Causes and Risk Factors of Bowen's Disease

Bowen's disease is an early form of skin cancer that affects the outermost layers of the skin. It may also be referred to as squamous cell carcinoma in situ. The exact cause of Bowen's disease remains unknown, but there are a number of risk factors that can make a person more susceptible to the disease.

These include age, exposure to ultraviolet (UV) radiation through sunbathing or tanning beds, having fair skin, or having a weakened immune system.

In this article, you'll learn more about the common causes and risk factors of Bowen's disease.

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Sun Exposure

Those who have had unprotected exposure to UV radiation are at an increased risk of developing Bowen's disease.

Exposure to UV radiation can come from being out in the sun or using tanning beds. The cumulative time spent exposed to UV radiation throughout life can influence the risk of developing Bowen's disease. Those who have a high amount of UV exposure are more likely to develop Bowen's disease as well as a more serious form of skin cancer, known as squamous cell carcinoma.

Those who work outdoors or spend a lot of their free time in the sun are at heightened risk.

People who use tanning beds are also at risk. They have a 67% greater risk of developing squamous cell carcinoma than those who don't use tanning beds. Over the past three decades, the number of women under age 40 who receive a diagnosis of squamous cell carcinoma has been on the rise, and experts believe this is related to the use of indoor tanning beds.

Age

Bowen's disease is most common in people in their 60s and 70s. It is believed that the reason Bowen's disease affects older people more than younger people is due to the cumulative effect of sun exposure over a person's lifetime. However, younger people are increasingly being diagnosed due to the use of indoor tanning beds.

Genetics

Bowen's disease is not a hereditary condition that is passed on in families. However, some of the risk factors for Bowen's disease, such as fair skin, do run in families.

Fair Skin

Bowen's disease can affect people of all skin colors, but those with fair skin are at an increased risk.

This is particularly the case for those with:

  • Red hair
  • Blond hair
  • Blue eyes
  • Green eyes
  • Skin with freckles
  • Skin that burns easily

Those with darker skin can still get Bowen's disease and other skin cancers, but Black people are more likely to have squamous cell carcinoma. Recently, researchers have also noticed an increase in cases of squamous cell carcinoma among Latinx individuals.

Weakened Immune System

Those who are immunosuppressed are more likely to develop Bowen's disease.

This includes people who might have reduced immune function due to:

  • Human immunodeficiency virus (HIV)
  • Receiving chemotherapy
  • Immunosuppressive medication taken for autoimmune diseases

The risk is particularly significant for those who have received an organ transplant and take immunosuppressive anti-rejection drugs. They are 100 times more likely to develop squamous cell carcinoma than their peers.

Those with an already weakened immune system are also at further risk of developing Bowen's disease due to sun exposure. That's because being out in the sun for an excessive amount of time weakens the immune system as well as damaging the skin with UV rays. Therefore, it's especially important for those who are immunocompromised to prioritize sunscreen and minimize time spent in direct sunlight.

Human Papillomavirus (HPV)

Those who have certain forms of human papillomavirus (HPV) may be at greater risk of Bowen's disease.

HPV is an umbrella term for more than 150 viruses. Some of these can cause cancer. HPV viruses 16, 18, 34, and 48 are believed to cause Bowen's disease in the genital area.

HPV virus types 2, 16, 34, and 35 have also been associated with Bowen's disease in parts of the body other than the genitals.

Other Rare Risk Factors

Occasionally, Bowen's disease may appear following radiotherapy treatment. 

Chronic arsenic exposure is another possible risk factor. Arsenic is used in manufacturing and may cause Bowen's disease 10 years after initial exposure. These days, exposure to arsenic is less common. 

Lifestyle Changes That Can Help Reduce Risk

While some risk factors for Bowen's disease are out of your control, such as your genetics, age, or having a weakened immune system, there are lifestyle changes you can make to protect your skin and reduce your chances of developing the condition. Healthy behaviors like eating an antioxidant-rich diet, exercising, and getting enough sleep may help, but most important is protecting your skin from the sun.

Protecting Against UV Damage

UV rays from the sun are one of the most damaging elements to the skin, and cumulative exposure to UV rays over your life span increases your risk of Bowen's disease. That said, using sunscreen, avoiding tanning beds, and minimizing your exposure to direct sunlight can make a big difference in reducing your exposure to UV damage.

Other ways to protect your skin from UV radiation, and lower your chance of developing Bowen's disease and other skin cancers, include:

  • Covering up your skin with clothing when out in the sun
  • Staying in the shade if spending time outdoors
  • Using a broad-spectrum daily sunscreen with SPF 15 or higher
  • Using an SPF of 30 or higher if you are going to be outside for longer than 15 minutes
  • Reapplying sunscreen every two hours, or immediately after swimming
  • Never using tanning beds
  • Doing monthly skin self-exams
  • Seeing a dermatologist every year

A Word From Verywell

The exact cause of Bowen's disease is unknown, but it is believed that a number of risk factors may play a role in developing the disease. These include exposure to the sun, being over age 50, having fair skin, having an HPV infection, and having a weakened immune system. Even so, there are ways to lower your chance of developing this condition. Making a point to keep your skin protected from the sun with sunscreen, protective clothing, and reduced exposure is a great first step.

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Article Sources
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  1. NHS. Bowen's Disease. Updated May 21, 2019.

  2. Skin Cancer Foundation. Squamous Cell Carcinoma Risk Factors. Updated May 2019

  3. National Organization for Rare Disorders. Bowen Disease. Updated November 9, 2020.

  4. British Association of Dermatologists. Bowen's Disease (Squamous cell carcinoma in situ). Updated January 2020.

  5. Oxford University Hospitals. Bowen's disease. Updated July 2020.

  6. Skin Cancer Foundation. UV Radiation & Your Skin. Updated June 2019.

  7. Skin Cancer Foundation. Sun Protection. Updated February 2019.