NEW YORK — To reduce melanoma incidence, prevention efforts can be shifted from indoor tanning efforts to focus on outdoor sun protection in average-risk adults, according to a speaker at HemOnc Today Melanoma and Cutaneous Malignancies.
Three years ago, the CDC released an infographic that showed one in three white women aged 16 to 25 years in the United States reported indoor tanning.
“Remarkably, I can come to you today and say that number has been cut at least in half,” Alan C. Geller, MPH, RN, senior lecturer at Harvard TH Chan School of Public Health and director of melanoma epidemiology at Massachusetts General Hospital, said during his presentation. “If you think about how long it takes to make a huge change, from the first time someone started indoor tanning in 1982 to now in 2017, we’ve seen these rates drop through the floor. This is a huge victory.”
Alan C. Geller
Still, incidence of invasive melanoma is expected to increase through 2031 in many parts of the world, with the exception of Australia. Further, mortality rates have been increasing in older adults, despite stabilizing or declining in young adults.
“It’s going to be difficult to see a drop in the overall mortality rate until we can begin to see a drop in the mortality rate among middle-aged and older people,” Geller said.
More than 120,000 Americans have died of melanoma since 2000, and it is the second most common cancer in young adults.
“This is a cancer that starts among young people, but fortunately the mortality rate among young people is low,” Geller said.
Ten European nations and 15 U.S. states have indoor tanning legislations for individuals aged younger than 18 years, which researchers have linked to the overall drop in melanoma mortality for individuals aged 20 to 50 years.
“Unfortunately, as part of the new administration, the idea of a federal ban on indoor tanning has gone away, and we are at the point now that we are stuck with just these 15 states, with the hope being that more states will improve on their own,” Geller said.
Still, data from the CDC showed 37% of U.S. adults reported being sunburned in the past year, and about 3,200 adults seek help at the ED for injuries from indoor tanning each year.
The best public health model has been the Australian SunSmart program, Geller said. That campaign began in about 1985, and the first reports showing a decreased melanoma incidence rate have been released.
“We can use this to help us think about something that is multilevel and comprehensive,” Geller said. “But, we need to do this strategically. We are on the edge of being able to drop the incidence rate in United States, and we need to ask, what is it going to take? Maybe it will be a modest change, a drop in the sun burning rate by 5% to 10%. How do we go about doing that?”
Study data indicate most melanomas occur in individuals considered at average risk, including those with few to some moles, a few sunburns, scant history of indoor tanning, and no personal or family history of melanoma, Geller said.
“What would happen if we could think of modest benefits amongst a much broader population, arguing that we are all at average risk for melanoma?” he said. “One’s impact is determined by your relationship between your reach and your effectiveness. If you can reach 50% of people with a 2% or 3% effect, it’s more effective than if you only reach 2% of people with a strong effect.”
One strategy would be to focus efforts on where people burn, Geller said. For instance, researchers can work with the travel industry to help protect travelers going from cold to warm climates.
“Most of our worst burns take place at the end of April, when you haven’t been out in the sun, and it’s been freezing and cold, then you get too much sun,” Geller said. “It’s very hard to think about this in the United States — there are very few policies for sun protection like there are for indoor tanning.”
In the past, it has been hard to improve sun protection due to the seasonal natural of sun protection, the few policies that exist like those for indoor tanning, less then optimal sunscreen-use skills, and because much burning is incidental, Geller said.
To overcome these barriers, demonstration projects can emphasize sun protection and early detection at the countywide and state levels. Further, researchers can follow the examples of indoor tanning efforts, tobacco reduction and breast cancer screening.
“If we can apply several of these lessons from indoor tanning and apply them to the world of sun protection, we can be quite successful and come back a few years from now and say we’ve really made some notable successes,” Geller said. – by Alexandra Todak
Geller AC. Skin cancer prevention. Presented at: HemOnc Today Melanoma and Cutaneous Malignancies; March 24-25, 2017; New York.
Disclosure: Geller reports no relevant financial disclosures.