{"id":"https://openalex.org/W7204876964","doi":"https://doi.org/10.1093/mr/roag080","title":"Methotrexate and malignancy in rheumatoid arthritis: Evidence, risks, and clinical considerations","display_name":"Methotrexate and malignancy in rheumatoid arthritis: Evidence, risks, and clinical considerations","publication_year":2026,"publication_date":"2026-09-01","ids":{"openalex":"https://openalex.org/W7204876964","doi":"https://doi.org/10.1093/mr/roag080","pmid":"https://pubmed.ncbi.nlm.nih.gov/42679184"},"language":"en","primary_location":{"id":"doi:10.1093/mr/roag080","doi":"https://doi.org/10.1093/mr/roag080","is_oa":true,"landing_page_url":"https://doi.org/10.1093/mr/roag080","pdf_url":null,"source":{"id":"https://openalex.org/S30446230","display_name":"Modern Rheumatology","issn_l":"1439-7595","issn":["1439-7595","1439-7609"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-c","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Modern Rheumatology","raw_type":"journal-article"},"volume":null,"type":"review","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"hybrid","oa_url":"https://doi.org/10.1093/mr/roag080","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5067195079","display_name":"Shigeru Iwata","orcid":"https://orcid.org/0000-0002-2076-1603","observed_orcids":["https://orcid.org/0000-0002-2076-1603"]},"institutions":[{"id":"https://openalex.org/I190805021","display_name":"Wakayama Medical University","ror":"https://ror.org/005qv5373","country_code":"JP","type":"education","lineage":["https://openalex.org/I190805021"]}],"countries":["JP"],"is_corresponding":true,"raw_author_name":"Shigeru Iwata","raw_affiliation_strings":["Department of Rheumatology and Clinical Immunology, Wakayama Medical University , Wakayama ,"],"raw_orcid":"https://orcid.org/0000-0002-2076-1603","affiliations":[{"raw_affiliation_string":"Department of Rheumatology and Clinical Immunology, Wakayama Medical University , Wakayama ,","institution_ids":["https://openalex.org/I190805021"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5091382070","display_name":"Masahiro Tada","orcid":"https://orcid.org/0000-0003-3161-3929","observed_orcids":["https://orcid.org/0000-0003-3161-3929"]},"institutions":[{"id":"https://openalex.org/I4210099064","display_name":"Osaka City General Hospital","ror":"https://ror.org/00v053551","country_code":"JP","type":"healthcare","lineage":["https://openalex.org/I4210099064","https://openalex.org/I4405284496"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Masahiro Tada","raw_affiliation_strings":["Department of Orthopaedic Surgery , Osaka City General Hospital, Osaka ,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Orthopaedic Surgery , Osaka City General Hospital, Osaka ,","institution_ids":["https://openalex.org/I4210099064"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5044262898","display_name":"Ryuji Koike","orcid":"https://orcid.org/0000-0001-5647-8159","observed_orcids":["https://orcid.org/0000-0001-5647-8159"]},"institutions":[{"id":"https://openalex.org/I4210161548","display_name":"Institute of Science Tokyo Hospital","ror":"https://ror.org/058548196","country_code":"JP","type":"healthcare","lineage":["https://openalex.org/I4210161548","https://openalex.org/I4400009020"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Ryuji Koike","raw_affiliation_strings":["Health Science Research and Development Center (HeRD), Institute of Science Tokyo Hospital , Tokyo ,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Health Science Research and Development Center (HeRD), Institute of Science Tokyo Hospital , Tokyo ,","institution_ids":["https://openalex.org/I4210161548"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5015519725","display_name":"Yuji Yamanishi","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Yuji Yamanishi","raw_affiliation_strings":["Rheumatology, Hiroshima Rheumatology Clinic , Hiroshima ,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Rheumatology, Hiroshima Rheumatology Clinic , Hiroshima ,","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5009842794","display_name":"Mie Fusama","orcid":"https://orcid.org/0000-0002-6636-2835","observed_orcids":["https://orcid.org/0000-0002-6636-2835"]},"institutions":[{"id":"https://openalex.org/I72031464","display_name":"Kansai University of International Studies","ror":"https://ror.org/00nthvx56","country_code":"JP","type":"education","lineage":["https://openalex.org/I72031464"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Mie Fusama","raw_affiliation_strings":["Health Sciences Department of Nursing, Kansai University of International Studies , Miki ,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Health Sciences Department of Nursing, Kansai