Severe sunburns , especially at a young age, are also linked to melanoma. Since , 12 new FDA-approved melanoma therapies have been developed for treatment of the disease. Of all clinical trial participants in the U. Almost half of all people who participate in a clinical trial do so to help advance science and the treatment of their condition. Today there are more than melanoma-focused clinical trials currently recruiting patients.
Over half of clinical trial participants would recommend participation to family and friends. Today, only 1 out of 20 cancer patients enroll in a clinical trial. Login Email. Remember me next time? Public health campaigns are increasing sun-protective behavior in the United States, but the effect on melanoma incidence is unknown. Objective To examine the incidence of melanoma in the United States and whether any age-specific differences are present.
Data analysis was performed from July 1, , to March 1, Main Outcomes and Measures The annual rates of melanoma in pediatric, adolescent, young adult, and adult age groups were determined.
Analyses were stratified by sex, and incidence rates were age-adjusted to the US standard population. Annual percentage change APC in incidence rate was calculated over the most recent decade for which data were available using the weighted least squares method.
Between and , the overall incidence rate increased from In adults aged 40 years or older, melanoma rates increased by an APC of 1. In contrast, clinically and statistically significant decreases were seen in melanoma incidence for adolescents and young adults. Data on skin pigmentation and sun protection history were unavailable; similar trends were observed with data limited to non-Hispanic whites.
Young adult women appeared to have twice the risk of melanoma as young adult men. Conclusions and Relevance The incidence of invasive melanoma in the United States appeared to decrease in adolescents and young adults from to , and this finding contrasted with increases in older populations. These incidence trends suggest that public health efforts may be favorably influencing melanoma incidence in the United States.
Melanoma is the fifth most common cause of cancer overall in the United States 1 and is the most prominent factor in skin cancer death, with more than deaths per year.
The highest modifiable risk factor for melanoma is well accepted to be UV light exposure, either by sunlight 13 or tanning beds. Thus, decreases in melanoma incidence in this population might suggest emerging benefit of sun protective campaigns or other favorable public health or ecologic changes.
To determine the burden of disease, we also describe the absolute number of incident cases in adolescent and young adult populations in the United States for these years.
Anatomic site was classified as head and neck, trunk, upper extremity, lower extremity, cutaneous unknown, ocular, and other sites. Histologic characteristics were classified as superficial spreading melanoma, nodular melanoma, spindle-cell melanoma, melanoma not otherwise specified, and other. Stage was categorized as local localized , regional regional direct extension, lymph node involvement, or both direct and lymph node , distant, and unknown.
The primary population for this study was patients with invasive melanoma because these are the most consistently reported registries. However, similar data extraction and analyses were performed for in situ melanomas to determine whether the lower rates of invasive melanoma over time were associated with more precursor lesions being removed in which one would expect a higher rate of in situ melanoma over time or with development of fewer lesions at risk in which a lower rate of in situ melanoma mirroring invasive melanoma would be expected.
We sought to evaluate the potential reasons for observed decreases in reported melanoma incidence in adolescents and young adults that represent an explanation other than a true decrease in invasive melanomas. To evaluate for miscategorization of atypical spitzoid neoplasms as melanoma, the fraction of cases that were spitzoid were compared over time. To evaluate for overdiagnosis of early lesions, the percentage of patients diagnosed with localized disease was compared longitudinally for stability.
Two-tailed P value for significance was set a priori at. Incidence rates were age-adjusted to the US standard population 19 age groups; census P 20 , 21 to minimize potential confounding by differences of age distribution over time. In brief, the crude rates number of new cases in the US population per year for each age and sex group were used to generate a weighted average, in which the weights are proportional to the corresponding age group from the standard population.
Trends in incidence rate for the most recent decade of data available were calculated using 2-year averages with annual percentage change calculated by the weighted least squares method, 24 , 25 age-adjusted to the US standard population, and performed separately for males and females as described above. Children age, years differed substantially from adolescents age, years and young adults age, years in terms of demographics Table.
Compared with younger children, adolescents and young adults were more likely to be female children, [ Adolescents and young adults were less likely than younger children to present with metastatic disease age years: 46 [5. This increase corresponded to an annual percentage change APC per year of 1. Increased melanoma incidence was largely associated with adults aged 40 years or older.
In this group of persons, melanoma incidence rates rose for both men APC, 1. The significant increase in adjusted incidence rates suggests that the increase in observed reported melanoma cases represented an elevated rate of melanoma occurrence and not simply a greater number of persons at risk.
The annual percentage increase in melanoma in those aged 40 years or older was found not only in localized disease APC, 1. In contrast to the overall increased incidence, trends in melanoma incidence appeared to differ among children, adolescents, and young adults.
Specifically, incident cases and incidence rates remained low and stable among children age, years. However, for both adolescents age, years and young adults age, years , the incidence peaked at approximately and then began to decrease Figure 2 ; eFigure in the Supplement. This finding was true of both absolute number of cases Figure 1 and annual incidence rate. An association with age was observed across the age spectrum.
Between and , incidence rates were decreasing for adolescents and young adults, approximately stable for middle-aged adults, and markedly increased for older adults Figure 3. Although declining incidence was observed across both young men and young women, melanoma appeared to remain more common in females than males in younger individuals and more common in males than females in older individuals Figure 4. Over the study period, the fraction of cases with a histologic category of other including spitzoid neoplasms was low and essentially stable between and for children This finding argues against recategorization of spitzoid melanoma as explaining decreased incidence.
