19 Feb Which States Have Most Ultraviolet-Related Melanomas?
MedicalResearch.com Interview with:
Farhad Islami, MD PhD
Scientific Director, Surveillance Research
American Cancer Society, Inc
MedicalResearch.com: What is the background for this study?
Response: Many cases of cutaneous melanoma (melanoma) in the United States have been attributed to ultraviolet (UV) radiation, but there was little information on the state-by-state burden of melanoma due to UV exposure. We estimated numbers, proportions and age-standardized incidence rates of malignant melanomas attributable to UV radiation in each US state by calculating the difference between observed melanomas during 2011–2015 and expected cases based on rates in a population with theoretically minimum UV exposure.
As there is no population completely unexposed to UV radiation, the reference rates we used were historical melanoma incidence rates in Connecticut during 1942–1954, when the melanoma burden was low. For most adults, melanomas diagnosed in that period likely reflected UV exposure accumulated in the 1930s or earlier, when exposure was minimized by clothing style and limited recreational exposure.
We estimated that 338,701 melanoma cases (91.0% of total, 372,335) in the United States during 2011–2015 were attributable to UV exposure; 94.3% of all these UV-attributable cases (or 319,412 cases) occurred in non-Hispanic whites. UV-attributable melanoma incidence rates and cases were higher among males than females, but attributable rates and cases in ages <45 years were higher among females.
MedicalResearch.com: What are the main findings?
Response: At the state level, we highlighted results for non-Hispanic whites, because a lower burden in some states might largely reflect higher proportions of non-whites in the population: melanoma incidence rates are lowest in blacks and are also substantially lower in other minorities in comparison to non-Hispanic whites.
The UV-attributable age-standardized rate (per 100,000 persons) among non-Hispanic whites was ≥23.3 in half of states; it ranged from 15.1 in Alaska to 65.1 in Hawaii. Multiple states along the East and West Coast (Delaware, Georgia, California, Maryland, North Carolina, Florida, Oregon, South Carolina, Washington, New Jersey, and New Hampshire), Alabama, and several landlocked states (Vermont, Utah, Minnesota, Idaho, Kentucky, and Colorado) also had high UV-attributable rates.
MedicalResearch.com: What should readers take away from your report?
Response: More than 90% of cutaneous melanomas in the United States are attributable to UV radiation. Although UV-attributable melanoma incidence rates vary across state, the burden of UV-attributable melanoma is considerably high in all states. Several factors can contribute to the risk of melanoma, including the strength of solar UV radiation (often measured as the UV Index) in the area, participation in outdoor activities, insufficient sun protection, and indoor tanning; the latter 3 are modifiable. At the individual level, people could reduce their risk of skin cancer by seeking shade when possible; avoiding times of peak sunlight and sunbathing; wearing protective clothing, hats, and sunglasses; using sunscreen appropriately; and avoiding indoor tanning. It is also important to implement and enforce preventive measures at the state and community levels to reduce UV radiation exposure; examples include banning indoor tanning for minors and school-based interventions. These measures can also reduce other cutaneous cancers.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: More information is needed on sun protection use by state and on the effects of interventions on sunburns and melanoma incidence, because previous studies have mainly assessed the effects of interventions on sun protection behaviors only. More research is also needed on strategies to increase appropriate sun protection use, which are suboptimal nationally. Lessons learned from successful interventions in other countries could also be a valuable tool to improve sun safety in the United States. Research on complex genetic mechanisms behind the development and progression of melanoma, as well as somatic mutations directly induced by UV exposure, could result in better understanding of carcinogenic mechanisms and identifying molecular targets for treatment of melanoma.
Any disclosures? Farhad Islami is employed by the American Cancer Society, which receives grants from private and corporate foundations, including foundations associated with companies in the health sector for research outside of the submitted work. The author is not funded by or key personnel for any of these grants and his salary is solely funded through American Cancer Society funds.
Farhad Islami, Ann Goding Sauer, Kimberly D. Miller, Stacey A. Fedewa, Adair K. Minihan, Alan C. Geller, J. Leonard Lichtenfeld, Ahmedin Jemal. Cutaneous melanomas attributable to ultraviolet radiation exposure by state. International Journal of Cancer, 2020; DOI: 10.1002/ijc.32921
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