Has mortality from melanoma stopped rising in Australia? Analysis of trends between 1931 and 1994

Giles, Graham G.; Armstrong, Bruce K.; Burton, Robert C.; Staples, Margaret; Thursfield, Vicky

doi:10.1136/bmj.312.7039.1121

Cited by 195 publications

(138 citation statements)

References 25 publications

(36 reference statements)

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“…The medical literature indicates that these did not start at the same time in all countries: in some Australian states, prevention programmes started in the 1960s (Giles et al, 1996) and then national programmes ('Slip, Slop, Slap' and 'Sun Smart') followed in the 1980s. In the USA, Canada, UK and Sweden, national programmes started in the 1980s or early 1990s (Robinson et al, 1997; Rivers and Gallagher, 1995;Melia, 1995;Möller et al, 1997).…”

Section: Is the End Of The Increasing Trend In Sight?mentioning

confidence: 99%

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Mortality from cutaneous melanoma: evidence for contrasting trends between populations

et al. 2000

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Figure 1Age-adjusted mortality rates for young (30-59) and old (60-79) men and women (world standard population) increases were observed among men. The annual percentage increase in rates for men and women 60-79 years old was, respectively, 12% and 4% in Australia, 7% and 2% in the USA, and 9% and 4% in the Nordic countries. We found a less marked difference between men and women in the CMM mortality increase in Canada (6% for men and 4% for women), Japan (6% and 4%) and the UK (7% and 5%). In France, Italy and Czechoslovakia, CMM mortality rates were low in the 1960s, but afterwards, average annual increases were 24% and 27% in French men and women, 15% and 13% in Italian men and women, and 17% and 33% in Czechoslovakian men and women. Because CMM mortality increased more in older than in younger people, those who died from CMM in 1994 were 10 years older on average than those who died in 1960. Age-period-cohort modelsThe age-period-cohort models yielded drift terms (measures of the average trend over time) that were all positive and in agreement with the annual percentage increases described above. CMM mortality rose linearly during the period of observation in every population. In every country but Japan, the increase was greater (higher drift) for men than for women. The largest sex differences in drift were observed in Australia, Canada and the USA. Consistent with the analysis of the age-standardized rates, the highest values for drift were found in France, Italy and Czechoslovakia.Trends in mortality rates by birth cohort have been derived from the APC model, and are shown in Figure 2 for three selected countries (Australia, UK and France). These countries were chosen because they represented the three CMM mortality patterns that we observed after APC modelling (see below). Each graph contains three plots that described different scenarios: in the upper plot, all the drift is attributed to a birth cohort effect, in the lower plot all the drift is attributed to a period effect. The rates displayed in Figure 2 simply reflect the trend in rates by birth cohort and are therefore not comparable with actual rates observed in populations. If in each scenario rates are decreasing, we can conclude that there is a real decrease. The trends in CMM mortality rates illustrated by these models describe three patterns:1. increasing rates until generations born around [1930][1931][1932][1933][1934][1935] (for Australia increasing rates ceased earlier), followed by decreasing rates in more recent birth cohorts (in Australia, the Nordic countries and the USA) 2. increasing rates until generations born during World War II, followed by flattening or slightly decreasing rates in more recent birth cohorts (UK, Canada) 3. a steep, almost linear, increase with no major change in this trend (France, Czechoslovakia, and Italy).CMM mortality rates in Japan showed a pattern similar to that described in the third group but the rates of increase were much smaller. DISCUSSIONWe have succeeded in identifying meaningful patterns in the g...

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Section: Is the End Of The Increasing Trend In Sight?mentioning

confidence: 99%

“…There is also evidence that CMM mortality rates are plateauing or beginning to fall in recent generations in the USA and in Australia (Scotto et al, 1991;Rousch et al, 1992;Giles et al, 1996). These declines in mortality are, however, restricted to recent birth cohorts while death rates continue to increase in older generations.…”

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Mortality from cutaneous melanoma: evidence for contrasting trends between populations

et al. 2000

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“…Introduction of the Papanicolaou test in the 1950s was followed by a dramatic decline in cervical cancer in those countries that made widespread screening available (Laara et al, 1987). The decline in Australian melanoma mortality for those born after 1950 is an additional example of effective intervention at the population level (Giles et al, 1996).…”

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confidence: 99%

Modifiable risk factors for cancer

2004

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Over 6 million people around the world die from cancer each year. Modifiable risk factors have been linked to a wide range of malignancies, including cancers of the oropharynx, oesophagus, larynx, lung, kidney, bladder, pancreas, skin, stomach, ovary, breast, cervix, uterus, prostate, and colon. Research indicates that over half of all cancers in developed countries could be prevented if we implemented population-wide measures to promote the following behaviours: reduce tobacco use, increase physical activity, control weight, improve diet, limit alcohol, utilise safer sex practices, get routine cancer screening tests, and avoid excess sun exposure.

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“…It is impossible to claim an effect from one specific factor although early detection may well have contributed. In Australia (Giles et al, 1996) a greater reduction in melanoma mortality was observed following an intensive early detection intervention in Queensland in the 1960s than in other states.…”

Section: Effects Of Early Detection On Melanoma Mortality 805mentioning

confidence: 99%

“…Mortality from melanoma has been falling or reaching a plateau in several countries (Streetly and Markowe, 1995;Giles et al, 1996;MacKie et al, 1997;La Vecchia et al, 1999;CohnCedermark et al, 2000;Severi et al, 2000). In the UK these trends first seemed to start before the interventions in 1985and 1987(Streetly and Markowe, 1995MacKie et al, 1997).…”

Section: Effects Of Early Detection On Melanoma Mortality 805mentioning

confidence: 99%

The relation between mortality from malignant melanoma and early detection in the Cancer Research Campaign Mole Watcher Study

et al. 2001

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Summary Between 1987 and 1989 the Cancer Research Campaign funded a health education programme for the early detection of cutaneous malignant melanoma in the general population in 6 health districts of England and 1 health board in Scotland (population of 3 million). The intervention was evaluated by studying its effects on annual and cumulative mortality rates for melanoma. Population-based data on mortality from melanoma were collected in the intervention areas, the health regions covering those areas, and 5 other health regions of England from 1981 to 1996. Deaths from melanoma in cases diagnosed after the start of the intervention were used to study cumulative mortality rates. The annual mortality rates for melanoma, 1981 to 1996, showed no significant difference in their trends between the intervention areas, and other areas of England and Wales. After adjustment for pre-intervention rates, there was also no significant reduction in cumulative mortality from melanoma in the intervention areas compared with the non-intervention areas: rate ratio 1.2 (95% Cl 0.9-1.7) in men, 0.9 (95% Cl 0.7-1.3) in females. The lack of a significant reduction in melanoma mortality associated with the intervention raises questions about this approach to early detection and emphasises the need for new strategies.

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Has mortality from melanoma stopped rising in Australia? Analysis of trends between 1931 and 1994

Abstract: Melanoma mortality in Australia peaked in about 1985 and has now plateaued. On the basis of trends in cohorts it can be expected to fall in coming years.

Cited by 195 publications

References 25 publications

Mortality from cutaneous melanoma: evidence for contrasting trends between populations

Mortality from cutaneous melanoma: evidence for contrasting trends between populations

Modifiable risk factors for cancer

The relation between mortality from malignant melanoma and early detection in the Cancer Research Campaign Mole Watcher Study

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