ࡱ> lnkq` +bjbjqPqP 6>::?}G ! ! !!t^+^+^+8+,+$K+,L--@-///,/ K K K K K K K$5MhOJ0K !7+///770K@2 0-@-EK@@@7H 8(- !@- K@7 K@@RbI  !J(-+ =۳^+9VJJ[K0KtJfP3:P<JP !J/RM2@3TI5///0K0K@///K7777$$$*$$$* !4T!J!b 4 "  Melanoma of the Skin Definition: Melanoma of the skin is characterized by uncontrolled growth of neoplastic cells developing from the melanocytes in the skin with the potential to invade and spread to other sites. In the Washington State Cancer Registry, new cases of melanoma are coded to ICD-O codes C44.0C44.9 with morphology codes 87208790. Summary Similar to the national pattern, in Washington State for 1999 2001 combined, whites had the highest and Asians and Pacific Islanders and African Americans the lowest age-adjusted incidence rates of melanoma. Non-Hispanics had a higher rate than Hispanics. There was a significant increase in the age-adjusted incidence rates during 1992 2001 for both whites and non-Hispanics. Melanoma incidence rates in Washington were higher in areas where a higher proportion of the population completed college and in areas with a lower proportion of population living in poverty. These findings are consistent with studies showing that melanoma is associated with higher socioeconomic status. It is not clear how much of the higher incidence of melanoma for whites is due to their susceptibility to the cancer-causing effects of sunlight and how much is related to whites being disproportionately represented in higher socioeconomic groups potentially associated with lifestyle and behavioral factors that increase the risk of melanoma or its detection. Rates  HYPERLINK "../AppendixA.doc" \l "RaceEthn" Race and Ethnicity In Washington State, whites had the highest HYPERLINK "../AppendixA.doc" \l "AARate"age-adjusted incidence rate of melanoma for 1999 2001 combined. Asians and Pacific Islanders and African Americans had the lowest rates, and Hispanics had a lower incidence rate than non-Hispanics. The high rates among whites and low rates among Asians and Pacific Islanders and African Americans mirror the national pattern. Furthermore, the high incidence among whites and non-Hispanics is supported by studies demonstrating that white non-Hispanics experience sunburnsa strong determinant of melanoma risk more frequently than people of other races and ethnicities.,  Education To assess the association between education and melanoma incidence, we assigned an educational level to each person diagnosed with melanoma based on the percent of people age 25 and older with a college education in the census tract in which the individual lived at the time of diagnosis. ( HYPERLINK "../AppendixA.doc" \l "Education" See Appendix A, Education.) In Washington for 1999 2001 combined, the age-adjusted incidence rate of melanoma rose as the proportion of the population completing college increased. This is consistent with studies showing that college graduates and people holding professional jobs,  (an indication of higher level of education) have an excess of melanoma. This finding is also consistent with 1999 data from the Washington Behavioral Risk Factor Surveillance System (BRFSS) showing that Washingtonians with relatively more education were more likely to report sunburn in the last year compared to people with lower educational levels. It is not clear how much of the association between higher level of education and higher incidence of melanoma is due to lifestyle behaviors that modify exposure to sunlight or some other factor, such as more frequent screening among those with more education, and how much is the result of whites being both more likely to develop melanoma and to have relatively high levels of formal education.  Poverty To study the link between poverty and melanoma, we measured poverty as the percent of the population living at or below the federal poverty level in the census tract in which the individual lived at the time of diagnosis. ( HYPERLINK "../AppendixA.doc" \l "Poverty" See Appendix A, Poverty.) In Washington for 1999 2001 combined, the age-adjusted incidence rate of melanoma increased as the proportion of the population living in poverty decreased. Additionally, people in census tracts where less than 10% of the population lived in poverty had significantly higher incidence rates compared to people in census tracts with higher levels of poverty. This is consistent with studies showing melanoma to be associated with higher socioeconomic status, as measured by type of occupation, NOTEREF _Ref77737996 \f \h 5, NOTEREF _Ref77738001 \f \h 6 or by percentage of families below poverty.  