By: Dr. Geoffrey Modest
MMWR just released an analysis of melanoma incidence, mortality trends, and projections in the US from 1982-2030 (see here). Melanoma is common (5th most common cancer in men and 7th in women) and is associated with the most skin cancer deaths, with deaths occurring most frequently in younger people (average of 20.4 years of potential life lost). Costs of treatment are high ($3.3 billion/yr in the US). And melanoma is largely preventable — 90% are attributable to skin damage from UV light exposure, with sunburns being a significant risk factor and 40% of US people reporting sunburn every year. There is clear efficacy of sun-protective behaviors in decreasing UV skin exposure, such as sunscreen, protective clothing. In addition there are suggestive data that cumulative UV radiation exposure over time may also be a culprit. results from MMWR:
–in 2011: 65,647 invasive melanomas in the US, with age-adjusted incidence rate of 19.7/100K, increasing with age and highest in non-Hispanic whites, in women 15-49yo, and in men >50.
–in 2011: 9,128 melanoma deaths, with age-adjusted death rate of 2.7/100K, higher in non-Hispanic whites, increasing with age, and higher in men (4.0) than women (1.7)
–from 1982-2011: melanoma incidence rates increased (doubling), though mortality remained the same.
–without intervention, there are projected to be 112,000 new cases in 2030 with annual cost for treatment projected to increase 252.4% from 2011-2030 (from $454 million to $1.6 billion)
–a comprehensive skin care prevention program (modeled after the one in Australia, which raised community awareness through mass media campaigns, programs in schools and workplaces, provider education, etc, had projected savings of $2.30 for every $1 spent) is estimated to prevent 20% of US melanoma cases from 2011-2030, averting 21,000 cases/yr, and reducing spending $250 million/yr (saving $2.7 billion from 2020-2030).
So, this seems like a largely preventable problem. There are pretty easy individual strategies available, including not using indoor tanning salons and using appropriate sunscreen protection — correct amount, reapplication rates, etc. But, as in Australia, the major potential impact would be from concerted, community-oriented and community-based public health initiatives. Some of the above gender differences may be attributable to the increased female use of indoor tanning salons (a 2013 report found that approx 1/3 of non-Hispanic white women aged 16-25 use indoor tanning salons each year) and decreased male use of sunscreen protection. It is also important to remember that there still is a melanoma risk in darker skinned individuals. Overall black incidence in 2011 was 1.0/100K, vs 24.6/100K in non-Hispanic whites; but the mortality in black americans was 0.4/100K vs 3.1/100K reflecting a 3-fold increased mortality-to-incidence ratio vs non-Hispanic whites. This higher mortality is perhaps related to data suggesting that darker-skinned people report more frequent sunburns, are less likely to use sun-protection strategies, have a higher incidence of poorer-survival melanomas perhaps related to later diagnosis, a lower perceived risk by patients and providers, and more melanomas in non-sun-exposed areas.