Understanding Melanoma: From Prevention to Cure Primary Prevention– A National Call to Action 31January 2015 Jeffrey E. Gershenwald, MD Professor, Dept of Surgical Oncology Professor, Dept of Cancer Biology Medical Director, Melanoma & Skin Center Co-Chair, Melanoma Cancer Genome Atlas Program Chair, AJCC Melanoma Expert Panel
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Primary Prevention: A National Call to Action - Dr. Jeff Gershenwald
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Understanding Melanoma:
From Prevention to Cure
Primary Prevention–
A National Call to Action
31January 2015
Jeffrey E. Gershenwald, MD
Professor, Dept of Surgical Oncology
Professor, Dept of Cancer Biology
Medical Director, Melanoma & Skin Center
Co-Chair, Melanoma Cancer Genome Atlas Program
Chair, AJCC Melanoma Expert Panel
Melanoma: A Rapidly Growing Problem
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1950 1960 1970 1980 1990
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Incidence
Death
2000
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1950-2000↑ 619% Incidence↑ 165% Mortality
While the rate of almost all major cancers is decreasing, the annual incidence of melanoma continues to rise ~3%/yr
The Challenge
• ≈ 80,000 individuals expected to be diagnosed with invasive melanoma in 2014
• Most aggressive form of skin cancer
• <5% of skin cancers diagnosed• >75% of skin cancer deaths (~9,000/year)
• Ranks second among all cancers in years of productive life lost
• Affected patients often young/otherwise healthy• 2nd most common cause of cancer in women 20-29yo
• Increasing mortality in men >50yo
• Cost of lost productivity estimated $3.5B/yr in US
1Linos et al., J Invest Dermatol. 2009;129:1666-1674; 2 American Cancer Society. Cancer Facts & Figures 2013; 3 Cust et al., Int J Cancer. 2011;128:2425-2435; 4 Boniol et al, BMJ. 2012;345:e4757
• Historical long-term survival for stage IV disease –very poor
1Linos et al., J Invest Dermatol. 2009;129:1666-1674; 2 American Cancer Society. Cancer Facts & Figures 2013; 3 Cust et al., Int J Cancer. 2011;128:2425-2435; 4 Boniol et al, BMJ. 2012;345:e4757
The Challenge
• UVR exposure from the sun and indoor tanning devices is a major independent risk factor for melanoma
• When controlling for multiple factors, tanning bed exposure <18 years old increased melanoma risk by 85%
• Half of U.S. children & adolescents ≥ 1 sunburns per year• 1 blistering sunburn in childhood 2X lifetime melanoma risk• ≥5 blistering sunburns between ages 15-20 years associated
with 80% increased risk of melanoma
1 Cust et al., Int J Cancer. 2011;128:2425-2435; 2 Boniol et al, BMJ. 2012;345:e4757; 3 Lazovich et
al., CEBP 2010;19:1557-1568; 4 Guy et al., JAMA Dermatol. 2014;150:501-511; 5Linos et al., J
Invest Dermatol. 2009;129:1666-1674; 6American Cancer Society. Cancer Facts & Figures 2014
Radiation exposures classified as Carcinogens by WHO/IARC
Lancet Oncology , August 2009
However….tanning facilities exceed number of Starbucks and McDonalds in >100 major US cities
Collaborative NIH/NCI/NHGRI effort to create a comprehensive collection of maps that chart genomic changes that occur in each type of cancer
Indoor Tanning Device Use Among US High School Students (N=14,590)
Guy GP Jr, et al. Prev Chronic Dis 2011;8(5):A116;
sun exposure, and decrease tanning behavior in youths
in order to reduce the incidence of melanoma
Support, facilitate and evaluate legislative activities
Maximize reach and impact of evidence-based interventions
Melanoma Prevention Flagship
Goals
Provide Individuals with the Information They Need to Make Informed, Healthy Choices About
UV Exposure
• Strategy 2A: Develop effective messages and interventions for specific audiences
• Strategy 2B: Support skin cancer prevention education in schools
• Current focus on child care and early learning centers, to teach children healthy sun protection behaviors from an early age curriculum, teacher training, parent education, technical assistance
1 Gritz, Tripp, et al., Health Educ Behav. 2007;34:562-77; 2 Gritz, Tripp, et al., Prev Med. 2005;41:357-66
Provide Individuals with the Information They Need to Make Informed, Healthy Choices About
UV Exposure, continued
• Current focus on collaboration with MDA’s Cancer Prevention & Control Platform (CP&CP) to disseminate pre-K-12 sun protection programs
• Strategy 2C: Integrate sun safety into workplace health education and promotion programs.• Engage corporate partnerships in collaboration with CP&CP
Promote Policies that Advance the National Goal of Preventing Skin Cancer, continued
• Strategy 3A: Support inclusion of sun protection in school policies, construction of school facilities, and school curricula
• Strategy 3C: Incorporate sun safety into workplace policies and safety trainings
Reduce Harms from Indoor Tanning
• Strategy 4B: Continue to develop, disseminate, and evaluate tailored messages to reduce indoor tanning among populations at high risk• Research to examine the effects of UV photography on UV
protection/exposure behavior
• Strategy 4C: Support organizational policies that discourage indoor tanning by adolescents and young adults• Discourage school-sponsored debit cards that pay for tanning services
• Strategy 4D: Enforce existing indoor tanning laws and consider adopting additional restrictions• Research to examine compliance with Texas SB 329
Strengthen Research, Surveillance, Monitoring, and Evaluation Related to Skin Cancer
Prevention
• Strategy 5B: Evaluate the effect of interventions and policies on behavioral and health outcomes• Dissemination and implementation research on sun protection
intervention for child care and early learning centers• Research to examine the effects of UV photography on UV