This finding is consistent with 1999 data from the BRFSS showing that Washingtonians with annual household incomes of more than $50,000 were more likely to report a sunburn in the last year compared to people with lower incomes. NOTEREF _Ref70131227 \f \h 7 As with education, it is not clear how much of the association between affluence and the incidence of melanoma reflects lifestyles NOTEREF _Ref70131789 \f \h 8 and how much is related to whites being both more likely to develop melanoma and more likely to be relatively affluent. Trends Age-adjusted incidence rates for melanoma for 1992 2001 have been increasing about 5% each year for whites and non-Hispanics. The rates for Asians and Pacific Islanders, American Indians and Alaska Natives, and Hispanics did not vary greatly over time. We were unable to assess changes for African Americans because of the low number diagnosed with melanoma each year. Other Measures of Impact and Burden Fortunately, death from melanoma is relatively rare. We were unable to compare melanoma death rates by race and ethnicity, because there were very few deaths in groups other than white and non-Hispanic. Additionally, in contrast to incidence, there was no clear relationship between death rates due to melanoma and either the percent of the population with college degrees or the percent living in poverty. This may be due to relatively good survival of people with relatively more economic resources and higher levels of education. NOTEREF _Ref70131789 \f \h 8, For More Information Melanoma of the Skin Chapter, 2002 Health of Washington State,  HYPERLINK "http://www.doh.wa.gov/HWS/doc/CD/CD_MEL.doc" http://www.doh.wa.gov/HWS/doc/CD/CD_MEL.doc. Data Sources (For additional detail, see  HYPERLINK "../AppendixB.doc" Appendix B.) State death data: Vital Registration System Annual Statistical Files, Washington State Deaths 1980-2002 CD-ROM issued November 2003. Cancer incidence data: Washington State Cancer Registry, 2003 Release. Population data for race and ethnicity: U.S. Census for 1990; National Center for Health Statistics bridged race population counts for 2000, 2001 and 2002; Public Health Seattle & King County intercensal interpolations for 1991 1999, EPE Unit, February 2003. Population data for education and poverty: U.S. Census 2000 Summary File 3, Tables P37 and P87 available through  HYPERLINK "http://factfinder.census.gov/home/saff/main.html?_lang=en" American Fact Finder. Downloaded December 2003. References      STYLEREF Heading-Chapter \* MERGEFORMAT Melanoma of the Skin  PAGE 2 The Health of Washington State, 2004 Supplement Updated: 07/16/2004 Washington State Department of Health The Health of Washington State, 2004 Supplement  PAGE 1  STYLEREF Heading-Chapter \* MERGEFORMAT Melanoma of the Skin Washington State Department of Health Updated: 07/16/2004  U.S. Cancer Statistics Working Group. United States Cancer Statistics: 2000 Incidence. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2003.  Hall HI, Saraiya M, Thompson T, et al. Correlates of sunburn experiences among U.S. adults: results of the 2000 National Health Interview Survey. Public Health Rep, 2003. 118:540-9.  Saraiya M, Hall HI and Uhler RJ. Sunburn prevalence among adults in the United States, 1999. Am J Prev Med, 2002. 23:91-7.  Hemminki K and Li X. Level of education and the risk of cancer in Sweden. Cancer Epidemiol Biomarkers Prev, 2003. 12:796-802.  Hemminki K, Zhang H and Czene K. Socioeconomic factors in cancer in Sweden. Int J Cancer, 2003. 105:692-700.  Reynolds P, Cone J, Layefsky M, et al. Cancer incidence in California flight attendants (United States). Cancer Causes Control, 2002. 13:317-24.  Washington State Department of Health. Health of Washington State. Melanoma of the skin. Olympia, WA, 2002 Aug [cited 2004, March 23rd] 418p. Available from http://www.doh.wa.gov/HWS.  Berwick M and Halpern A. Melanoma epidemiology. Curr Opin Oncol, 1997. 9:178-82.  Harrison RA, Haque AU, Roseman JM, et al. Socioeconomic characteristics and melanoma incidence. Ann Epidemiol, 1998. 8:327-33.  HYPERLINK "http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10910307" Van Durme DJ, Ferrante JM, Pal N, Wathington D, Roetzheim RG, Gonzalez EC. Demographic predictors of melanoma stage at diagnosis. 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