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O'Sullivan DE, Brenner DR, Villeneuve PJ, Walter SD, Demers PA, Friedenreich CM, King WD. Estimates of the current and future burden of melanoma attributable to ultraviolet radiation in Canada. Prev Med 2019; 122:81-90. [PMID: 31078176 DOI: 10.1016/j.ypmed.2019.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Exposure to ultraviolet radiation (UVR) is an established cause of cutaneous melanoma. The purpose of this study was to estimate the current attributable and future avoidable burden of melanoma related to exposure to UVR and modifiable UVR risk behaviors (sunburn, sunbathing, and indoor tanning). The population attributable risk (PAR) associated with UVR in 2015 was estimated by comparing Canadian melanoma incidence rates in 2015 to estimated incidence rates of a 1920 birth cohort. Rates were adjusted for changes in reporting and ethnicity. We estimated PARs for modifiable UVR risk behaviors using Caucasian prevalence data from the Second National Sun Survey and relative risks that are generalizable to Canada from meta-analyses of relevant studies. Attributable cases apply to 98.9% of melanomas in Canada that occur in Caucasians. We also estimated the future burden of UVR risk behaviors using the potential impact fraction framework and potential reductions in prevalence of 10% to 50% from 2018 to 2042. Adult sunburn and sunbathing were associated with increased risks of melanoma of 1.28 (95% CI: 1.15, 1.43) and 1.44 (95% CI: 1.18, 1.76), respectively. In 2015, we estimate that 62.3% of melanomas in Canada were attributable to exposure to UVR and that 29.7% were attributable to the combination of sunburn (7.4%), sunbathing (17.8%), and indoor tanning (7.0%). A 50% reduction in modifiable UVR behaviors could avoid an estimated 11,980 melanoma cases by 2042. Prevention strategies aimed at modifiable UVR behaviors are crucial to reduce the growing burden of melanoma in Canada.
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Affiliation(s)
- Dylan E O'Sullivan
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Darren R Brenner
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada; Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul J Villeneuve
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Stephen D Walter
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Toronto, Ontario, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada; Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Will D King
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
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Tran JM, Schwartz R, Fung K, Rochon P, Chan AW. Comprehensive capture of cutaneous melanoma by the Ontario Cancer Registry: validation study using community pathology reports. Cancer Causes Control 2016; 27:137-42. [PMID: 26537120 DOI: 10.1007/s10552-015-0690-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 10/26/2015] [Indexed: 11/27/2022]
Abstract
Melanoma is often managed outside hospital settings, creating the potential for underreporting to cancer registries. To our knowledge, completeness of melanoma capture in cancer registries has not been assessed using external data sources since the 1980s. We evaluated the melanoma capture rate from 1993 to 2009 in a provincial cancer registry. We identified all melanoma diagnoses in pathology reports from a major community laboratory in Ontario, Canada. Pathologically confirmed diagnoses were linked to Ontario Cancer Registry (OCR) records using health insurance numbers. We calculated capture rates as the proportion of patients with melanoma confirmed by a pathology report, with a corresponding melanoma diagnosis in OCR. OCR captured 3,798 of 4,275 (88.8, 95 % confidence interval: 87.9, 89.8 %) invasive melanoma diagnoses over the 17-year period. Annual capture rates of 94 % or higher were found for over half the study period. Among all 29,133 melanoma diagnoses in OCR, 27.6 % were registered based on a pathology report alone, compared with 3.4 % for non-cutaneous malignancies. This suggests that comprehensive capture of melanoma cases by a provincial cancer registry is achievable using source data from community laboratories. There is a need for ongoing validation to ensure data remain accurate and complete to reliably inform clinical care, research, and policy.
