A large Veterans Affairs study has shown that nicotinamide, a form of vitamin B3, can significantly lower the risk of new skin cancers among patients with a history of the disease. The research, involving over 33,000 veterans, found a 14% overall risk reduction, with even greater benefits for early users. These findings build on a 2015 clinical trial and may influence preventive strategies.
Since 2015, dermatologists have recommended nicotinamide to patients with prior skin cancer, based on a trial of 386 participants that demonstrated fewer new cases among those taking the supplement compared to those who did not. Confirming these results on a larger scale proved challenging due to nicotinamide's over-the-counter availability, which limits documentation in medical records.
To address this, researchers accessed the Veterans Affairs Corporate Data Warehouse, reviewing outcomes for 33,833 veterans prescribed 500 milligrams of nicotinamide twice daily for more than 30 days. Of these, 12,287 patients took the supplement, while 21,479 did not. The study tracked subsequent diagnoses of basal cell carcinoma or cutaneous squamous cell carcinoma.
Results revealed a 14% overall decrease in skin cancer risk for nicotinamide users. For patients starting the supplement after their first skin cancer, the risk reduction increased to 54%. The effect was most pronounced for squamous cell carcinoma, a common nonmelanoma skin cancer, though benefits diminished if treatment began after multiple prior cancers.
In a subgroup of 1,334 immunocompromised patients with solid organ transplants, overall risk reduction was not statistically significant, but early nicotinamide use correlated with fewer squamous cell carcinoma cases.
The study's corresponding author, Lee Wheless, MD, PhD, from Vanderbilt University Medical Center, noted: "There are no guidelines for when to start treatment with nicotinamide for skin cancer prevention in the general population. These results would really shift our practice from starting it once patients have developed numerous skin cancers to starting it earlier. We still need to do a better job of identifying who will actually benefit, as roughly only half of patients will develop multiple skin cancers."
This research, supported by a Department of Veterans Affairs grant, suggests potential for earlier preventive use of nicotinamide, though further studies are needed to refine patient selection.