University of International Studies , Miki ,","institution_ids":["https://openalex.org/I72031464"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5056937078","display_name":"Haruka Tsuchiya","orcid":"https://orcid.org/0000-0002-2114-7656","observed_orcids":["https://orcid.org/0000-0002-2114-7656"]},"institutions":[{"id":"https://openalex.org/I74801974","display_name":"The University of Tokyo","ror":"https://ror.org/057zh3y96","country_code":"JP","type":"education","lineage":["https://openalex.org/I74801974"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Haruka Tsuchiya","raw_affiliation_strings":["Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo , Tokyo \u00a0"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo , Tokyo \u00a0","institution_ids":["https://openalex.org/I74801974"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5034591782","display_name":"Kunihiro Yamaoka","orcid":"https://orcid.org/0000-0001-8858-9435","observed_orcids":["https://orcid.org/0000-0001-8858-9435"]},"institutions":[{"id":"https://openalex.org/I64189623","display_name":"Kitasato University","ror":"https://ror.org/00f2txz25","country_code":"JP","type":"education","lineage":["https://openalex.org/I64189623"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Kunihiro Yamaoka","raw_affiliation_strings":["Department of Rheumatology, Kitasato University , Sagamihara ,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Rheumatology, Kitasato University , Sagamihara ,","institution_ids":["https://openalex.org/I64189623"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5058629132","display_name":"Hideto Kameda","orcid":"https://orcid.org/0000-0002-4330-5782","observed_orcids":["https://orcid.org/0000-0002-4330-5782"]},"institutions":[{"id":"https://openalex.org/I129634264","display_name":"Toho University","ror":"https://ror.org/02hcx7n63","country_code":"JP","type":"education","lineage":["https://openalex.org/I129634264"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Hideto Kameda","raw_affiliation_strings":["Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University , Tokyo ,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University , Tokyo ,","institution_ids":["https://openalex.org/I129634264"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":7,"corresponding_author_ids":["https://openalex.org/A5067195079"],"corresponding_institution_ids":["https://openalex.org/I190805021"],"apc_list":{"value":3208,"currency":"USD","value_usd":3208},"apc_paid":{"value":3208,"currency":"USD","value_usd":3208},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"36","issue":"6","first_page":"861","last_page":"868"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10200","display_name":"Rheumatoid Arthritis Research and Therapies","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2745","display_name":"Rheumatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10200","display_name":"Rheumatoid Arthritis Research and Therapies","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2745","display_name":"Rheumatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10685","display_name":"Viral-associated cancers and disorders","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13026","display_name":"Natural Compounds in Disease Treatment","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2707","display_name":"Complementary and alternative medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/methotrexate","display_name":"methotrexate","score":0.996999979019165},{"id":"https://openalex.org/keywords/rheumatoid-arthritis","display_name":"rheumatoid arthritis","score":0.9990000128746033},{"id":"https://openalex.org/keywords/cancer-risk","display_name":"cancer risk","score":0.8619999885559082},{"id":"https://openalex.org/keywords/tumor-recurrence","display_name":"tumor recurrence","score":0.8999999761581421},{"id":"https://openalex.org/keywords/lymphoma","display_name":"lymphoma","score":0.9020000100135803},{"id":"https://openalex.org/keywords/lung-cancer","display_name":"lung cancer","score":0.7580000162124634},{"id":"https://openalex.org/keywords/melanoma","display_name":"melanoma","score":0.8730000257492065},{"id":"https://openalex.org/keywords/non-melanoma-skin-cancer","display_name":"non-melanoma skin cancer","score":0.9660000205039978},{"id":"https://openalex.org/keywords/colorectal-cancer","display_name":"colorectal cancer","score":0.9229999780654907},{"id":"https://openalex.org/keywords/tumor-necrosis-factor-inhibitors","display_name":"tumor necrosis factor inhibitors","score":0.9900000095367432},{"id":"https://openalex.org/keywords/shared-decision-making","display_name":"shared