The percentage of people who die of malignant melanoma is expected to decrease by 2050, even though the total number of deaths will likely rise due to population aging, according to research presented at the European Cancer Congress 2017.
The hope is that new treatments will decrease the number of deaths more than anticipated, said Alice Koechlin of the French International Prevention Research Institute.
She said those born between 1900 and 1960, when UV radiation was not believed to be dangerous and health professionals thought exposure to sunlight was beneficial, are at highest risk of dying from melanoma.
“These beliefs were boosted by observations that exposure to ultraviolet light and sunshine could heal some skin infections and rickets, and by the discovery of vitamin D,” Koechlin said in a press release. “It was common for babies and school children to be treated with commercial UV radiation-emitting devices and exposed, unclothed, to the midday sun. This fashion faded in the 1960s as effective treatments, such as vaccines and antibiotics, became available and people became aware that sun exposure and sunburn during childhood were strong risk factors for developing skin cancer in later life.”
Koechlin and her colleagues used statistics to assess whether current cancer rates were connected with the year of a person’s birth, effects of aging, or the introduction of new medical technologies and treatments. Their estimates focus on death rates and overall deaths in Australia, the United States, and Sweden between 2014 and 2050.
They based their estimations on two scenarios. One assumes there will be no effective therapies available for melanoma. The other assumes there will be a treatment available that reduces melanoma deaths by 25 percent, beginning in 2015. Part of that assumption is that all patients will have access to the treatment.
The estimates suggested that melanoma was deadliest in Australian men around 2015 and in Australian women around 1990. In the United States, melanoma was deadliest in men in 2005 and in women in 1995. In Sweden, melanoma death rates peaked around 2010 for both men and women.
The model predicts that Australian death rates in 2050 will be half of what they were in the peak years. U.S. rates will be 2 1/2 to three times lower in 2050 than in the peak years. In Sweden, rates in 2050 will be 1 1/2 times lower than in peak years.
However, aging populations will bring an increase in total melanoma deaths until 2030-2035, if no effective therapy is found, the researchers said.
“With an effective therapy, we would expect to see decreases in the number of melanoma deaths from 2030,” Koechlin said. “In 2050, the numbers of melanoma deaths in Australia would be equal to those of around 2005: 846 men and 408 women. In the USA they would be equal to those of around 1990 for men, with 3,646 deaths, and to 1980 for women, with 1,876 deaths. In Sweden they would be equal to those of around 2000: 231 men and 174 women.
“As time passes, melanoma deaths will become steadily rarer in people younger than 50 years, and after 2050, practically all melanoma deaths will occur in people over the age of 70,” she added.
“Our findings clearly show that most of the death toll due to melanoma has been caused by medically backed exposures to highly carcinogenic UV radiation between 1900 and 1960,” continued. “They also show that UV-protection of children pays off because rates of melanoma death keep going down from around 1960 to the current day as the UV protection of children based on clothing, shading and avoidance of excessive sun exposure has spread in most light-skinned populations, starting in Australia.
“Skin screening, based on the opportunistic early detection of skin cancers, does not affect melanoma mortality and our analyses confirm this evidence. So, generations that have been over-exposed to high UV doses keep the high probability of developing a deadly melanoma at some stage in their lives. The good news is that the risk declines rapidly as skin protection increases, and that effective treatments are starting to be available,” she concluded.
For heaven’s sake don’t avoid the midday/high angle sun completely!
http://www.sciencedirect.com/science/article/pii/S1574789111000238
Melanoma is a very curious disease. Despite being associated with sun exposure, outdoor workers rates are lower, and unchanged (1940-present), compared to indoor workers, whose rates have been increasing for decades.
The Lancet:
“Paradoxically, outdoor workers have a decreased risk of melanoma compared with indoor workers, suggesting that chronic sunlight exposure can have a protective effect.”
However the alarming rise is in majority part due to a medical term called “diagnostic drift”. It is now apparent that doctors are regularly and more frequently reporting early Stage 1 and non-cancerous growths, as opposed to a less efficient norm in past decades.
Per the British Journal of Dermatology:
“There was no change in the combined incidence of the other stages of the disease, and the overall mortality only increased from 2.16 to 2.54 cases per 100,000 per year … We therefore conclude that the large increase in reported incidence is likely to be due to diagnostic drift, which classifies benign lesions as stage 1 melanoma.”
Further…
“These findings should lead to a reconsideration of the treatment of ‘early’ lesions, a search for better diagnostic methods to distinguish them from truly malignant melanomas, re-evaluation of the role of ultraviolet radiation and recommendations for protection from it, as well as the need for a new direction in the search for the cause of melanoma.”
There are many theories as to the nature of this invigoration (diagnostic drift), one of which is quite obvious.
Vitamin D levels appear intimately connected with melanoma diagnosis, and prognosis. It is medical fact that those at initial diagnoses have thinner/smaller lesions if having higher vitamin D sera level, as well as prognosis more optimistic, at time of initial diagnosis, with higher levels.
The Journal “Medical Hypotheses”:
“We hypothesize that one factor involves indoor exposures to UVA (321–400nm) passing through windows, which can cause mutations and can break down vitamin D3 formed after outdoor UVB (290–320nm) exposure, and the other factor involves low levels of cutaneous vitamin D3.
After vitamin D3 forms, melanoma cells can convert it to the hormone, 1,25-dihydroxyvitamin D3, or calcitriol, which causes growth inhibition and apoptotic cell death in vitro and in vivo.
… We agree that intense, intermittent outdoor UV over exposures and sunburns initiate CMM [cutaneous malignant melanoma]; we now propose that increased UVA exposures and inadequately maintained cutaneous levels of vitamin D3 promotes CMM.”
The AA of D has maintained a monolithic position for many years. It may behoove them to consider the implications of new research regardless of the impact on revenue.
If the conventional wisdom is at odds with the facts…