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Author Notes:

Correspondence to: Ann C. Mertens, PhD, Department of Pediatrics, Emory University, 2015 Uppergate Dr, Atlanta, GA 30322. Email: amerten@emory.edu.

The study sponsor had no role in the study design, analysis or interpretation of the data, writing of the manuscript, or the decision to submit the manuscript for publication.


Research Funding:

This work was supported by Lance Armstrong Foundation (to ACM), the National Cancer Institute grant (CA 55727 to LLR) and the National Cancer Institute subgrant (5U2415 to MS), the National Cancer Institute/National Institutes of Health contract (N02 CP-2010-00-15 to MS), and the Intramural Research Program of the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health.

Radiation-Related Risk of Basal Cell Carcinoma: A Report From the Childhood Cancer Survivor Study


Journal Title:

Journal of the National Cancer Institute


Volume 104, Number 16


, Pages 1240-1250

Type of Work:

Article | Post-print: After Peer Review


Background: Basal cell carcinoma (BCC) is the most common malignancy in the United States. Ionizing radiation is an established risk factor in certain populations, including cancer survivors. We quantified the association between ionizing radiation dose and the risk of BCC in childhood cancer survivors. Methods: Participants in the Childhood Cancer Survivor Study who reported a BCC (case subjects, n = 199) were matched on age and length of follow-up to three study participants who had not developed a BCC (control subjects, n = 597). The radiation-absorbed dose (in Gy) to the BCC location was calculated based on individual radiotherapy records using a custom-designed dosimetry program. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between demographic and treatment factors, therapeutic radiation dose, and surrogate markers of sun sensitivity (skin and hair color) and the risk of BCC. A linear dose–response model was fitted to evaluate the excess odds ratio per Gy of radiation dose. Results: Among case subjects, 83% developed BCC between the ages of 20 and 39 years. Radiation therapy, either alone or in combination with chemotherapy, was associated with an increased risk of BCC compared with no chemotherapy or radiation. The odds ratio for subjects who received 35 Gy or more to the skin site vs no radiation therapy was 39.8 (95% CI = 8.6 to 185). Results were consistent with a linear dose–response relationship, with an excess odds ratio per Gy of 1.09 (95% CI = 0.49 to 2.64). No other treatment variables were statistically significantly associated with an increased risk of BCC. Conclusions: Radiation doses to the skin of more than 1 Gy are associated with an increased risk of BCC.

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