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The current burden of non-melanoma skin cancer attributable to ultraviolet radiation and related risk behaviours in Canada

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Abstract

Purpose

Ultraviolet radiation (UVR) is an established cause of non-melanoma skin cancer (NMSC)—basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The aim of this study was to estimate the current burden of BCC and SCC associated with UVR and modifiable UVR behaviours (sunburn, sunbathing, and indoor tanning) in Canada in 2015.

Methods

The current burden of BCC and SCC associated with UVR was estimated by comparing 2015 incidence rates with rates of less exposed body sites (trunk and lower limbs) after adjusting for estimated surface areas. The burden associated with modifiable UVR behaviours was estimated by using prevalence estimates among Caucasians from the Second National Sun Survey, and relative risks that are generalizable to Canadians from conducting meta-analyses of relevant studies.

Results

We estimated that 80.5% of BCCs and 83.0% of SCCs were attributable to UVR. Adult sunburn was associated with relative risks of 1.85 (95% CI 1.15–3.00) for BCC and 1.41 (95% CI 0.91–2.18) for SCC, while adult sunbathing was associated with relative risks of 1.82 (95% CI 1.52–2.17) for BCC and 1.14 (95% CI 0.53–2.46) for SCC. We estimated that 18.6% of BCCs and 9.9% of SCCs were attributable to adult sunburn, while 28.1% of BCCs were attributable to adult sunbathing. We estimated that 46.2% of BCCs and 17.3% of SCCs were attributable to modifiable UVR behaviours combined.

Conclusion

Our results provide quantifiable estimates of the potentially avoidable burden of NMSCs among Canadians. These estimates can be used to motivate prevention efforts in Canada.

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Abbreviations

BCC:

Basal cell carcinoma

CI:

Confidence interval

AC:

Attributable cases

NMSC:

Non-melanoma skin cancer

NSS2:

The Second National Sun Survey

PAR:

Population attributable risk

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RR:

Relative risk

SCC:

Squamous cell carcinoma

UVA:

Ultraviolet A

UVB:

Ultraviolet B

UVR:

Ultraviolet radiation

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Acknowledgments

Additional members of the ComPARe study team: Prithwish De, Cancer Care Ontario, Toronto, Ontario, Canada; Leah Smith, Canadian Cancer Society, Toronto, Ontario, Canada; Elizabeth Holmes, Canadian Cancer Society, Toronto, Ontario, Canada; Xin Grevers, Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada; Karena Volesky, Departments of Oncology and Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Zeinab El-Masri, Cancer Care Ontario, Toronto, Ontario, Canada; Robert Nuttall, Canadian Cancer Society, Toronto, Ontario, Canada; Mariam El-Zein, Department of Oncology, McGill University, Montréal, Québec, Canada; Tasha Narain, Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada; Priyanka Gogna, Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada.

Funding

This research was supported by a Canadian Cancer Society Research Institute Partner Prevention Research Grant (#703106). Dylan O’Sullivan was supported by a Queen Elizabeth II Scholarship, Ontario Graduate Scholarship, and Chen-Aronson Fellowship in Causes of Cancer. Darren Brenner held a Canadian Cancer Society Prevention Capacity Development Award (#703917). Christine Friedenreich was supported by an Alberta Innovates Health Solutions Health Senior Scholar Award and by the Alberta Cancer Foundation Weekend to End Women’s Cancers Breast Cancer Chair.

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Authors and Affiliations

  1. Department of Public Health Sciences, Queen’s University, Carruthers Hall, 62 Fifth Field Company Lane 2nd floor, Kingston, ON, K7L 3N6, Canada

    Dylan E. O’Sullivan & Will D. King

  2. Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, CancerControl Alberta, Calgary, AB, Canada

    Darren R. Brenner & Christine M. Friedenreich

  3. Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Darren R. Brenner & Christine M. Friedenreich

  4. School of Mathematics and Statistics, Carleton University, Ottawa, ON, Canada

    Paul J. Villeneuve

  5. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Stephen D. Walter

  6. Occupational Cancer Research Centre, Ontario Health, Toronto, ON, Canada

    Paul A. Demers

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  1. Dylan E. O’Sullivan
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  2. Darren R. Brenner
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  7. Will D. King
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Correspondence to Will D. King.

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O’Sullivan, D.E., Brenner, D.R., Villeneuve, P.J. et al. The current burden of non-melanoma skin cancer attributable to ultraviolet radiation and related risk behaviours in Canada. Cancer Causes Control 32, 279–290 (2021). https://doi.org/10.1007/s10552-020-01382-1

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