lt;p&gt;Given the aging of the population, the authors called for further research in this area to help limit costs for follow-up in this large population.&lt;/p&gt;
&lt;p&gt;A limitation of the study was the lack of information about ultraviolet light exposure early in life.&lt;/p&gt;
&lt;p&gt;And, since the most study participants were Dutch females, white, and over age 55, the findings may not be generalizable to people of different age, ethnicity, skin type, or location.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors declared no financial conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>