Similarly, the percentage of adolescents presenting with localized disease was only slightly decreased This finding suggests that overdiagnosis was not a major factor in observed peak incidence rates. Trends in in situ melanoma incidence in the US Cancer Statistics database were similar to the trends in invasive melanoma reported herein. As the best available surrogate for skin pigmentation, we evaluated whether trends in non-Hispanic white individuals mirrored those of the larger population; if these rates were instead stable, they would suggest that demographic changes are the major factor.
However, the APC decrease in melanoma incidence rate between and in young non-Hispanic white individuals was similar in magnitude to the larger population. Despite changes in melanoma therapy associated with improved survival, 27 melanoma remains the deadliest skin cancer in the United States.
These efforts were associated with specific reductions in melanomas diagnosed starting around , and similar to our observations, results were particularly pronounced in younger populations. In the United States, reported melanoma incidence was rapidly increasing in all ages, including pediatric, adolescent, and young adult populations, through In this study, we used the large NPCR-SEER data set and found what appears to be a sustained, statistically and clinically significant downtrend in melanoma incidence in adolescent and young adult populations from to , with the total number of US adolescent and young adult reported cases decreasing by In contrast to the reported observations in young adult populations, melanoma incidence markedly increased in persons 40 years or older across the same time period, with increases particularly pronounced in the oldest cohorts.
Although detailed evaluation of trends in older adults is beyond the scope of this study, these increases did not appear to be simply associated with overdiagnosis of clinically insignificant localized lesions because the annual percentage increase in melanoma in those aged 40 years or older was found not only in localized disease APC, 1. These disparate trends between adolescents and young adults vs older adults further suggest that observed differences reflect real clinical differences and not simply changes in database ascertainment.
One potential explanation is that sun protection during younger years is especially beneficial and thus should be one key focus of public health efforts; however, we continue to advocate for lifetime UV light exposure protection.
It will be interesting to determine the outcomes of the present adolescent and young adult cohorts over time and whether they maintain their lower incidence of melanoma. Our data have limitations that need to be considered when interpreting the study findings. The national registry data do not include information about skin pigmentation, UV light exposure, sunburn history, sun-protective behavior eg, sunscreen , protective clothing, sun avoidance, or tanning bed use.
Because of this lack of information, we cannot estimate the association between increased sun-protective behavior and reductions in melanoma incidence.
However, this change in behavior remains a plausible explanation for decreased melanoma rates in adolescent and young adult populations. We further cannot isolate the association of any one intervention with reduced invasive melanoma incidence eg, sunscreen; clothing; education campaigns, such as ABCDE [asymmetry, border, color, diameter, and evolution]; increased dermatologic care; and reduced access to tanning beds , and, to our knowledge, changes in any one of these factors cannot explain the specific year of peak invasive melanoma in approximately in adolescent and young adult populations.
The absence of observed association in pediatric age, years age groups may reflect different causes in this population, with a greater genetic component and lower contribution of UV exposure. Melanoma has been increasing in incidence over the past several decades and is now the fifth most common invasive cancer in men and women. The first is the apparent improvement in systemic therapies over the past 5 years, with new targeting and immunotherapies that are reporting improved survival outcomes for patients with metastatic disease.
The reported data are observational and thus cannot conclusively determine the cause of this statistically and clinically significant decrease. However, a likely explanation for the reduced melanoma incidence in adolescents and young adults is success at increased UV exposure protection.
These data provide an impetus to further improve multimodal efforts aimed at reducing the burden of melanoma and encourage ongoing UV exposure protection efforts throughout the lifetime of individuals. Corresponding Author: Jennifer M. Published Online: November 13, Author Contributions: Drs Paulson and Gupta contributed equally as primary authors, and Drs Madeleine and Gardner contributed equally as senior authors.
Drs Paulson and Gardner had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. There are multiple sub-types of skin cancer, which can present problems when collating data. For example, non-melanoma skin cancer is often not tracked by cancer registries, or registrations of this cancer are often incomplete because most cases are successfully treated via surgery or ablation.
In addition, many cases of cancer are not identified or recorded: some countries do not have cancer registries, regions of some countries have few or no records, records in countries suffering war or other disruption are bound to be incomplete and some people with cancer do not consult a physician.
Due to these factors, it is likely that the reported global incidence of skin cancer is an underestimate. Non-melanoma skin cancer is also usually omitted from comparative rankings of the most common cancers. The Continuous Update Project Panel judged there is strong evidence that drinking water contaminated with arsenic increases the risk of skin cancer and greater adult attained height increases the risk of malignant melanoma.
There is strong evidence that beta-carotene as high-dose supplements has no substantial effect on the risk of non-melanoma skin cancer. There is some evidence that drinking coffee might decrease the risk of malignant melanoma in women and might decrease the risk of basal cell carcinoma in men and women. There is some evidence that consuming alcoholic drinks might increase the risk of malignant melanoma and basal cell carcinoma; greater adult attained height might increase the risk of basal cell carcinoma; and greater birthweight might increase the risk of malignant melanoma.
Age-standardised rates are used in the tables. This is a summary measure of the rate of disease that a population would have if it had a standard age structure.
Standardisation is necessary when comparing populations that differ with respect to age because age has a powerful influence on the risk of dying from cancer. Close Menu Exposures. Wholegrains, vegetables and fruit. Meat, fish and dairy. Preservation and processing of foods. Non-alcoholic drinks.
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