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Affiliation(s)
- Jennifer M Tran
- Division of Dermatology, Department of Medicine, University of Toronto, 790 Bay St, Suite 735, Toronto, ON, Canada.
| | - Rodrigo Schwartz
- Department of Dermatology, Clinica Las Condes, Santiago, Chile
- Faculty of Medicine, University of Chile, Santiago, Chile
| | - Kinwah Fung
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Paula Rochon
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - An-Wen Chan
- Division of Dermatology, Department of Medicine, University of Toronto, 790 Bay St, Suite 735, Toronto, ON, Canada.
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
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Lowe GC, Saavedra A, Reed KB, Velazquez AI, Dronca RS, Markovic SN, Lohse CM, Brewer JD. Increasing incidence of melanoma among middle-aged adults: an epidemiologic study in Olmsted County, Minnesota. Mayo Clin Proc 2014; 89:52-9. [PMID: 24388022 PMCID: PMC4389734 DOI: 10.1016/j.mayocp.2013.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/06/2013] [Accepted: 09/11/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To identify changes in the incidence of cutaneous melanoma over time in the fastest-growing segment of the US population-middle-aged adults. PATIENTS AND METHODS By using the Rochester Epidemiology Project resource, we identified patients aged 40 to 60 years who had a first lifetime diagnosis of melanoma between January 1, 1970, and December 31, 2009, in Olmsted County, Minnesota. The incidence of melanoma and overall and disease-specific survival rates were compared by age, sex, year of diagnosis, and stage of disease. RESULTS Between 1970 and 2009, age- and sex-adjusted incidence increased significantly over time (P<.001) from 7.9 to 60.0 per 100,000 person-years, with a 24-fold increase in women and a 4.5-fold increase in men. Although not significant (P=.06), the incidence of melanoma increased with age. Overall and disease-specific survival improved over time, with hazard ratios of 0.94 (P<.001) and 0.93 (P<.001) for each 1-year increase in the year of diagnosis, respectively. Each 1-year increase in the age at diagnosis was associated with an increased risk of death from any cause (hazard ratio, 1.07; P=.01) but was not significantly associated with disease-specific death (P=.98). Sex was not significantly associated with death from any cause (P=.81) or death from disease (P=.23). No patient with malignant melanoma in situ died from disease. Patients with stage II, III, and IV disease were more than 14 times more likely to die from disease than were patients with stage 0 or I disease (P<.001). CONCLUSION The incidence of cutaneous melanoma among middle-aged adults increased over the past 4 decades, especially in middle-aged women, whereas mortality decreased.
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Affiliation(s)
| | | | - Kurtis B Reed
- Department of Dermatology, Mayo Clinic, Rochester, MN
| | | | | | - Svetomir N Markovic
- Division of Medical Oncology, Mayo Clinic, Rochester, MN; Division of Hematology, Mayo Clinic, Rochester, MN; Division of Clinical Immunology and Immunotherapeutics, Mayo Clinic, Rochester, MN
| | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
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Reed KB, Brewer JD, Lohse CM, Bringe KE, Pruitt CN, Gibson LE. Increasing incidence of melanoma among young adults: an epidemiological study in Olmsted County, Minnesota. Mayo Clin Proc 2012; 87:328-34. [PMID: 22469345 PMCID: PMC3538462 DOI: 10.1016/j.mayocp.2012.01.010] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 01/18/2012] [Accepted: 01/23/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify the change in the incidence of cutaneous melanoma over time among young adults. PATIENTS AND METHODS Using Rochester Epidemiology Project data, we identified patients aged 18 to 39 years who had a first lifetime diagnosis of melanoma from January 1, 1970, through December 31, 2009, in Olmsted County, Minnesota. Demographic and clinical information, including survival, was abstracted, and estimates of the incidence of melanoma and overall and disease-specific survival were generated. RESULTS From 1970 to 2009, the incidence of melanoma increased by 8-fold among young women and 4-fold among young men. Overall and disease-specific survival seemed to improve over time; hazard ratios comparing year of diagnosis with mortality were 0.92 and 0.91, respectively. CONCLUSION The incidence of cutaneous melanoma among young adults is rapidly increasing, especially among women. Continued close monitoring of this high-risk population is necessary.
