Background Most melanoma studies use data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program or individual cancer registries. Small numbers of melanoma cases have ...limited in-depth analyses for all racial and ethnic groups. Objective We sought to describe racial and ethnic variations in melanoma incidence and survival. Methods Incidence for invasive melanoma and 5-year melanoma-specific survival were calculated for whites, blacks, American Indians/Alaskan Natives, Asians/Pacific Islanders (API), and Hispanics using data from 38 population-based cancer registries. Results Incidence rates of melanoma were significantly higher for females than males among whites and Hispanics under 50 years of age and APIs under 40 years of age. White and black patients were older (median age: 59-63 years) compared with Hispanics, American Indians/Alaskan Natives, and API (median age: 52-56 years). The most common histologic type was acral lentiginous melanoma among blacks and superficial spreading melanoma among all other racial and ethnic groups. Hispanics had the highest incidence rate of acral lentiginous melanoma, significantly higher than whites and API. Nonwhites were more likely to have advanced and thicker melanomas at diagnosis and lower melanoma-specific survival compared with whites. Limitations Over 50% of melanoma cases did not have specified histology. The numbers of nonwhite patients were still relatively small despite broad population coverage (67% of United States). Conclusions Racial and ethnic differences in age at melanoma diagnosis, anatomic sites, and histologic types suggest variations in etiologic pathways. The high percentages of advanced and thicker melanomas among nonwhites highlight the need to improve melanoma awareness for all race and ethnicity in the United States.
Background Increasing cutaneous melanoma incidence rates in the United States have been attributed to heightened detection of thin (≤1-mm) lesions. Objective We sought to describe melanoma incidence ...and mortality trends in the 12 cancer registries covered by the Surveillance, Epidemiology, and End Results program and to estimate the contribution of thin lesions to melanoma mortality. Methods We used joinpoint analysis of Surveillance, Epidemiology, and End Results incidence and mortality data from 1992 to 2006. Results During 1992 through 2006, melanoma incidence rates among non-Hispanic whites increased for all ages and tumor thicknesses. Death rates increased for older (>65 years) but not younger persons. Between 1998 to 1999 and 2004 to 2005, melanoma death rates associated with thin lesions increased and accounted for about 30% of the total melanoma deaths. Limitations Availability of long-term incidence data for 14% of the US population was a limitation. Conclusions The continued increases in melanoma death rates for older persons and for thin lesions suggest that the increases may partly reflect increased ultraviolet radiation exposure. The substantial contribution of thin lesions to melanoma mortality underscores the importance of standard wide excision techniques and the need for molecular characterization of the lesions for aggressive forms.
Background Sunscreen is a common form of sun protection, but little is known about patterns of use. Objective We sought to assess patterns of sunscreen use on the face and other exposed skin among US ...adults. Methods Using cross-sectional data from the 2013 Summer ConsumerStyles survey (N = 4033), we calculated descriptive statistics and adjusted risk ratios to identify characteristics associated with regular sunscreen use ( always/most of the time when outside on a warm sunny day for ≥1 hour). Results Few adults regularly used sunscreen on the face (men: 18.1%, 95% confidence interval CI 15.8-20.6; women: 42.6%, 95% CI 39.5-46.7), other exposed skin (men: 19.9%, 95% CI 17.5-22.6; women: 34.4%, 95% CI 31.5-37.5), or both the face and other exposed skin (men: 14.3%, 95% CI 12.3-16.6; women: 29.9%, 95% CI 27.2-32.8). Regular use was associated with sun-sensitive skin, an annual household income ≥$60,000, and meeting aerobic activity guidelines ( P s < .05). Nearly 40% of users were unsure if their sunscreen provided broad-spectrum protection. Limitations Reliance on self-report and lack of information on sunscreen reapplication or other sun-safety practices are limitations. Conclusion Sunscreen use is low, especially among certain demographic groups. These findings can inform sun-safety interventions and the interpretation of surveillance data on sunscreen use.
