Cases of melanoma among U.S. adolescents and young adults declined markedly from 2006 to 2015 even as the skin cancer's incidence continued to increase among older adults and the general population during the span, research shows. The findings are based on national cancer-registry data and suggest that public-health efforts advocating sun protection are changing behaviors among millennials and post-millennials.
The researchers at the University of Washington School of Medicine and Fred Hutchinson Cancer Research Center in Seattle gathered de-identified patient data of 988,000 invasive melanoma cases from databases at the Centers for Disease Control and Prevention and the National Cancer Institute. They calculated annual percentage of change for multiple demographics including age and found that across all ages the number of melanoma cases rose steadily during the study span, from 50,272 in 2001 to 83,362 in 2015. The overall increasing incidence rates seen over time were primarily driven by adults 40+ years, the JAMA Dermatology study says. However, for adolescents and young adults, incidence peaked around 2005 and then fell sharply through 2015: The incidence rate among males dropped about four percent per year and, among females, about 4.5 percent per year across the two age groups.
The drop-off mirrors reductions in melanoma rates seen among younger populations in Australia starting around 1988. The authors attribute Australia's turnaround to public-health campaigns for sun-protective behaviors, including a Slip! Slop! Slap! Campaign. "There seems to be a breakthrough happening that might really reverse the trend for increasing melanoma incidence," says Margaret Madeleine, co-senior author of the study and a Fred Hutchinson epidemiologist specializing in cancer-incidence trends. "We were wondering, with the advent of public health programs to increase sun protection - sunscreen and hats and staying in the shade and all the recommendations for skin cancer prevention - if that effort is working. Is there a corresponding decrease we can see reflected in melanoma rates?"
"The vast majority of my practice is older and middle-age adults, but absolutely melanoma can affect younger patients," added Dr. Jennifer Gardner, co-senior editor of the study and a clinical assistant professor of medicine (dermatology) at the UW School of Medicine. "I do have patients who are in the prime of their life and otherwise healthy, and they're thinking about other things and bigger ambitions, and unfortunately this diagnosis really hits them quite hard. In the United States we we're doing a better job of treating more advanced types of melanoma, but we are still seeing it increasing overall, so the public health work is not done. More efforts for prevention make a lot of sense."
Link Between Melanoma And CLL
Chronic lymphocytic leukemia – or CLL - is the most common type of leukemia in the U.S., with about 140,000 people living with the disease and with immune dysfunction as a major complication. While studying a large group of individuals with CLL, a Wilmot Cancer Institute scientific team discovered these patients had a sizable 600 percent higher risk of melanoma. Although a higher risk of melanoma had been known, a full analysis of detection rates and treatments among CLL patients has never been reported before, said Clive Zent, M.D., professor of Hematology/Oncology and Medicine at the University of Rochester Medical Cancer and Wilmot, who led the study published by the journal Leukemia Research.
As a result of this data, Zent recommends that all clinical teams who care for CLL patients should actively monitor for melanoma as a part of routine care. The goal is to catch the skin cancer early and manage it with the newest targeted therapies. Study results showed that 22 melanomas were diagnosed among 470 people in the cohort, a rate that's more than 600 percent higher than what would be expected in a similar group of age and gender-matched people from the general population. Of the 22 diagnoses, 68 percent were detected through monitoring in the UR Medicine dermatology clinic associated with Wilmot, and nine percent were found by CLL specialists. Eighty eight percent of the cases involved earlier-stage disease with a better prognosis.
Researchers also noted that one CLL patient, a 75-year-old woman, who developed advanced melanoma, was treated with a targeted cancer-immunotherapy drug, pembrolizumab (Keytruda), and went into remission for more than two years. She had been taking another targeted therapy, ibrutinib, for the leukemia. Zent believes this is the first published report to offer evidence that the ibrutinib/pembrolizumab combination was effective. "We do not for sure know why CLL patients are more susceptible to melanoma, but the most likely cause is a suppressed immune system," Zent says. "Normally, in people with healthy immune systems, malignant skin cells might be detected and destroyed before they become a problem. But in CLL patients, failure of this control system increases the rate at which cancer cells can grow into tumors, and also the likelihood that they will become invasive or spread to distant sites."
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With over 30 years of writing and editing experience for newspapers, magazines and corporate communications, Kevin Kerfoot writes about natural health, nutrition, skincare and oral hygiene for Trusted Health Products’ natural health blog and newsletters.
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