Skin cancer rates far higher than previously thought, according to new national database
Data from the newly established UK skin cancer database, the largest database of its kind in the world, has revealed that there are over 45,000 cutaneous squamous cell carcinomas (cSCC) every year in England, 350 per cent more than previous estimates suggested. Squamous cell carcinoma is the second most common form of skin cancer.
These data are important as they enable researchers and policy makers to evaluate the effectiveness of prevention initiatives, screening, staging (the process of grading a cancer in terms of size, depth and whether it has spread to other parts of the body), and treatments for what is a very common cancer.
Developed by experts at Queen Mary University of London and Public Health England (PHE), and funded by the British Association of Dermatologists, the database fills in enormous gaps in the recording of skin cancer, ensuring that accurate numbers for the three most common types of skin cancer: melanoma, basal cell carcinoma (BCC), and cSCC, are available for the whole of the UK. The study has been published in JAMA Dermatology.
Along with BCCs, cSCCs make up what are collectively called keratinocyte cancers, also known as non-melanoma skin cancers, which are the most common cancers in the UK.
Previously, the data on keratinocyte cancers has been very poor. They were rarely registered by cancer registries due to the sheer number of cases and the complexity of accurately registering multiple tumours per patient.
Changes in cancer registration processes in England in 2013, including the introduction of nationalised and automated cSCC registration, has enabled the creation of this population-based nationwide dataset.
A higher risk of cSCC was associated with being older, male, white, and of lower socioeconomic deprivation. This tallies with the consensus that the increase in SCCs in the UK is as a result of the ageing population, tanning trends, and easier access to foreign holidays, which results in greater cumulative UV exposure.
The researchers were also able to use the data to ascertain the number of cases of metastatic cSCC (i.e. it has spread to other parts of the body) in England. Between 2013 and 2015 there were 1,566 patients diagnosed with metastatic SCC for the first time. 85 per cent of these patients had their diagnosis of metastatic SCC within two years of their initial SCC diagnosis.
Until the end of 2016, 13,453 deaths from all causes were observed among the 76,977 patients diagnosed with their first cSCC in 2013 to 2015. The 3-year survival was 65 per cent among men and 68 per cent among women. Comparatively, expected three-year survival of an 80 year old in England between 2013-2015 would be 76 per cent in men and 82 per cent in women.
In the 836 of these patients who subsequently developed a metastatic SCC, the 3-year survival was 46 per cent in men and 29 per cent in women.
Professor Irene Leigh of Queen Mary University of London, lead author of the study, said:
"Due to their frequency, the healthcare burden of squamous cell carcinoma is substantial, with high risk patients requiring at least two to five years clinical follow-up after treatment and patients often developing multiple tumours. With poor three-year survival once cSCC has metastasised, earlier identification of these high-risk patients and improved treatment options are vital."
Nina Goad of the British Association of Dermatologists, said:
"This database is an important national milestone in the treatment of skin cancer, the UK's most common cancer. Previously, researchers and policy makers have been working on a puzzle without all the pieces. Now they know how many cases are being treated every year, better decisions can be made about treatment, prevention, and screening. This is a real step forward."
This dataset on the number of cSCC cases in England is the first released from the UK skin cancer database, with more to be published shortly.
More information: Zoë C. Venables et al, Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England, JAMA Dermatology (2018). DOI: 10.1001/jamadermatol.2018.4219