Background Exposure to ultraviolet radiation (from solar and nonsolar sources) is a risk factor for skin cancer. Objective We sought to summarize recent estimates on sunburns, sun-protection ...behaviors, and indoor tanning available from national and selected statewide behavioral surveys. Methods Estimates of the prevalence of sunburn, sun-protection behaviors, and indoor tanning by US adults, adolescents, and children collected in national surveys in 1992, 2004 to 2005, and 2007 to 2009 were identified and extracted from searches of computerized databases (ie, MEDLINE and PsychINFO), reference lists, and survey World Wide Web sites. Sunburn estimates from 3 state Behavioral Risk Factors Surveillance Systems were also analyzed. Results Latest published estimates (2005) showed that 34.4% of US adults were sunburned in the past year. Incidence of sunburns was highest among men, non-Hispanic whites, young adults, and high-income groups in national surveys. About 3 in 10 adults routinely practiced sun-protection behaviors, and women and older adults took the most precautions. Among adolescents, 69% were sunburned in the previous summer and less than 40% practiced sun protection. Approximately 60% of parents applied sunscreen and a quarter used shade to protect children. Indoor tanning was prevalent among younger adults and females. Limitations Limitations include potential recall errors and social desirability in self-report measures, and lack of current data on children. Conclusion Many Americans experienced sunburns and a minority engaged in protective behaviors. Females and older adults were most vigilant about sun protection. Substantial proportions of young women and adolescents recently used indoor tanning. Future efforts should promote protective hats, clothing, and shade; motivate males and younger populations to take precautions; and convince women and adolescents to reduce indoor tanning.
Community-wide Interventions to Prevent Skin Cancer Sandhu, Paramjit K., MD, MPH; Elder, Randy, PhD; Patel, Mona, MPH ...
American journal of preventive medicine,
October 2016, Letnik:
51, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Context Skin cancer is a preventable and commonly diagnosed cancer in the U.S. Excessive ultraviolet radiation exposure is a known cause of skin cancer. This article presents updated results of two ...types of interventions evaluated in a previously published Community Guide systematic review: multicomponent community-wide interventions and mass media interventions when used alone. Evidence acquisition Studies assessing multicomponent community-wide and mass media interventions to prevent skin cancer by reducing ultraviolet radiation exposure were evaluated using Community Guide systematic review methods. Relevant studies published between 1966 and 2013 were included and analyzed for this review. Evidence synthesis Seven studies evaluating the effectiveness of multicomponent community-wide interventions showed a median increase in sunscreen use of 10.8 (interquartile interval=7.3, 23.2) percentage points, a small decrease in ultraviolet radiation exposure, a decrease in indoor tanning device use of 4.0 (95% CI=2.5, 5.5) percentage points, and mixed results for other protective behaviors. Four studies evaluating the effectiveness of mass media interventions found that they generally led to improved ultraviolet protection behaviors among children and adults. Conclusions The available evidence showed that multicomponent community-wide interventions are effective in reducing the deleterious effects of ultraviolet radiation exposure by increasing sunscreen use. There was, however, insufficient evidence to determine the effectiveness of mass media interventions alone in reducing ultraviolet radiation exposure and increasing ultraviolet protection behaviors, indicating a continuing need for more research in this field to improve assessment of effectiveness.
Background The benefits of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) on cervical cancer screening for participating uninsured low-income women have never been ...measured. Purpose To estimate the benefits in life-years (LYs) gained; quality-adjusted life-years (QALYs) gained; and deaths averted. Methods A cervical cancer simulation model was constructed based on an existing cohort model. The model was applied to NBCCEDP participants aged 18–64 years. Screening habits for uninsured low-income women were estimated using National Health Interview Survey data from 1990 to 2005 and NBCCEDP data from 1991 to 2007. The study was conducted during 2011–2012 and covered all 68 NBCCEDP grantees in 50 states, the District of Columbia, five U.S. territories, and 12 tribal organizations. Separate simulations were performed for the following three scenarios: (1) women who received NBCCEDP (Program) screening; (2) women who received screening without the program (No Program); and (3) women who received no screening (No Screening). Results Among 1.8 million women screened in 1991–2007, the Program added 10,369 LYs gained compared to No Program, and 101,509 LYs gained compared to No Screening. The Program prevented 325 women from dying of cervical cancer relative to No Program, and 3,829 relative to No Screening. During this time period, the Program accounted for 15,589 QALYs gained when compared with No Program, and 121,529 QALYs gained when compared with No Screening. Conclusions These estimates suggest that NBCCEDP cervical cancer screening has reduced mortality among medically underserved low-income women who participated in the program.
