Hair color, socioeconomic status among risk factors for recurring basal cell carcinoma

An unusual finding: One disease that is more prevalent in HIGH status people. May be because the poor tend to be couch potatoes while richer people get into the outdoors more (Golf etc.). Exposure to the sun is the main cause of BCCs

Patients who receive a diagnosis of the skin cancer basal cell carcinoma at a younger age—along with those who have red hair, a higher socioeconomic status and a cancerous lesion on their upper extremities—appear to be at higher risk of developing multiple cancers and require closer follow-up, according to a report in the August issue of Archives of Dermatology, one of the JAMA/Archives journals.

"Basal cell carcinoma is the most common type of cancer in people with European ancestry, and its incidence continues to increase steeply," the authors write as background information in the article. "Although basal cell carcinoma therapy is relatively straightforward and basal cell carcinoma mortality rates are extremely low, the high incidence of basal cell carcinoma and the high risk of developing multiple lesions put a major burden on limited health care resources, placing basal cell carcinoma in fifth place on the list of most expensive cancers to treat in the United States."

Risk factors for the disease include older age, being male, race and genetic predisposition, which may interact with UV light exposure or other environmental hazards. To investigate the incidence of and risk factors for single vs. multiple basal cell carcinoma lesions, Ville Kiiski, M.D., and colleagues at Erasmus Medical Center, Rotterdam, the Netherlands, studied two cohorts of 10,994 Dutch adults 55 or older, one in 1990 and one in 1999. Patients with basal cell carcinoma lesions were identified from Dutch national records and potential risk factors—including sex, age, hair color, eye color, educational level and other demographic and health characteristics—were determined when individuals entered the study.

A total of 524 (4.8 percent) individuals in both cohorts had basal cell carcinoma, of whom 361 had single lesions and 163 (31.1 percent) had multiple lesions. Individuals who developed their first lesion after age 75 were significantly less likely to develop multiple lesions, whereas red hair and a first lesion located on the upper extremities was associated with a significantly increased risk of developing multiple lesions.

"In contrast to developing a first lesion, high educational level was significantly positively associated with developing multiple lesions," the authors write. "This finding may be explained by the probability that people with higher levels of education (which correlates strongly with socioeconomic status) have different lifestyles (e.g., more frequent exposure to UV rays for intermittent periods)." It may also be that these individuals were more likely to develop cancer in places other than the face and neck, or because they tend to live longer and thus have more time to develop lesions, the authors note.

Known risk factors for basal cell carcinoma, including having blue eyes and fair or blond hair, were not associated with the risk for additional lesions. "The observed discrepancy among risk factor profiles of developing single or multiple basal cell carcinoma lesions may suggest that once cumulative environmental-genetic interaction has surpassed a certain threshold and resulted in a lesion, the phenotypic characteristics of patients seem less important. The clinical relevance of this finding is that physicians' risk assessment efforts should differentiate between patients at risk for a first lesion and those who have a history of basal cell carcinoma."

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The cruel irony of organic standards

The triumph of purist ideology over compassion and science means suffering and death for organic farm animals across America.

The week-old dairy calf, gangly and still, lay on a barn floor, her long-lashed eyes rolled back to expose the blue-white rim. The next morning, when I went to help my neighbor with his newborns, the calf was dead.

Department of Agriculture (USDA) regulations defining organic standards mandate that if this calf had gotten one dose of antibiotics, even to save her life, she could never give organic milk—even after the two years it takes for her to become a milker, and even though neither she nor her milk would retain any trace of antibiotics.

Farmers are not generally callous or cruel, but neither are they sentimental. Organic standards mandate that they take all measures to save the life of an animal, but treatment strategies can be subjective, and loss of organic status factors into a farmer’s decision. After all, antibiotics don’t always work, and sometimes animals recover without them. So decent farmers wait while an animal suffers, and crosses that line past which no intervention can reverse the slide to death.

“Yes, I have seen examples of when producers had a little too much optimism,” says Brian Baker, director of Alfred State College’s Institute for Sustainablity. He opposed the 100 percent antibiotic ban when it was proposed, and would like to see a reasoned debate on the issue.

A few weeks later, another calf started to fail. Too weak to suck, Jordan let milk from the bottle leak into my hand as I cupped her head. The farmer weighed his options, and muttering in frustration and anger, reached for the antibiotics and the phone. He injected the calf and called the organic standards regulator to report that Jordan was no longer organic. The next morning the calf was back on her feet, but ruined as an organic milker. With that one shot, an ethical farmer lost much of his investment in breeding and maintaining quality organic stock.

Clearly, antibiotic overuse in conventional agriculture is a disaster. Daily low-dose antibiotics make animals grow larger and quicker, and they hold off disease and infection so livestock can survive the crowded, filthy conditions at industrial farms and feedlots. But as the 15-17 million pounds of sub-therapeutic antibiotics that America’s livestock consume annually breed resistance in virulent pathogens, the antibiotics humans rely on are failing. In 2006, the U.S. government reported that 1.7 million hospital infections that year caused more than 90,000 patient deaths, up from 13,300 in 1992.

In the 1990s, an embattled organics movement defeated agribusiness’s attempt to allow all drugs, toxic pesticides and genetic engineering to fall under the proposed USDA organic label. Some speculate that when agribusiness saw that its strategy to eviscerate standards would fail, it began advocating regulations so strict that few farmers would adopt them, and those that did would become uncompetitive.

While some European and Canadian organic regulations are tighter, farmers there can administer therapeutic antibiotics as long as the animal is treated rarely, and is withdrawn from meat or milk production for twice the time the drug remains in its system.

Some organic proponents now quietly recognize that the 100 percent ban on antibiotics needs to be re-examined, especially in light of a growing move to incorporate animal welfare into the discussion.

Others remain pure. Allowing one-time therapeutic antibiotics is “a slippery slope,” says Ronnie Cummins, national director of the Organic Consumers Association, and would “undermine consumer confidence in organics. It’s the same position [I have] as on human vaccines. They are dangerous, and that’s why I didn’t vaccinate my kid.”

But when I took an unscientific survey at the Montpelier, Vt., farmers market, every consumer I asked assumed that organic livestock are, and should be, getting antibiotics for life-threatening diseases, and that a “no-antibiotics” label meant no sub-therapeutic use. Organic farmers I asked want the regulation changed, and several locavore producers said they would not go organic, precisely because they wanted the option of treating a sick animal without risking financial hardship.

It’s time for the organic movement to incorporate science and compassion into organic standards and allow the rare, regulated use of life-saving antibiotics. 

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