March 16, 2010

Substantial Increases in Nonmelanoma Skin Cancers

Additional articles in Archives of Dermatology examine costs, management of skin cancer

Both new diagnoses and a history of non-melanoma skin cancer appear to have become increasingly common, and the disease affects more individuals than all other cancers combined, according to two reports in the March issue of Archives of Dermatology, one of the JAMA/Archives journals.

The article is one of several in the issue focusing on skin cancers, and is being published in conjunction with a JAMA theme issue on cancer. The March issues of Archives of Pediatrics & Adolescent Medicine, Archives of Neurology, Archives of Internal Medicine, Archives of Ophthalmology, Archives of Surgery, Archives of Facial Plastic Surgery and Archives of Otolaryngology"“Head & Neck Surgery will also publish articles on this topic.

Non-melanoma skin cancer is the most common malignant disease in the United States, according to background information in one of the articles. The disease is associated with substantial illness and cost, and a death rate that is lower than other cancers but still significant. However, non-melanoma skin cancer is not typically reported to cancer registries, and the most recent peer-reviewed, published national estimates date back to 1994. "Understanding skin cancer incidence and treatment is important for planning prevention strategies and allocating resources for treatment," the authors write.

In one article, Robert S. Stern, M.D., of Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, developed a mathematical model to estimate the prevalence of non-melanoma skin cancer in 2007. "This model used age-specific incidence data adjusted to reflect changes in incidence from 1957 to 2006, the age distribution of the population from 1957 to 2006 and the likelihood that an incident tumor was the first ever for that person," Dr. Stern writes.

Based on the model, Dr. Stern estimates that approximately 13 million white, non-Hispanic Americans had had at least one non-melanoma skin cancer by 2007. About one in five 70-year-olds have had non-melanoma skin cancers, and most who were affected have had more than one. "The prevalence of a history of skin cancer is far higher than that of any other cancer and exceeds that of all other cancers diagnosed since 1975," and is about five times higher than that of breast or prostate cancer, he writes.

In another article, Howard W. Rogers, M.D., Ph.D., of Advanced Dermatology, Norwich, Conn., and colleagues analyzed data from two Medicare databases and national surveys to estimate the incidence and treatment rates of non-melanoma skin cancer in 2006.

The total number of procedures to treat skin cancer in the Medicare population increased 76.9 percent from an estimated approximately 1.6 million procedures in 1992 to approximately 2 million procedures in 2006. Between 2002 and 2006, when database linkages allowed more detailed analyses, procedures to treat non-melanoma skin cancer increased 16 percent, the number of procedures per affected person increased 1.5 percent and the number of individuals undergoing at least one procedure increased by 14.3 percent.

Based on the results, the researchers estimate that in 2006 there were more than 3.5 million non-melanoma skin cancers in the United States and that approximately 2.1 million patients were treated for the disease.

"There is an epidemic of non-melanoma skin cancer in the United States, as illustrated by comparison with the previously published estimates and the 4.2 percent yearly average increase in cases in the Medicare population from 1992 to 2006," the authors conclude. "To date, educational programs emphasizing sun protection have mainly been disappointing in slowing skin cancer rates. In the face of ongoing increases in skin cancer incidence, continued national research and programs on treatment, education and prevention are critical."


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