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Affiliation(s)
| | - Jerry D. Brewer
- Department of Dermatology, Mayo Clinic, Rochester, MN
- Correspondence: Address to Jerry D. Brewer, MD, Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Christine M. Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Crystal N. Pruitt
- Mayo Medical School, College of Medicine, Mayo Clinic, Rochester, MN
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Amerio P, Manzoli L, Auriemma M, Carbone A, Proietto G, Angelucci D, Tulli A. Epidemiology and clinical and pathologic characteristics of cutaneous malignant melanoma in Abruzzo (Italy). Int J Dermatol 2009; 48:718-22. [DOI: 10.1111/j.1365-4632.2009.03974.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pearce J, Barnett R, Kingham S. Slip! Slap! Slop! Cutaneous malignant melanoma incidence and social status in New Zealand, 1995-2000. Health Place 2006; 12:239-52. [PMID: 16546691 DOI: 10.1016/j.healthplace.2004.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2004] [Indexed: 10/25/2022]
Abstract
Numerous studies have noted a strong social gradient in many types of ill health. In particular, people in more deprived areas tend to be less healthy than those in more affluent communities, even once the demographic and socio-economic differences of the people in those areas have been taken into account. The social gradient is evident for many types of health outcomes, including diseases such as cancer. However, this positive relationship is not evident for rates of melanoma incidence and mortality, with rates of the disease tending to decrease with measures of disadvantage. In this study, we assess the relationship between the incidence of melanoma and deprivation in New Zealand, a country with particularly high rates of the disease. In the light of greater public awareness of the risk factors associated with melanoma, through public awareness campaigns such as 'Slip! Slap! Slop' and 'No Suntan is Safe', we analyse small-area data on standardised rates of melanoma for the period 1995-2000. We found that melanoma rates increase with social status, even once other confounding factors are controlled for, but that the relationship is very small. Furthermore, the relationship between melanoma incidence and deprivation is context-dependent. Possible explanations for the relationship between melanoma and deprivation are discussed, including more frequent exposure to intermittent sunshine among less disadvantaged groups and the underreporting of melanoma incidence in the New Zealand cancer registry among individuals in lower social groups.
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Affiliation(s)
- Jamie Pearce
- Department of Geography, University of Canterbury, Private Bag 4800, Christchurch 8020, New Zealand.
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Abstract
BACKGROUND Cancer surveillance is essential for assessing patterns of cancer occurrence. State cancer registries do not capture all available cases potentially biasing results. Secondary data may be useful in identifying new cases and estimating the number of cases missed. OBJECTIVE We sought to create 2 distinct data sources from Medicare claims to use in combination with registry data as 3 sources for a capture-recapture analysis to estimate the capture rate and bias in capture of a statewide cancer registry. METHODS Data from the Virginia cancer registry (Registry) were merged with Medicare inpatient (Part A) as well as Medicare outpatient and physician claims (Part B) to provide 3 sources to estimate missing cases. A 3-source loglinear model was used to estimate the number of missing cancer cases for breast, lung, colorectal, and prostate cancer. Models included main effects and interactions. Additional analysis looked at the effect of demographic and comorbidity variables. RESULTS Loglinear models demonstrated mostly positive dependence between the 3 sources, implying that 2-source models would underestimate missing cases and overestimate capture rates. Using capture-recapture estimates of total number of cancer cases as the denominator, capture rates for Registry ranged from 59% (colorectal) to 74% (lung). When the aggregate of cases found by either Medicare or Registry were used the capture rates ranged from 74% (prostate) to 89% (breast). Further analysis indicated that capture rates differed by demographic characteristics. CONCLUSION We conclude that Medicare claims are useful to supplement a Registry, estimate the number of missing cases, and assess bias in capture.
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Affiliation(s)
- Donna McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA 23298-0032, USA.
