Cutaneous malignant melanoma:\u00a0Incidence<\/p>\n
For cutaneous melanoma, global data are available on incidence and mortality. The global\u00a0burden of disease estimates for the year 2000 (available at www.who.int\/evidence\/bod) used\u00a0incidence and mortality estimates from Globocan 2000 \u00a0to calculate the burden of disease\u00a0due to melanoma.<\/p>\n
The assessment of the burden of disease due to UVR from melanoma was\u00a0derived in the current work by applying the calculated population attributable fraction\u00a0estimates to these data.\u00a0Population attributable fraction. The fraction of disease in the population attributable to UVR exposure has been estimated at\u00a096% in males and 92% in females in the USA, by comparison of white and black populations. Comparison of white populations in New South Wales, Australia, with ethnically similar populations in England and Wales gives a PAF of 89% (males) and 79% (females).<\/p>\n
Examination of ecological and individual-level studies indicates little relationship of PAF to\u00a0latitude (see Appendix 3). There is also little relationship between PAFs estimated from\u00a0ecologic studies and those estimated from case-control studies. As discussed in section 2.3\u00a0above, this presumably reflects both a difficulty with measuring exposure and the difficulty in\u00a0finding a truly non-exposed population as the control group in epidemiological studies.\u00a0We therefore did not apply a PAF which varies with latitude, but used constant PAFs for\u00a0upper and lower estimates of the burden of disease from CMM, that is caused by UVR.\u00a0Estimation of disease burden.<\/p>\n
There is generally an increase in incidence of melanoma with decreasing latitude. This has\u00a0been shown within the Nordic countries, the USA and Australia. However, this relationship\u00a0does not persist across non-homogeneous populations – mortality from melanoma is four to\u00a0six times higher in Nordic countries than in the Mediterranean countries\u00a0and there is an\u00a0opposite relationship of melanoma incidence to latitude in Italy.<\/p>\n
Since melanoma is\u00a0likely to be related to intermittent high intensity sun exposure, particularly in fair-skinned\u00a0individuals, those at greatest risk are likely to be fair skinned people from higher latitudes\u00a0who intermittently are exposed to high intensity UVR on holidays.\u00a0Langford used multilevel modeling to examine the relationship between melanoma mortality\u00a0and UVB exposure in several countries. He found that the United Kingdom, Ireland,\u00a0Belgium and the Netherlands generally showed a positive relationship, whereas France\u00a0showed very little relationship, Italy showed a negative relationship.<\/p>\n
Germany and Denmark,\u00a0while having higher rates of melanoma mortality, did not show a positive relationship of UVB\u00a0exposure with mortality.\u00a0Few studies have been done in dark-skinned populations and these have been mainly\u00a0descriptive. In these populations, the incidence of melanoma is very low and the behaviour of\u00a0the disease is quite different – melanoma occurs at a later age and affects the plantar and \u00a0palmar surfaces of the feet and hands. This is unlikely to be due to UVR exposure (lack of\u00a0exposure to this site) and may represent a baseline of incidence of cutaneous melanoma.<\/p>\n
WHO has estimated the burden of disease for the year 2000\u00a0from cutaneous\u00a0malignant melanoma using incidence and mortality data derived from Globocan 2000.\u00a0As noted in Appendix 3, case control studies indicate that the population attributable fraction\u00a0is approximately 0.2. However, it seems likely that there is a great deal of error inherent in the\u00a0exposure measurement in these individual-level epidemiological studies that may\u00a0systematically bias the effect estimate towards the null. Thus, upper (0.9, derived from\u00a0ecological data) and lower (0.5, based on a consensus of expert opinion) estimates for\u00a0population attributable fraction were applied to the WHO melanoma GBD estimates.<\/p>\n","protected":false},"excerpt":{"rendered":"
Global data on incidence and mortality are available for cutaneous melanoma. The Global Burden of Disease Estimates for the Year 2000 (available at www.who.int\/evidence\/bod) used incidence and mortality estimates from Globocan 2000 to calculate the burden of disease due to melanoma.<\/p>\n","protected":false},"author":13,"featured_media":0,"parent":5638,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5707","page","type-page","status-publish","hentry"],"yoast_head":"\n