10158953040862JAMA DermatolJAMA DermatolJAMA dermatology2168-60682168-608429387875588581410.1001/jamadermatol.2017.5541HHSPA955565ArticleTrends in Melanoma Incidence Among Non-Hispanic Whites in the United States, 2005 to 2014HolmanDawn M.MPHFreemanMaryBeth B.MPHShoemakerMeredith L.MPHDivision of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GeorgiaCorresponding Author: Dawn M. Holman, MPH, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F76, Chamblee, GA 30341-3717 (dholman@cdc.gov)2932018013201801320191543361362
Skin cancer is a major public health concern in the United States.1 Melanoma, the third most common type of skin cancer, is diagnosed in over 70000 individuals and causes more than 9000 deaths each year.2 Melanoma is often caused, in part, by over-exposure to ultraviolet (UV) radiation from the sun and indoor tanning devices, and incidence rates are highest among non- Hispanic whites (NHW).1 Previous reports3 have indicated that melanoma incidence rates were increasing among NHW adults of all ages, but analyses of more recent data by age group are warranted. This study provides the latest national data on melanoma incidence trends among NHWs by 10-year age groups.
Methods
We analyzed data from the Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries (NPCR) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program that met United States Cancer Statistics publication criteria.2 The data covered approximately 99.1% of the US population. We limited analyses to NHWs 15 years or older. We calculated melanoma incidence rates and average annual counts by 10-year age groups from January 2010 to December 2014 and presented rates per 100000 persons, age-adjusted to the 2000 US standard population using 19 age groups.4 We calculated average annual percent change in melanoma incidence rates by 10-year age groups from January 2005 to December 2014; CDC Human Subject institutional review board (IRB) approval was not required for this analysis because the project met the CDC NPCR research analysis requirements, which are approved by the CDC’s IRB.
Results
From January 2010 to December 2014, a total of 192 979 melanomas were diagnosed among NHW males 15 years or older, and 131 976 melanomas were diagnosed among NHW females 15 years or older. More than 70%of melanomas were diagnosed among individuals 55 years or older. Melanoma incidence rates among NHW males ranged from 2.0 per 100000 among those aged 15 to 24 years to 198.3 per 100000 among those older than 85 years (Table). Among NHW females, incidence rates ranged from 4.5 per 100000 among those aged 15 to 24 years to 60.9 among those older than 85 years.
Among both NHW males and females 15 years or older, we observed statistically significant increases in melanoma incidence from January 2005 to December 2014. Among males and females combined and among males only, melanoma incidence decreased significantly among those aged 15 to 24, 25 to 34, and 35 to 44 years and increased significantly among those aged 55 to 64, 65 to 74, 75 to 84, and older than 85 years. Among females only, melanoma incidence decreased significantly among those aged 15 to 24 and 25 to 34 years and increased significantly among those aged 45 to 54, 55 to 64, 65 to 74, 75 to 84, and older than 85 years.
Discussion
Melanoma incidence rates have increased in recent years among NHWs, particularly men older than 54 years and women older than 44 years. In contrast, rates have decreased slightly among younger NHWs (men younger than 45 years and women younger than 35 years). National surveillance data indicate that use of indoor tanning, which exposes users to intense levels of UV radiation, and the prevalence of sunburn, a biological indicator of over exposure to UV radiation, have decreased in recent years, particularly among adolescents and young adults.5,6 Decreases in indoor tanning and sun burn would be expected to result in decreases in melanoma incidence rates over time. Although primary skin cancer prevention efforts have often focused on children, adolescents, and young adults, the steady increase in melanoma incidence rates among older adults indicates a need for efforts that promote skin cancer preventive behaviors throughout adulthood. Such efforts could focus on groups at high risk, such as outdoor workers and intentional tanners. Ongoing surveillance of melanoma incidence is warranted to monitor progress toward national skin cancer prevention goals and guide prevention strategies.
Funding/Support: This research was supported in part by appointments (Ms Shoemaker and Ms Freeman) to the Research Participation Program at Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and the Centers for Disease Control and Prevention. Ms Holman is a federal employee, and her work on this article was performed as part of her official duties.
Role of the Funder/Sponsor: The funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Institutes of Health.
Conflict of Interest Disclosure: None reported.
Author Contributions: Ms Holman had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: All authors.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Holman, Freeman.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: All authors.
