Melanoma Among Blacks in the United States MaryBeth Freeman, MPH ORISE Fellow

Transcription

1 Melanoma Among Blacks in the United States MaryBeth Freeman, MPH ORISE Fellow NAACCR Annual Conference June 13, 2018

2 Data Visualizations Tool U.S. Cancer Statistics

3 Public Use Databases U.S. Cancer Statistics Cancer incidence and population data 100% population coverage for the U.S. and Puerto Rico

4 Introduction

5 Background - Research Gaps Melanoma is one of the most common cancers in the United States Recent research has focused primarily on white and Hispanic populations Relatively fewer studies conducted among black and African-American populations in the US even though there is a range of skin complexions within this race

6 Skin Complexion Skin type or complexion is a key risk factor for skin cancer Melanin produced by the skin provides protection to deeper layers of skin cells from UV damage Skin that produces more melanin is naturally darker and provides more photoprotection from UV (and vice versa) However, UV exposure can cause DNA damage to all types of skin

7 Melanoma Among Blacks Black men and women in the US are at lower risk of melanoma diagnosis compared to whites, but they are often diagnosed at a later stage and have poor survival as a result The purpose of this research is to examine melanoma incidence and survival among black populations in the US by: Age Stage at diagnosis Histology

8 Methods

9 United States Cancer Statistics We examined cancer incidence data from the United States Cancer Statistics (USCS) database Covers 99.1% of the US population for the years Cases limited to non-hispanic black populations, except when non-hispanic whites were used as a comparison group

10 Analysis We used SEER*Stat software version to calculate: Age-adjusted rates per 100,000 population Rate ratios (RRs)* 95% confidence intervals (95% CI) 5-year relative survival rates (actuarial method) *RRs considered significant if they differed from 1 at p<0.05

11 Results

12 Melanoma Incidence Among Blacks United States, Age Rate (95% CI) Both Sexes Male Female N (%) Rate (95% CI) N (%) Rate (95% CI) N (%) (0.2, 0.3) 281 (15.4) 0.2 (0.2, 0.2) 118 (13.7) 0.3 (0.2, 0.3) 163 (16.8) ^ (1.2, 1.4) 663 (36.2) 1.4^ (1.3, 1.6) 335 (39.0) 1.2^ (1.1, 1.3) 328 (33.8) ^ (4.4, 5.1) 885 (48.4) 5.6^ (5.1, 6.2) 406 (47.3) 4.2^ (3.8, 4.6) 479 (49.4) Histology Superficial spreading melanoma 0.1 (0.1, 0.1) 183 (28.7) 0.1 (0.1, 0.1) 79 (27.0) 0.1 (0.1, 0.1) 104 (30.1) Nodular melanoma 0.1 (0.1, 0.1) 161 (25.2) 0.1 (0.1, 0.1) 75 (25.6) 0.1 (0.1, 0.1) 86 (24.9) Acral lentiginous melanoma 0.2^ (0.2, 0.2) 294 (46.1) 0.2^ (0.2, 0.2) 139 (47.4) 0.2^ (0.1, 0.2) 155 (44.9) ^ The RR indicates that the rate is statistically significantly different (p<0.05) than the rate for the reference group (first listed grou

13 Melanoma Incidence Among Blacks United States, Age Rate (95% CI) Both Sexes Male Female N (%) Rate (95% CI) N (%) Rate (95% CI) N (%) (0.2, 0.3) 281 (15.4) 0.2 (0.2, 0.2) 118 (13.7) 0.3 (0.2, 0.3) 163 (16.8) ^ (1.2, 1.4) 663 (36.2) 1.4^ (1.3, 1.6) 335 (39.0) 1.2^ (1.1, 1.3) 328 (33.8) ^ (4.4, 5.1) 885 (48.4) 5.6^ (5.1, 6.2) 406 (47.3) 4.2^ (3.8, 4.6) 479 (49.4) Histology Superficial spreading melanoma 0.1 (0.1, 0.1) 183 (28.7) 0.1 (0.1, 0.1) 79 (27.0) 0.1 (0.1, 0.1) 104 (30.1) Nodular melanoma 0.1 (0.1, 0.1) 161 (25.2) 0.1 (0.1, 0.1) 75 (25.6) 0.1 (0.1, 0.1) 86 (24.9) Acral lentiginous melanoma 0.2^ (0.2, 0.2) 294 (46.1) 0.2^ (0.2, 0.2) 139 (47.4) 0.2^ (0.1, 0.2) 155 (44.9) ^ The RR indicates that the rate is statistically significantly different (p<0.05) than the rate for the reference group (first listed grou

14 Stage at diagnosis Relative 5-year Melanoma Survival Among Blacks, NPCR, Both Sexes Male Female Relative Survival N (%) Relative Survival N (%) Relative Survival N (%) Localized (52) (47) (56) Regional (21) (23) (20) Distant (15) (17) (13) Histology Superficial spreading melanoma (11) (11) (11) Nodular melanoma (8) (9) (8) Acral lentiginous melanoma (16) (15) (17)

15 Stage at diagnosis Relative 5-year Melanoma Survival Among Blacks, NPCR, Both Sexes Male Female Relative Survival N (%) Relative Survival N (%) Relative Survival N (%) Localized (52) (47) (56) Regional (21) (23) (20) Distant (15) (17) (13) Histology Superficial spreading melanoma (11) (11) (11) Nodular melanoma (8) (9) (8) Acral lentiginous melanoma (16) (15) (17)

16 Percent of melanoma cases by stage at diagnosis among blacks and NHWs, % 6% 7% 5% 19% 10% 19% 11% 18% 9% 75% 21% 22% 19% Distant Regional Localized 50% 84% 83% 87% 25% 61% 59% 63% 0% Male and Female Male Female

17 5-year relative survival comparison by stage among blacks and NHWs, Localized Regional Distant Male,Black Male,NHW Female,Black Female,NHW

18 Proportion of melanoma cases diagnosed by histology among blacks and NHWs, Black NHW Superficial spreading melanoma Nodular melanoma Acral lentiginous melanoma

19 Discussion

20 Subtype Disparities ALM was the most common subtype diagnosed among blacks Survival was poorer for ALM (and nodular melanoma) than superficial spreading melanoma (the most common subtype diagnosed among NHWs) ALM is not thought to be related to UV radiation, which may account for the higher proportion in occurrence among black populations

21 Acral Lentiginous and Nodular Melanoma Both ALM and NM have atypical presentations, not adhering to the ABCDE guidelines traditionally used to identify melanoma Education of medical providers as well as black Americans is needed to increase awareness of these types of melanoma, especially due to their poor relative survival

22 Skin Complexion Considerations Darker skin confers more protection against UV than comparatively fairer skin, but skin type and tone can vary widely among persons of the same race and ethnicity 13% of black Americans reported getting a sunburn in the past 12 months Of the above 13%, 19% reported getting 4 or more sunburns in the same time period Many black Americans perceive they are at lower risk of skin cancer and use sun protection strategies less frequently than NHWs

23 Conclusion Sun protection strategies are important regardless of skin complexion More research is needed into the causes of ALM and NM histology Improved awareness of ALM and NM histology type among medical professionals and black Americans is needed due to atypical presentation

24 Acknowledgements Natasha Buchanan Lunsford, PhD Meg Watson, MPH Manxia Wu, MD MPH MaryBeth Freeman, MPH This project was supported in part by an appointment (MaryBeth Freeman) to the Research Participation Program at the Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and the Centers for Disease Control and Prevention.

25 Go to the official federal source of cancer prevention information: Follow DCPC r The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.