...although registries incur substantial fixed cost, higher volume registries will have lower cost per case, generating large economies of scale. ...the data presented in this monograph can serve as ...baseline information to identify efficiencies in data collection methods, which is consistently reported as a high cost activity across the registries. ...monitoring and prioritizing cancers that have evidence-based interventions may be important for cancer registries. CDC is partnering with a large number of countries, national and international partners, including the International Agency for Research on Cancer, to improve cancer registration and with the Bloomberg Data for Health Initiative to improve cause of death globally 14, both with a specific focus on low and middle income countries. References 1 A Comprehensive Global Monitoring Framework, Including Indicators, and a Set of Voluntary Global Targets for the Prevention and Control of Noncommunicable Diseases, 2012, WHO, (accessed on 14.09.16) 2 Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012, 2012, GLOBOCAN, accessed on 30.08.16) 3 B.W. Stewart, C.P. Wild, World Cancer Report 2014, 2014, International Agency for Research on Cancer, Lyon, France 4 F. Bray, A. Znaor, P. Cueva, A. Korir, S. Rajaraman, A. Ullrich, S.A. Wang, D.M. Parkin, Planning and Developing Population-based Cancer Registration in Low- and Middle-income Settings, 2014, International Agency for Research on Cancer, Lyon, France, (IARC Technical Publication No. 43) 5 S. Subramanian, J.C. Green, F. Tangka, H. Weir, F. Michaud, D. Ekwueme, Economic assessment of central cancer registry operations Part 1: methods and conceptual framework, J. Registry Manag., Vol. 34,...
Introduction Current U.S. cervical cancer screening guidelines recommend a 3- or 5-year screening interval depending on age and screening modality. However, many women continue to be screened ...annually. The purpose of this study is to investigate U.S. women’s self-reported frequency of cervical cancer screening, acceptance of an extended screening interval (once every 3–5 years), and preferred screening options. Methods Data from a 2012 web-based survey of U.S. women aged ≥18 years who had not undergone a hysterectomy or been diagnosed with cervical cancer (N=1,380) were analyzed in 2014. Logistic regression models of extended screening interval use, acceptance, and preference were developed. Results Annual Pap testing was the most widely used (48.5%), accepted (61.0%), and preferred (51.1%) screening option. More than one third of respondents (34.4%) indicated that an extended screening interval would be acceptable, but only 6.3% reported that they were currently screened on an extended interval. Women who preferred an extended screening interval (32.9% of those willing to accept regular screening) were more likely to report no primary care visits during the last 12 months (AOR=2.05, p <0.003), no history of abnormal Pap test results (AOR=1.71, p =0.013), and that their last Pap test was performed by an internist/family practitioner rather than an obstetrician–gynecologist (AOR=2.03, p <0.001). Conclusions U.S. women’s acceptance of and preference for an extended cervical cancer screening interval appears to be more widespread than utilization. Strategies to educate women about the reasoning behind recommendations for less-than-annual testing and to foster informed preferences should be devised and evaluated.
Objective Guidelines recommend when the human papillomavirus (HPV) and Papanicolaou tests are used together (HPV co-test) for routine cervical cancer screening, screening intervals can be extended to ...3 years. We assessed HPV test practices and Papanicolaou test screening interval recommendations of US providers. Study Design Using a multistage probability design, we analyzed nationally representative data that were collected in 2006 through the Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Results Approximately 51% of providers ordered the HPV co-test; however, clinical vignettes found that <15% of providers who ordered the HPV test recommend the next Papanicolaou test in 3 years for women with concurrent normal HPV co-test results and a documented normal screening history. Conclusion Overall, annual cervical cancer screening continues to be a common recommendation, regardless of whether a screening history has been established or an HPV test has been ordered.
Opting Out of Cervical Cancer Screening Cooper, Crystale Purvis, PhD; Saraiya, Mona, MD, MPH
American journal of preventive medicine,
September 2014, Letnik:
47, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Background Some primary care physicians choose not to provide cervical cancer screening. Purpose To investigate the characteristics and screening beliefs of family practitioners and internists who ...treat adult women in outpatient settings but perform no routine Pap tests. Methods A survey of U.S. primary care physicians (N=892) was conducted and analyzed in 2012. Results Participants who performed no Pap tests during a typical month (17.2% of family practitioners and 44.3% of internists) generally reported that they referred patients to gynecologists for cervical cancer screening. The most significant predictor of Pap test non-provision was agreement that patients are best served by having Pap tests performed by gynecologists (AOR=8.80, 95% CI=5.58, 13.88, p <0.001). Conclusions The perception that patients benefit from cervical cancer screening administered by gynecologists may deter screening in primary care settings, resulting in missed opportunities to offer screening to women who are never or rarely screened.
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