The Geographic and Demographic Distribution of Melanoma Throughout the United States: Implications for Primary and Secondary Prevention Bertina Backus.

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Presentation transcript:

The Geographic and Demographic Distribution of Melanoma Throughout the United States: Implications for Primary and Secondary Prevention Bertina Backus 1, Myles Cockburn 2, Bruce Caldwell 1, Laurie MacDougall 1, and Susan Gershman 1 1 Massachusetts Cancer Registry, MA Dept. of Public Health, Boston, MA 2 University of Southern California/Keck School of Medicine, Los Angeles, CA

Abbreviations These abbreviations will be noted throughout the presentation: ► ► NCI/SEER: National Cancer Institute / Surveillance, Epidemiology and End Results Program ► ► CDC/NPCR: Centers for Disease Control and Prevention / National Program of Cancer Registries ► ► NAACCR/CINA: North American Association of Central Cancer Registries / Cancer Incidence in North America ► ► USCS: United States Cancer Statistics

Background ► ► Historically, national cancer incidence data for the United States have been based on information from the NCI/SEER Program. ► ► In more recent years, the CDC/NPCR has led to the establishment of central cancer registries in all U.S. states and territories. ► ► Data from both these programs are made available via NAACCR/CINA and USCS.

NCI/ SEER Cancer Incidence Statistics NAACCR Cancer Incidence in North America United States Cancer Statistics (collaboration of NCI, CDC, and NAACCR) Registry Funding Sources Program Data Sets and Reports Cancer Query System (CANQUES): SEER Cancer Incidence Statistics ( ) SEER Cancer Statistics Review, CINA+ Online ( ) Cancer in North America , Vol. One: Combined Cancer Incidence for the U.S. and Canada USCS Expanded Dataset on CDC WONDER ( ) United States Cancer Statistics: 2004 Incidence & Mortality CDC/ NPCR Overview of Relationships Between Funding Sources, Programs, and Data Sets

Goals ► ► To compare these programs and determine which one best represents the U.S. in order to evaluate incidence rates for melanoma. ► ► To examine how geographic differences in the racial/ethnic distribution of the U.S. population and in regional ground level ultraviolet (UV) radiation affect regional and national incidence rates for melanoma.

Coverage of U.S. Cancer Incidence Data Sets

Distribution of Covered Populations by Race/Ethnicity

Data Sources for Maps ► ► Cancer Data: NAACCR/CINA, ► ► Population Data: same ► ► UV Radiation Data: National Solar Radiation Database ► ► Exclusions   10 states that were not included in CINA   2 states for which UV data were not available   1 state with problematic data  37 states in final data set

Median Ground Level Ultraviolet Radiation Levels

Melanoma Incidence, : All Races

Percent White non-Hispanic

Melanoma Incidence, : White non-Hispanics

Discussion ► ► It is critical that incidence data for cancers with strong racial/ethnic variation, such as melanoma, be stratified by race. ► ► We must recognize that rates of melanoma are best predicted by population structure, not UV level. ► ► In order to effectively target cancer control programs, we must ensure that we are using the right data.

Limitations Project Limitation: ► ► Missing study data Data Limitations: ► ► Errors/missing information in the medical record ► ► Unstable rates for non-white populations ► ► Non-standardized race/ethnicity coding ► ► Underreporting/completeness of reporting

Implications for Prevention Activities ► ► Melanoma prevention programs need to be implemented across all U.S. states and territories, since the incidence of melanoma is not solely dependent on UV radiation. ► ► Programs need to be aware of which populations are at risk and to focus on demography rather than geography.

Acknowledgements ► ► Thanks to my co-authors ► ► We acknowledge the Centers for Disease and Prevention for its support of the staff and the development of this presentation under cooperative agreement number 1 U58 DP awarded to the Massachusetts Department of Public Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.