decision-making","score":0.9509999752044678}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9641000032424927},{"id":"https://openalex.org/C2779399171","wikidata":"https://www.wikidata.org/wiki/Q1483951","display_name":"Malignancy","level":2,"score":0.8741999864578247},{"id":"https://openalex.org/C2777575956","wikidata":"https://www.wikidata.org/wiki/Q187255","display_name":"Rheumatoid arthritis","level":2,"score":0.7878999710083008},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.666700005531311},{"id":"https://openalex.org/C2781059491","wikidata":"https://www.wikidata.org/wiki/Q422232","display_name":"Methotrexate","level":2,"score":0.644599974155426},{"id":"https://openalex.org/C2776256026","wikidata":"https://www.wikidata.org/wiki/Q47912","display_name":"Lung cancer","level":2,"score":0.5284000039100647},{"id":"https://openalex.org/C2779338263","wikidata":"https://www.wikidata.org/wiki/Q208414","display_name":"Lymphoma","level":2,"score":0.5012000203132629},{"id":"https://openalex.org/C143998085","wikidata":"https://www.wikidata.org/wiki/Q162555","display_name":"Oncology","level":1,"score":0.4620000123977661},{"id":"https://openalex.org/C50440223","wikidata":"https://www.wikidata.org/wiki/Q1475848","display_name":"Risk factor","level":2,"score":0.45559999346733093},{"id":"https://openalex.org/C121608353","wikidata":"https://www.wikidata.org/wiki/Q12078","display_name":"Cancer","level":2,"score":0.45159998536109924},{"id":"https://openalex.org/C2777077863","wikidata":"https://www.wikidata.org/wiki/Q170990","display_name":"Arthritis","level":2,"score":0.35269999504089355},{"id":"https://openalex.org/C90924648","wikidata":"https://www.wikidata.org/wiki/Q120569","display_name":"Gastroenterology","level":1,"score":0.3334999978542328},{"id":"https://openalex.org/C2779668873","wikidata":"https://www.wikidata.org/wiki/Q6693756","display_name":"Lower risk","level":3,"score":0.32190001010894775},{"id":"https://openalex.org/C526805850","wikidata":"https://www.wikidata.org/wiki/Q188874","display_name":"Colorectal cancer","level":3,"score":0.3158000111579895},{"id":"https://openalex.org/C16005928","wikidata":"https://www.wikidata.org/wiki/Q171171","display_name":"Dermatology","level":1,"score":0.30300000309944153},{"id":"https://openalex.org/C198451711","wikidata":"https://www.wikidata.org/wiki/Q327657","display_name":"Rheumatology","level":2,"score":0.28940001130104065},{"id":"https://openalex.org/C2909813644","wikidata":"https://www.wikidata.org/wiki/Q2509220","display_name":"Hematological malignancy","level":2,"score":0.2874999940395355},{"id":"https://openalex.org/C17991360","wikidata":"https://www.wikidata.org/wiki/Q21173843","display_name":"Tumor necrosis factor alpha","level":2,"score":0.28040000796318054},{"id":"https://openalex.org/C82789193","wikidata":"https://www.wikidata.org/wiki/Q2142611","display_name":"Relative risk","level":3,"score":0.2606000006198883},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.2517000138759613}],"mesh":[{"descriptor_ui":"D001172","descriptor_name":"Arthritis, Rheumatoid","qualifier_ui":"Q000188","qualifier_name":"drug therapy","is_major_topic":true},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008727","descriptor_name":"Methotrexate","qualifier_ui":"Q000009","qualifier_name":"adverse effects","is_major_topic":true},{"descriptor_ui":"D008727","descriptor_name":"Methotrexate","qualifier_ui":"Q000627","qualifier_name":"therapeutic use","is_major_topic":true},{"descriptor_ui":"D009369","descriptor_name":"Neoplasms","qualifier_ui":"Q000139","qualifier_name":"chemically induced","is_major_topic":true},{"descriptor_ui":"D009369","descriptor_name":"Neoplasms","qualifier_ui":"Q000453","qualifier_name":"epidemiology","is_major_topic":true},{"descriptor_ui":"D012307","descriptor_name":"Risk Factors","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D018501","descriptor_name":"Antirheumatic Agents","qualifier_ui":"Q000009","qualifier_name":"adverse effects","is_major_topic":true},{"descriptor_ui":"D018501","descriptor_name":"Antirheumatic Agents","qualifier_ui":"Q000627","qualifier_name":"therapeutic use","is_major_topic":true}],"locations_count":2,"locations":[{"id":"doi:10.1093/mr/roag080","doi":"https://doi.org/10.1093/mr/roag080","is_oa":true,"landing_page_url":"https://doi.org/10.1093/mr/roag080","pdf_url":null,"source":{"id":"https://openalex.org/S30446230","display_name":"Modern Rheumatology","issn_l":"1439-7595","issn":["1439-7595","1439-7609"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-c","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Modern Rheumatology","raw_type":"journal-article"},{"id":"pmid:42679184","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42679184","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Modern rheumatology","raw_type":"Journal