1. Approximately two million Americans annually have basal cell carcinomas (BCC). The majority of these patients are elderly, male, and Caucasian.
Evidence Rating Level: 2 (Good)
Study Rundown: Non-melanoma skin cancer (NMSC), which includes basal and squamous cell carcinoma (BCC and SCC, respectively), is one of the most common malignant tumors in the United States. In the US alone, it has been estimated that nearly $1.4 billion is spent annually in treating NMSC. Despite the significant burden of disease, there are not many up-to-date estimates of incidence rates. These investigators used data from the Kaiser Permanente healthcare system to estimate annual BCC incidence rates by age, sex, race/ethnicity and to assess changes over time. They found that between 1998 and 2012, the incidence of BCC had risen by approximately 17%. The study was strengthened by its use of a large validated skin cancer registry. However, use of a database from a single healthcare setting, consisting of only insured health plan members, also limited the generalizability of their findings.
In-Depth [retrospective cohort]: This study used data between 1998 and 2012 from the Kaiser Permanente healthcare system in Northern California (KPNC) to analyze a previously validated BCC registry. Study investigators selected cases of biopsy-proven BCC by using the surgical pathology biopsy records from the KPNC system. Annual incidence rates were estimated by dividing the number of BCC cases per year by the KPNC membership person-years in the same year. To expand these findings to estimate incidence in the US, estimates were standardized by age, sex, race/ethnicity distribution using the 2010 US Census population. There were 221,624 BCC cases identified in the KPNC population between 1998-2012. Males had higher incidence rates than females (incidence rate ratio [IRR], 1.65; 95% CI, 1.60-1.70). Patients ages >80 and between ages 65-79 both had increased incidence rates when compared to those between 40-64 years of age (IRR, 2.96; 95% CI, 2.86-3.06; and IRR, 5.14; 95% CI, 4.94-5.35, respectively). Finally, Caucasians had higher incidence rates than Hispanics (IRR, 8.56; 95% CI, 7.79-9.41), Asians (IRR, 33.13; 95% CI, 27.84-39.42), and blacks (IRR, 72.98; 95% CI, 49.21-108.22).
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