Σάββατο, 24 Δεκεμβρίου 2016

INCIDENCE AND MORTALITY OF MELANOMA ON THE RISE

Both the incidence of and mortality from invasive melanoma in the United States have been rising during the past few decades, despite efforts to raise awareness and increase primary prevention and early detection.
An estimated 76,380 Americans will receive a melanoma diagnosis in 2016, say Alex M. Glazer, MD, of the National Society for Cutaneous Medicine, Millwood, New York, and coauthors in a research letter published online in JAMA Dermatology.
The authors reported on melanoma incidence rates 6 years ago (Arch Dermatol. 2010;146:318). A comparison of rates showed that from 2009 to 2016, the incidence rates per 100,000 population grew from 22.2 to 23.6. The current lifetime risk of developing invasive melanoma is now 1 in 54, a jump from 1 in 58.
"There does appear to be an increase in the incidence of melanoma in the US," said Dr Glazer. "Some have speculated that this incidence increase is due to the detection of early/in situ lesions alone, but we are seeing increases in all thicknesses of melanoma as well as in the mortality rate associated with melanoma.
"The incidence is increasing more rapidly than the mortality rate, which may indicate that early detection is having some effect on mortality and has not been fully recognized yet," he told Medscape Medical News.
The findings come from an analysis of data from the American Cancer Society. The authors calculated the lifetime risk of developing melanoma in the United States on the basis of estimated annual incidence, average life expectancy, and base-year population, after adjusting for individuals with multiple primary melanomas.
The raw incidence rates were calculated for 2016 and were compared with those from 2009 to determine the cumulative increase. The compound annual growth rates (CAGRs) were then calculated to ascertain the grow rate during the 7-year period between the two studies.
Dr Glazer and his team found that the incidence of in situ melanoma had increased at a more rapid rate (3.0% CAGR), with the lifetime risk increasing from 1 in 78 in 2009 to 1 in 58 in 2016.
When combined together, the lifetime risk for being diagnosed with invasive or in situ melanoma was 1 in 28.
Mortality rates had also gone up. The annual number of population-adjusted melanoma deaths increased (1.5% CAGR) from 2.8 to 3.1 per 100,000 population. Current estimates are that 10,130 Americans will die from melanoma in 2016, which is a jump from 8650 in 2009.
Taking Preventive Steps
There are a number of reasons why the rates are rising, explained Dr Glazer.
"An aging population with high levels of sun exposure throughout their lives, prior to the widespread adoption of sunscreens and sun protective clothing, may be contributing to the increased incidence of melanoma," said Dr Glazer. "Additionally, indoor tanning has led to high UV levels in certain subsets of the population."
There are steps that the public can take to reduce their risk of developing melanoma, he emphasized.
"It is important that people continue to avoid known risk factors, including excessive sun exposure, and take preventive steps when they are in areas with high UV levels," said Dr Glazer. These measures include applying and reapplying sunscreen, wearing hats and sun protective clothing, and seeking shade to avoid direct sun exposure, he noted.
Other recognized risk factors associated with melanoma include a family history of melanoma, having many moles or unusual moles, and having fair skin. "These individuals may be at higher risk of developing melanoma and should be extra careful in the sun and prudent about identifying changing or suspicious skin lesions," Dr Glazer pointed out.
"Physician-driven total-body skin exams can be extremely useful in detecting melanomas at earlier stages, before invasive disease is present, which may also impact morbidity and mortality associated with a melanoma," he added. "Additionally, total body skin exams provide a 'teachable moment' where patients can be educated on warning signs which may help them self-recognize early suspicious lesions."
The authors have disclosed no relevant financial relationships.
JAMA Dermatol. Published online December 21, 2016

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