Article"}],"best_oa_location":{"id":"doi:10.1093/mr/roag080","doi":"https://doi.org/10.1093/mr/roag080","is_oa":true,"landing_page_url":"https://doi.org/10.1093/mr/roag080","pdf_url":null,"source":{"id":"https://openalex.org/S30446230","display_name":"Modern Rheumatology","issn_l":"1439-7595","issn":["1439-7595","1439-7609"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-c","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Modern Rheumatology","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":1.0}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":40,"referenced_works":["https://openalex.org/W1892676932","https://openalex.org/W1977445011","https://openalex.org/W1991891486","https://openalex.org/W2005490856","https://openalex.org/W2009928292","https://openalex.org/W2017281030","https://openalex.org/W2017497764","https://openalex.org/W2023380965","https://openalex.org/W2031986546","https://openalex.org/W2045399297","https://openalex.org/W2045789990","https://openalex.org/W2061220719","https://openalex.org/W2071099746","https://openalex.org/W2089548173","https://openalex.org/W2093220748","https://openalex.org/W2117335168","https://openalex.org/W2144015200","https://openalex.org/W2531692844","https://openalex.org/W2586216539","https://openalex.org/W2586671754","https://openalex.org/W2608009506","https://openalex.org/W2741777722","https://openalex.org/W3011903216","https://openalex.org/W3018517995","https://openalex.org/W3115536511","https://openalex.org/W3119413978","https://openalex.org/W3124884545","https://openalex.org/W3171954900","https://openalex.org/W4283381496","https://openalex.org/W4387517356","https://openalex.org/W4388295382","https://openalex.org/W4391238528","https://openalex.org/W4391751618","https://openalex.org/W4405222084","https://openalex.org/W4406499022","https://openalex.org/W4417231363","https://openalex.org/W4417305226","https://openalex.org/W7135041886","https://openalex.org/W7161276301","https://openalex.org/W7161291013"],"related_works":["https://openalex.org/W2005490856","https://openalex.org/W4385797933","https://openalex.org/W2995987323","https://openalex.org/W4229983521","https://openalex.org/W2755004778","https://openalex.org/W7028144133","https://openalex.org/W100940247","https://openalex.org/W2080372545","https://openalex.org/W2019449527","https://openalex.org/W3115536511"],"abstract_inverted_index":{"In":[0,168],"this":[1],"review,":[2],"we":[3],"summarized":[4],"the":[5,9,29,38,85,99,160,197],"current":[6],"evidence":[7,111,195],"on":[8,218],"risks":[10,198],"of":[11,31,48,79,87,102,131,139,179,188,199],"incident":[12],"malignancy":[13,39,49,162,166],"and":[14,72,104,144,185,206,221],"cancer":[15,89],"recurrence":[16,180],"in":[17,50,159,181,202],"patients":[18,51,114,126,182,203],"with":[19,24,42,52,66,115,118,135,149,175,183,204],"rheumatoid":[20],"arthritis":[21],"(RA)":[22],"treated":[23,117],"methotrexate":[25],"(MTX).":[26],"Before":[27],"considering":[28],"effect":[30],"MTX,":[32],"it":[33],"is":[34,82,109,193,224],"important":[35],"to":[36,91,113,121],"recognize":[37],"risk":[40,47,78,86,101,130,138,163,178],"associated":[41,174],"RA":[43,53,116,184,205],"itself.":[44],"The":[45,77],"overall":[46,132,161],"modestly":[54],"increased,":[55,83],"as":[56],"per":[57],"two":[58],"meta-analyses,":[59],"although":[60],"Japanese":[61],"studies":[62],"report":[63],"inconsistent":[64],"findings,":[65],"one":[67],"showing":[68],"a":[69,74,128,186],"slight":[70,75],"decrease":[71],"another":[73],"increase.":[76],"malignant":[80,140],"lymphoma":[81],"whereas":[84],"colorectal":[88],"appears":[90],"be":[92,214],"reduced.":[93],"Additionally,":[94],"there":[95,108],"are":[96],"concerns":[97],"regarding":[98,196,210],"increased":[100,137,165,177],"lung":[103,142],"skin":[105,190],"cancers.":[106],"However,":[107],"limited":[110],"specific":[112],"MTX.":[119],"According":[120],"an":[122,136,176],"Australian":[123],"report,":[124],"these":[125],"have":[127,154],"higher":[129],"malignancy,":[133],"along":[134],"lymphoma,":[141],"cancer,":[143],"melanoma.":[145],"Studies":[146],"comparing":[147],"MTX":[148,171,200,211],"tumour":[150],"necrosis":[151],"factor":[152],"inhibitors":[153],"reported":[155],"no":[156],"significant":[157],"difference":[158],"or":[164],"risk.":[167],"White":[169],"patients,":[170],"has":[172],"been":[173],"history":[187],"non-melanoma":[189],"cancer.":[191],"There":[192],"insufficient":[194],"use":[201,212],"malignancy.":[207],"Therefore,":[208],"decisions":[209],"should":[213],"made":[215],"individually":[216],"based":[217],"shared":[219],"decision-making,":[220],"careful":[222],"follow-up":[223],"necessary.":[225]},"counts_by_year":[],"updated_date":"2026-11-08T12:12:28.789561","created_date":"2026-09-02T00:00:00"}