Administrative, technical, or material support: Shoemaker.
Study supervision: Holman.
US Department of Health and Human ServicesThe Surgeon General’s Call to Action to Prevent Skin CancerWashington, DCOffice of the Surgeon General, US Dept of Health and Human Services2014US Cancer Statistics Working GroupUnited States Cancer Statistics: 1999–2014 Incidence and Mortality Web-based ReportAtlanta, GACenters for Disease Control and Prevention and National Cancer Institute, US Dept of Health and Human Services2017JemalAWardEMJohnsonCJAnnual report to the nation on the status of cancer, 1975–2014, featuring survivalJ Natl Cancer Inst2017109910.1093/jnci/djx030TiwariRCCleggLXZouZEfficient interval estimation for age-adjusted cancer ratesStat Methods Med Res200615654756917260923GuyGPJrWatsonMSeidenbergABHartmanAMHolmanDMPernaFTrends in indoor tanning and its association with sunburn among US adultsJ Am Acad Dermatol20177661191119328522044National Cancer InstituteCancer trends progress reportSunburnhttps://progressreport.cancer.gov/prevention/sunburnAccessed September 25, 2017
Average Annual Counts and Incidence Ratesa of Melanoma From January 2010 to December 2014 and Trends Over Time From January 2005 to December 2014 by Age Among Non-Hispanic White Males and Females
Age, y
Males and Females
Males
Females
AAC, No. (%)
Rate (95% CI)
AAPC
AAC, No. (%)
Rate (95% CI)
AAPC
AAC, No. (%)
Rate (95% CI)
AAPC
≥15
64 991.0 (100)
33.3 (33.2–33.5)
1.4b
38 595.8 (59.4)
41.7 (41.5–41.9)
1.6b
26 395.2 (40.6)
27.2 (27.0–27.3)
1.0b
15–24
832.6 (1.3)
3.2 (3.1–3.3)
−5.1b
256.6 (0.7)
2.0 (1.9–2.1)
−4.0b
576.0 (2.2)
4.5 (4.4–4.7)
−5.5b
25–34
2923.4 (4.5)
12.1 (11.9–12.3)
−1.7b
1007.2 (2.6)
8.3 (8.0–8.5)
−1.9b
1916.2 (7.3)
15.9 (15.6–16.3)
−1.5b
35–44
5023.4 (7.7)
20.5 (20.2–20.7)
−0.5b
2113.4 (5.5)
17.1 (16.8–17.4)
−0.7b
2910.0 (11.0)
23.8 (23.5–24.2)
−0.4
45–54
9836.2 (15.1)
32.4 (32.1–32.7)
0.4
4979.4 (12.9)
32.8 (32.4–33.3)
−0.2
4856.8 (18.4)
32.0 (31.6–32.4)
1.0b
55–64
14 371.8 (22.1)
50.4 (50.1–50.8)
1.3b
8803.8 (22.8)
63.2 (62.6–63.8)
0.7b
5568.0 (21.1)
38.3 (37.9–38.8)
2.3b
65–74
15 056.0 (23.2)
82.0 (81.5–82.6)
2.5b
10 148.8 (26.3)
117.3 (116.3–118.4)
2.3b
4907.2 (18.6)
50.5 (49.9–51.2)
2.7b
75–84
11 726.8 (18.0)
109.9 (109.0–110.8)
3.6b
8038.4 (20.8)
174.6 (172.9–176.3)
3.4b
3688.4 (14.0)
60.8 (59.9–61.7)
2.9b
>85
5220.8 (8.0)
107.0 (105.7–108.3)
4.6b
3248.2 (8.4)
198.3 (195.3–201.4)
4.4b
1972.6 (7.5)
60.9 (59.7–62.1)
3.5b
Abbreviations: AAC, average annual count; AAPC, average annual percent change.
Incidence data are from population areas that met United States Cancer Statistics publication criteria (https://www.cdc.gov/cancer/npcr/uscs/technical_notes/criteria.htm) for January 2010 to December 2014 (for counts and rates) and January 2005 to December 2014 (for AAPCs) and were reported to the National Program of Cancer Registries (Centers for Disease Control and Prevention) and the Surveillance, Epidemiology, and End Results Program (National Cancer Institute), which cover about 99.1%of the US population. Rates are per 100 000 and age-adjusted to the 2000 US standard population.