Relevant Degree Programs
Dermatoepidemiology; Examining the epidemiology of skin cancer in the general population and identifying high risk population groups Skin cancer prevention; Using national surveys conducted by Statistics Canada, I have examined skin cancer prevention behaviours practiced by Canadians; Spectoscopy; Using imaging to differentiate skin cancer from benign lesions. Photobiology to study properties of the skin.
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Graduate Student Supervision
Master's Student Supervision (2010 - 2020)
Background: Disease surveillance is essential for accurate cost estimates, monitoring and evaluation of risk factors and comorbidities of the diseases. Keratinocyte carcinoma (KC) and atopic dermatitis (AD) are frequently occurring skin diseases associated with reduced quality of life and significant burdens. However, KCs are excluded from cancer registries, and AD are reliant on survey sampling. Literature publications have limited claims-based methodologies for KC and AD ascertainment. Thus, there is a lack of any population-based method of ascertainment that is complete, efficient and generalizable for these conditions.Objectives: To propose and validate the use of health insurance claims and prescription records in ascertaining two independent skin conditions.Methods: This retrospective study involved reviewing medical charts and health insurance claims data of patients receiving care by family practitioners and specialists in metropolitan Vancouver from 2010 to 2018. Information on patient demographics, histopathology, atopy, physician diagnoses, claim codes and prescriptions associated with KC and AD were collected respectively in accordance with data abstraction forms. Algorithmic models were developed with predictor variables based on combinations of demographics, claim codes (diagnosis and therapy), and prescriptions.Results: Algorithms for KC ascertainment included the diagnostic code 173 (ICD-9: “other malignant neoplasm of skin” with service codes for procedural treatment and prescriptions for imiquimod, 5-fluorouracil, or vismodegib. High sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was achieved with values of 86.6% (confidence interval: 79.2-94.0%), 97.4% (CI: 96.2-98.6%), 78.9% (CI: 70.5-87.3%), 98.5% (CI: 97.6-99.4%) respectively. For AD ascertainment, the best-performing algorithms included predictors such asivage, diagnostic codes 691 or 692 (ICD-9: Other atopic dermatitis and related conditions; Contact dermatitis and other eczema), service codes for ultraviolet therapies, with either prescriptions for topical steroids, topical immunomodulators, or systemic immunosuppressive therapy. High sensitivity and PPV of 94.8% (CI: 93.2-96.3%) and 87.9% (CI: 85.8-90.1%), respectively, was achieved.Conclusion: Our health insurance claims and prescription records algorithms ascertained KC and AD with high predictive accuracy. These algorithmic definitions can be utilized in population databases for evaluating epidemiologic trends and subsequently plan for effective public health initiatives and resource allocations.
Background: Ultraviolet (UV) phototherapy is an important treatment option in Canada for skin diseases. However, the long-term risk of skin cancer, has not been adequately studied and quantified in the published literature.Objectives: The objectives include i) to create an electronic database for patients receiving phototherapy at the Psoriasis and Phototherapy Clinic, Skin Care Center, Vancouver; ii) to explore incidence of skin cancers including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma in patients with UVB therapy; iii) to evaluate skin cancers by anatomical distribution and skin type; iv) to compare incidence rate of skin cancers in patients with phototherapy and British Columbia general population; v) to correlate total treatment session, cumulative dosage with skin cancer risk; vi) to estimate correlation between skin type and narrow-band UVB (NB-UVB) minimal erythemal dose.Methods: A retrospective chart review was conducted on patients receiving UV therapy from May 1977 to November 2018. These patients were identified via medical charts at the Psoriasis and Phototherapy Clinic. Pathological ascertainment of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma for these patients was verified through linkage with an interhospital pathology database for the British Columbia Lower Mainland regional health authorities.Results: A total of 3,506 patients (1,999 male and 1,507 female) were analyzed for an average of 7.1 years. A total of 170 new skin cancers developed in 79 patients after receiving UVB phototherapy without systemic psoralen plus UVA. Male patients had significantly lower BCC incidence compared to BC general population (Z scores