Hereditary factors in basal cell carcinoma of the skin: a population-based cohort study in twins

The contribution of hereditary factors in basal cell carcinoma of the skin has not been well defined at the population level. We aimed to assess the hereditary component in basal cell carcinoma by comparing its occurrence in monozygotic and dizygotic twin pairs. The Finnish Twin Cohort, comprising 12,941 adult, like-sex twin pairs with established zygosity and resident in Finland in 1975, was linked with the Finnish Cancer Registry. We identified 335 twin pairs in which at least one twin had basal cell carcinoma diagnosed between 1953 and 1996. Standardized incidence ratios, concordances, tetrachoric correlations and pairwise relative risks were computed by standard methods. Components of variance in liability were estimated by structural equation modelling. There was an elevated risk of basal cell carcinoma for the co-twin of a diseased twin, but no difference in risk by zygosity. During the prospective follow-up in 1976-96, the probandwise concordance was 7.7% in monozygotic and 7.0% in dizygotic pairs. Model fitting indicated that genetic factors were not needed to account for the distribution of basal cell carcinoma in twin pairs. These results confirm the major role of environmental factors in the aetiology of basal cell carcinoma.