Trends in mortality from melanoma in Canada and prediction of future rates

Trends in Invasive Cutaneous Melanoma in Saskatchewan 1970–1999

Background:

Melanoma incidence rates have increased dramatically in white populations worldwide during the past several decades. A more modest increase has been observed for melanoma-related mortality. Cause-specific and disease-free survivals are related to tumor characteristics, gender, age, and possibly anatomic site. It is difficult to accurately assess these trends without information on tumor thickness that is often unavailable.

Objective:

This study determines trends in melanoma incidence, mortality, and survival in Saskatchewan for a 30-year period, incorporating analysis of tumor thickness.

Methods:

Information about cases of primary cutaneous melanoma for the 30-year period 1970–1999 was obtained from the population-based Saskatchewan Cancer Registry. A 50% random sample of charts was reviewed to collect information about Breslow depth, Clark level, and other demographic data not available from the Registry. Multivariate regression analysis was used to determine the significance of prognostic factors on incidence and five-year relative survival rates.

Results:

The number of patients registered increased dramatically during the study period. The increase was greatest for thin lesions in all age groups. Anatomic site varied by gender. Head and neck tumors showed continual increase in risk with increasing age. Mortality rates in females have been stable over time but increased for males in the 1990s. The prognostic factors that predicted excess mortality at five years were tumor thickness, Clark level, and gender.

Conclusion:

The observed increase in melanoma appears to be real and not the result of increased surveillance or screening. Tumor characteristics (Breslow depth, Clark level) and gender were significant prognostic indicators of five-year excess mortality.

Public health responses for skin cancer prevention: the policy framing of Sun Safety in Australia, Canada and England

This paper employs the policy analytic approaches of framing and narrative to examine national differences in public health policies using a case study of Sun Safety programs in Australia, Canada and England. The study shows how a single public health issue identified at the global scale (rising skin cancer rates) is framed differently based upon specific social, cultural and political situations. The result is a different story, or narrative, embedded in each national policy. This study provides an example of how health policy is defined, constrained and limited through the process of problem identification and policy resolution. The paper concludes that framing and narrative analysis are powerful tools for understanding the place-specific implementation of public health policies and initiatives.

Sunscreens and cutaneous malignant melanoma: an Italian case-control study

The possible relation between use of sunscreens and the risk of cutaneous malignant melanoma (CMM) was investigated in a case-control study conducted in 27 Italian centres on 542 incident, histologically confirmed cases and 538 controls admitted for acute, other than neoplastic or dermatologic conditions. Compared with subjects reporting never sunscreen use, the multivariate odds ratios (OR), after allowance for age, sex, geographic area, education, skin, eye and hair colour, freckles, number of naevi, history of sunburns, tanning pattern and duration of sunny vacations, were 0.97 (95% confidence interval [CI] 0.69 to 1.35) for those reporting "sometimes" and 0.80 (95% CI 0.54 to 1.17) for those reporting "often " sunscreen use. With reference to type of product most frequently used, the ORs were 0.96 (95% CI 0.52 to 1.77) for minimal, 0.90 (95% CI 0.63 to 1.28) for moderate and 1.41 (95% CI 0.85 to 2. 35) for high sunburn protection factor. With reference to duration of use, the OR was 0.86 (95% CI 0.58 to 1.29) for use started since >/=20 years. None of the corresponding trends in risks were significant. The ORs for sunscreen use were similar across strata of major identified covariates and, if anything, tended to decline after multivariate analysis. The present findings confirm that sunscreen use, as currently adopted in Italy, is not appreciably related to subsequent CMM risk.

Recent declines in worldwide mortality from cutaneous melanoma in youth and middle age

Trends in age-standardised death-certification rates for skin cancer [mainly cutaneous malignant melanoma (CMM)] over the period 1955-1995 were considered for 22 developed countries (18 from Europe, Canada, the United States, Australia and New Zealand) on the basis of the World Health Organization database. Between 1955 and 1984, mortality from CMM has been rising in both young adults (20 to 44 years) and middle aged population (45 to 64 years) in most European countries, North America and Australia. Between 1985 and 1995, CMM mortality rates were still rising in several countries for middle-aged males, though, to a lesser extent, they were more favourable in middle-aged women and declined in young adults in most countries, particularly in northern Europe.