Over the past 16 years, we have established a unique, population-based study of non-melanoma skin cancer in New Hampshire that has made important scientific and public health contributions and informed policy decisions. Basal cell carcinoma (BCC) and squamous cell skin carcinoma (SCC), collectively termed non- melanoma skin cancer (NMSC), comprise the mostly frequently diagnosed cancers in the US. Consequently, these malignancies account for substantial morbidity, disfigurement and health care costs. However, few population-based epidemiologic studies exist in the US or globally. In the past three decades, both major types of NMSC - BCC and SCC - have increased dramatically. Of particular concern is accumulating evidence of a substantial rise in the occurrence of BCC at younger ages, for reasons not yet identified. It is imperative to measure and establish the risk factors that underlie this trend as these individuals not only have an increased likelihood of developing additional NMSCs, but invasive cutaneous melanomas and other malignancies as well. Building on our established population-based study of NMSCs, we will determine whether incidence rates of early-onset BCC have continued to increase. Further, we will investigate whether developing a BCC at an early age is due to emerging factors e.g., use of newer generation tanning devices, photosensitizing drugs, immunosuppressive agents and other nascent exposures. We will determine whether melanoma-related traits influence risk of early-onset BCCs including number of nevi and family history of melanoma. To investigate these new hypotheses, we will conduct targeted enrollment of new cases and controls (an additional 550 cases and 600 controls). This will entail continuing our collaborative, state-wide case ascertainment network of dermatologists, dermatopathologists and pathologists, which simultaneously allows us to measure incidence rates. Residents of New Hampshire newly diagnosed with BCC before age 50 years will be prospectively identified through this surveillance system. Age and sex frequency matched controls will be selected from New Hampshire driver's license records. We will conduct a standardized personal interview encompassing exposures of interest along with a complete assessment of sun exposure history, sun sensitivity and pigmentary traits, and will archive a blood (or buccal) sample. Pooling data from the previous grant period will permit us to test hypotheses with statistical power not otherwise possible, providing a cumulative total of approximately 1,200 early-onset BCC cases and 1,200 controls. Using our comprehensive approach, we can address an emerging public health concern, determine avoidable risk factors for the most common cancer in the US, and aid the discovery of new risk factors for other malignancies.

Public Health Relevance

Recent evidence suggests that basal cell carcinomas, the most common cancer in humans, are becoming more widespread among younger adults and women, for reasons as yet unknown;however, because this type of cancer is not routinely monitored in the US, we have limited information about their occurrence and risk factors. Our goal is to fill this important gap by leveraging our long-standing study of skin cancer in a US population. We propose to estimate the current rates and trends in these tumors and to help identify the underlying causes of their occurrence.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-PSE-G (02))
Program Officer
Carrick, Danielle M
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Dartmouth College
Family Medicine
Schools of Medicine
United States
Zip Code
Rees, Judy R; Zens, M Scot; Gui, Jiang et al. (2014) Non melanoma skin cancer and subsequent cancer risk. PLoS One 9:e99674
Sverrisson, Einar F; Zens, Michael S; Fei, Dennis Liang et al. (2014) Clinicopathological correlates of Gli1 expression in a population-based cohort of patients with newly diagnosed bladder cancer. Urol Oncol 32:539-45
Farzan, Shohreh F; Karagas, Margaret R; Christensen, Brock C et al. (2014) RNASEL and MIR146A SNP-SNP interaction as a susceptibility factor for non-melanoma skin cancer. PLoS One 9:e93602
Vineretsky, Karin A; Karagas, Margaret R; Kuriger-Laber, Jacquelyn K et al. (2014) HLA-C -35kb expression SNP is associated with differential control of ?-HPV infection in squamous cell carcinoma cases and controls. PLoS One 9:e103710
Karagas, Margaret R; Zens, M Scot; Li, Zhigang et al. (2014) Early-onset basal cell carcinoma and indoor tanning: a population-based study. Pediatrics 134:e4-12
Robinson, Sarah N; Zens, Michael S; Perry, Ann E et al. (2013) Photosensitizing agents and the risk of non-melanoma skin cancer: a population-based case-control study. J Invest Dermatol 133:1950-5
Hu, Ting; Andrew, Angeline S; Karagas, Margaret R et al. (2013) Statistical epistasis networks reduce the computational complexity of searching three-locus genetic models. Pac Symp Biocomput :397-408
Urbanowicz, Ryan John; Andrew, Angeline S; Karagas, Margaret Rita et al. (2013) Role of genetic heterogeneity and epistasis in bladder cancer susceptibility and outcome: a learning classifier system approach. J Am Med Inform Assoc 20:603-12
Farzan, Shohreh F; Waterboer, Tim; Gui, Jiang et al. (2013) Cutaneous alpha, beta and gamma human papillomaviruses in relation to squamous cell carcinoma of the skin: a population-based study. Int J Cancer 133:1713-20
Cottingham, Kathryn L; Karimi, Roxanne; Gruber, Joann F et al. (2013) Diet and toenail arsenic concentrations in a New Hampshire population with arsenic-containing water. Nutr J 12:149

Showing the most recent 10 out of 96 publications