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Abstract
Cancer registries are used to compare incidences between regions, plan for service provision, and to assess the impact of health interventions. Significant variation in data capture for skin cancers and reporting of results was evident between regional cancer registries in the UK when assessed in 1991. Using a postal questionnaire we sought to document methods of recording skin cancer incidence in the UK in 2000, and to assess if practice has changed from 1991. All UK cancer registries were asked for details of their method of skin cancer case registration and latest available incidence figures. Methodology was assessed against recently implemented national standards. All registries responded to the survey. Sources of data were more uniform than was the case 9 years ago. All registries except one attained national standards for basal cell carcinoma data collection, but only half of the registries attained standards for squamous cell carcinoma. Ten of the 12 correctly recorded numbers of malignant melanomas, but three still failed to record the Breslow thickness or Clarke's level. Wide variation is evident in the recorded incidences for each of the malignancies, and the efficiency at which figures are made available. Thus, although there has been improvement since 1991, variability still exists between UK registries in methods of data capture, the data recorded, and efficiency of data processing in skin cancer registration.
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Affiliation(s)
- R G Goodwin
- Department of Dermatology, Singleton Hospital, Sketty Lane, Swansea, UK
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McClish D, Penberthy L. Using Multivariate Capture-Recapture Techniques and Statewide Hospital Discharge Data to Assess the Validity of a Cancer Registry for Epidemiologic Use. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2004. [DOI: 10.1007/s10742-005-4305-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Katalinic A, Kunze U, Schäfer T. Epidemiology of cutaneous melanoma and non-melanoma skin cancer in Schleswig-Holstein, Germany: incidence, clinical subtypes, tumour stages and localization (epidemiology of skin cancer). Br J Dermatol 2003; 149:1200-6. [PMID: 14674897 DOI: 10.1111/j.1365-2133.2003.05554.x] [Citation(s) in RCA: 191] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Population-based figures on skin cancer are essential for a realistic assessment of the personal disease burden, prevention modes and the need for caring. The Robert Koch Institute in Germany estimates the incidence of melanoma skin cancer as seven cases in 100 000 persons (age-standardized by the European standard rate). Population-based studies presumably show higher incidence rates of 10-16 cases in 100 000 persons. Few data exist for non-melanoma skin cancer (NMSC) as this is not systematically registered in Germany. OBJECTIVES To present the first population-based results from the Schleswig-Holstein (Germany) Cancer Registry on incidence, stage distribution, clinical types and localization of skin cancer and to compare the results with other studies. METHODS The Cancer Registry of the Bundesland Schleswig-Holstein with 3500 registering institutions, 100 of which are dermatological institutions, investigates all notifiable incident cancer cases according to international standards. From the recorded data all melanoma and NMSC cases were identified and evaluated. RESULTS Between 1998 and 2001, 1784 malignant melanoma (MM) and 12 956 NMSC cases underwent diagnostic and analytical evaluation. For MM, age-standardized incidence rates were 12.3 and 14.8 in 100 000 men and women, respectively, and the mean age of men was greater than that of women (56.6 vs. 54.9 years, P < 0.05). Superficial spreading melanoma was the most frequent clinical type (39.1%). The tumours were predominantly located on the trunk in men (46.8%) in contrast to leg and hip in women (39.5%). For NMSC, the age-standardized incidence rates were 100.2 and 72.6 in 100 000 men and women, respectively. More than 80% of all tumours were basal cell carcinoma. CONCLUSIONS The first population-based data from Schleswig-Holstein on the characteristics (age, sex, histological subtypes, localization and stage) of skin tumours agree well with the existing literature and may thus be regarded as representative. However, markedly higher incidences for MM and NMSC in the north of Germany compared with other parts of the country were observed. As the incidence rates from the north of Germany fit well into the European geographical pattern, we assume no regional increase. Therefore, the official German estimates on cutaneous tumours may largely depend on regional factors and may not be regarded as representative for all regions in Germany.
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Affiliation(s)
- A Katalinic
- Institute for Cancer Epidemiology, University of Lübeck, Beckergrube 43-47, 23552 Lübeck, Germany.
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