Journal Article

Repeated Occurrence of Basal Cell Carcinoma of the Skin and Multifailure Survival Analysis: Follow-up Data from the Nambour Skin Cancer Prevention Trial

Nirmala Pandeya, David M. Purdie, Adèle Green and Gail Williams

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 161, issue 8, pages 748-754
Published in print April 2005 | ISSN: 0002-9262
Published online April 2005 | e-ISSN: 1476-6256 | DOI: http://dx.doi.org/10.1093/aje/kwi098
Repeated Occurrence of Basal Cell Carcinoma of the Skin and Multifailure Survival Analysis: Follow-up Data from the Nambour Skin Cancer Prevention Trial

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The aim of this study was to apply multifailure survival methods to analyze time to multiple occurrences of basal cell carcinoma (BCC). Data from 4.5 years of follow-up in a randomized controlled trial, the Nambour Skin Cancer Prevention Trial (1992–1996), to evaluate skin cancer prevention were used to assess the influence of sunscreen application on the time to first BCC and the time to subsequent BCCs. Three different approaches of time to ordered multiple events were applied and compared: the Andersen-Gill, Wei-Lin-Weissfeld, and Prentice-Williams-Peterson models. Robust variance estimation approaches were used for all multifailure survival models. Sunscreen treatment was not associated with time to first occurrence of a BCC (hazard ratio = 1.04, 95% confidence interval: 0.79, 1.45). Time to subsequent BCC tumors using the Andersen-Gill model resulted in a lower estimated hazard among the daily sunscreen application group, although statistical significance was not reached (hazard ratio = 0.82, 95% confidence interval: 0.59, 1.15). Similarly, both the Wei-Lin-Weissfeld marginal-hazards and the Prentice-Williams-Peterson gap-time models revealed trends toward a lower risk of subsequent BCC tumors among the sunscreen intervention group. These results demonstrate the importance of conducting multiple-event analysis for recurring events, as risk factors for a single event may differ from those where repeated events are considered.

Keywords: carcinoma, basal cell; epidemiologic methods; neoplasms, multiple primary; proportional hazards models; skin neoplasms; survival analysis; BCC, basal cell carcinoma

Journal Article.  4991 words.  Illustrated.

Subjects: Public Health and Epidemiology

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