Melanoma Falls in Younger Americans: Success of Sun Education?

Megan Brooks

November 13, 2019

Public health campaigns encouraging sun-protective behaviors in the United States appear to be paying off — at least among young people.

A new analysis found that the incidence of invasive melanoma in the US decreased in adolescents and young adults from 2006 to 2015, although it rose in older age groups.

"Based on how this study was conducted, we do not know why these trends are occurring," Jennifer Gardner, MD, clinical assistant professor of dermatology, University of Washington School of Medicine, Seattle, told Medscape Medical News.

However, a "plausible explanation" is that public health campaigns and messaging aimed at promoting sun protection in childhood may be having a positive impact on melanoma incidence in adolescents and young adults, said Gardner.

In the late 1990s and 2000s, the US launched several public health measures to boost sun-protective behaviors. Other research has suggested modest improvements over time with increased use of sunscreen in adolescents and young adults. 

The US findings are in line with what has been seen in Australia, where a reduction in the incidence of melanoma cases since the 1980s is thought to be likely due to sun-wise campaigns, as reported last month by Medscape Medical News.

The study was published online today in JAMA Dermatology.

In the study, Gardner and colleagues analyzed data on 988,103 cases of invasive melanoma reported to the National Program of Cancer Registries (NPCR)–Surveillance Epidemiology and End Results (SEER) combined database for 2001–2015.

Between 2006 and 2015, the incidence of melanoma increased overall (from 200.1 to 229.1 cases per million person-years), but declined significantly among adolescents (ages 10-19 years) and young adults (ages 20-29 years). The total number of reported cases among adolescents and young adults fell by about 23%.

Melanoma incidence fell by 4.4% annually for male adolescents and 5.4% for female adolescents, and by 3.7% for male young adults and 3.6% for female young adults.

In contrast to adolescents and young adults, melanoma rates markedly increased in adults age 40 years or older (1.8% annual increase in both men and women), with increases particularly pronounced in the oldest cohorts.

"We know that early childhood sunburns and extensive UV light exposure early in life is a risk factor for developing melanoma later in life, so it may be that these public health interventions did not impact melanoma incidence in those older than 40 years of age given the timing of when they were implemented," Gardner told Medscape Medical News.

"It may be that older individuals adopted UV-protective behaviors later in life and we have yet to see the impact on this change," she added.

"However, we still strongly support UV-protection throughout one's lifetime to minimize the risk of developing skin cancer, including melanoma," she said.

The hope, said Gardner, is that there will continue to be a "durable trend in lowered melanoma incidence for younger individuals, and it will be interesting to see if the current adolescent and young adult groups continue to have a lower incidence of melanoma over time."

Support for the study was provided by grants from the National Institutes of Health, the Fred Hutchinson Cancer Research Center Integrated Immunotherapy Research Core, and a Society for Immunotherapy of Cancer–Merck fellowship. Gardner has disclosed no relevant financial relationships.

JAMA Dermatol. Published online November 13, 2019. Abstract

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