Skin Cancer Screening Remains Inconsistent After Organ Transplant

SKIN cancer screening remains inconsistent among solid organ transplant recipients, despite sharply elevated post-transplant malignancy risk.

Skin Cancer Screening Remains Uneven After Transplant

Solid organ transplant recipients face a substantially increased risk of cutaneous malignancy because lifelong immunosuppressive therapy is required to prevent graft rejection. A narrative review of 17 studies found that participation in clinician-led full skin examinations varies across countries and healthcare settings, even though most guidelines recommend at least annual screening for this high-risk population.

Non-melanoma skin cancer is the most common post-transplant malignancy in countries with predominantly fair-skinned populations. Compared with the general population, solid organ transplant recipients have a 65- to 250-fold increased risk of squamous cell carcinoma and a 10- to 16-fold increased risk of basal cell carcinoma. Squamous cell carcinoma is also more aggressive in this group, with higher rates of lymph node spread, recurrence, and mortality. Melanoma risk ranges from comparable with the general population to up to ten-fold higher.

Barriers Span Patients, Clinicians, And Health Systems

The review grouped factors affecting skin cancer screening participation into patient, clinician, and system-level domains. Patient-level barriers were largely tied to socio-demographic factors, while clinician-level influences included awareness of screening guidelines and the prioritization of skin cancer risk during post-transplant care.

At the system level, structured protocols and better access to dermatologists appeared to improve screening uptake. These findings suggest that inconsistent participation is not simply a patient behavior issue, but a broader care delivery challenge requiring coordinated action across transplant, primary care, and dermatology services.

Full Skin Examinations Are Central To Risk Reduction

Clinician-led full skin examinations remain a key part of surveillance alongside photoprotective behaviors and regular self-skin assessments. Early detection is particularly important for solid organ transplant recipients because advanced skin cancer treatment can be complicated by drug interactions and the risk of graft rejection with systemic therapies.

The review highlights a need for clearer pathways that identify high-risk patients, promote annual or more frequent screening, and ensure timely dermatologist access. Addressing barriers across patient, clinician, and system levels may improve skin cancer screening participation and reduce the burden of preventable morbidity in this vulnerable population.

 

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These Common Meds Weaken the Response to COVID-19 Vaccines

Researchers at Michigan Medicine recently found that a small but significant percentage of Americans under the age of 65 take medications that can weaken their immune system. These medications increase one's risk of Covid-19 symptoms and make them more likely to require hospitalization if they contract the virus. Moreover, there is growing evidence that these drugs may reduce the efficacy of Covid-19 vaccinations.

Read on to find out which prescription drugs may cause this, and what can be done to mitigate the problem. 

 

What medications can hamper the immune system? 

 

Data analysis from more than 3 million adults found that nearly 3% take immuno-suppressive drugs. These kinds of drugs are usually used to treat conditions where there is an inappropriate immune response that sees certain parts of a person’s body as a threat. When the immune system begins to attack these body parts, it can end up damaging them. An example of this type of condition is rheumatoid arthritis, where the immune system attacks the joints. Immuno-suppressive drugs are used to decrease the damage done to the patient’s own tissues.

Another case where people might be prescribed immuno-suppressive drugs would be after an organ transplant. Certain types of chemotherapy also have the side effect of suppressing the immune system. 

 

While these types of medications are only used by people with specific chronic conditions, there is also a type of immuno-suppressive drug that is significantly more commonly used - steroids. 

 

Steroids are medications like prednisone and dexamethasone. They are usually prescribed to treat short-term ailments like allergic rashes, bronchitis, and sinus infections. As Dr. Beth Wallace, a rheumatologist at Michigan Medicine, explained to Healthline, “Steroids are very immuno-suppressive. We’re learning more and more that even short courses and low doses of steroids can increase people’s risk of infections, and can reduce their response to vaccines, like the COVID vaccine.”

How can this problem be mitigated?

Vaccines work by teaching the immune system to recognize a specific threat so that it can respond appropriately if it ever encounters the same threat again. However, according to Dr. Wallace, immuno-suppressive drugs work by reducing the ability of your immune system to recognize and fight off threats. 

 

The new study comes at a time when doctors are beginning to realize the negative effects immuno-suppressants may have on patients’ response to the Covid-19 vaccination. This raises the question, 'How can this problem be mitigated?' 

 

Researchers are currently investigating several strategies. However, as of right now, “it's difficult to formulate guidelines around vaccinating these patients." Possible solutions that are currently being looked into are temporarily halting the use of immuno-suppressive medications around the time of the Covid-19 vaccination and giving an extra ‘booster’ shot.

Dr. Meghan Baker, a hospital epidemiologist who works with immunocompromised patients at the Dana-Farber Cancer Institute, added that experts often recommend completing the Covid-19 vaccine series at least two weeks before starting the medications. If this is not possible, however, they recommend that patients speak with their personal physician about the risks versus benefits of delaying therapy. 

 

It’s important to note that specific recommendations regarding the timing of immune-suppressing medications would have to be tailored to the needs of the individual. For example, if someone is doing chemotherapy to treat active cancer, the risk of temporarily stopping that treatment is different from the risk of stopping a medication that someone has been taking for years to treat their stable rheumatoid arthritis. 

 

In general, experts claim that people on immuno-suppressive therapies can and should get vaccinated. Although the protective effect may be reduced depending on the underlying condition or the immuno-suppressive therapy, most people will still get some degree of protection from the vaccine. “It may reduce the chance that they become infected or develop the severe illness if infected,” said Baker. 

 

Due to this risk, those who are immunocompromised must continue taking precautions to minimize potential exposure to the novel coronavirus. We will keep you updated on any new developments on this topic, of course.

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New study finds link between lifestyle and more severe covid infection, deaths

A sedentary lifestyle is associated with more severe COVID-19 infection and an increased risk of dying from the viral disease, according to a large-scale study.

Researchers, including those from the University of California San Diego, found that COVID-19  patients in the US who were consistently inactive during the two years preceding the pandemic were more likely to be admitted to hospital.

Inactive patients were also more likely to require intensive care, and die compared to those who had consistently met physical activity guidelines, they said.

The study, published in the British Journal of Sports Medicine, showed that physical inactivity was surpassed only by advanced age and a history of organ transplant as a risk factor for severe disease.

"It is notable that being consistently inactive was a stronger risk factor for severe COVID-19 outcomes than any of the underlying medical conditions and risk factors identified by (The Centers for Disease Control) except for age and a history of organ transplant," the researchers said.

"In fact, physical inactivity was the strongest risk factor across all outcomes, compared with the commonly cited modifiable risk factors, including smoking, obesity, diabetes, hypertension (high blood pressure), cardiovascular disease and cancer," they said.

Several risk factors for severe COVID-19 infection have been identified, including advanced age, male sex, and certain underlying medical conditions, such as diabetes, obesity, and cardiovascular disease, the researchers said.

However, physical inactivity is not one of them, even though it is a well-known contributory risk factor for several long term conditions, including those associated with severe COVID-19, they said.

To explore its potential impact on the severity of the infection, including hospital admission rates, need for intensive care, and death, the team compared these outcomes in 48,440 adults with confirmed COVID-19 infection between January and October 2020.

The patients' average age was 47, with nearly two thirds of them being women (62 per cent). Their average weight (BMI) was 31, which is classified as obese.

Around half had no underlying conditions, including diabetes, COPD, cardiovascular disease, kidney disease, and cancer, nearly 1 in 5 (18 per cent) had only one, and almost a third (32 per cent) had two or more conditions.

The researchers took account of potentially influential factors, such as race, age, and underlying medical conditions.

They found that patients with COVID-19 who were consistently physically inactive were more than twice as likely to be admitted to hospital as those who clocked up over 150 minutes of physical activity every week.

Such patients were also 73 per cent more likely to require intensive care, and 2.5 times more likely to die of the infection, according to the study.

Patients who were consistently inactive were also 20 per cent more likely to be admitted to hospital, 10 per cent more likely to require intensive care, and 32 per cent more likely to die of their infection than those doing some physical activity regularly.

The researchers, including those from Kaiser Permanente Medical Center in the US, noted that this is an observational study, and as such, can't establish cause.

The study also relied on patients' own assessments of their physical activity, they said.

"We recommend that public health authorities inform all populations that short of vaccination and following public health safety guidelines such as social distancing and mask use, engaging in regular (physical activity) may be the single most important action individuals can take to prevent severe COVID-19 and its complications, including death," the researchers added.

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