Clarke Christina A, McKinley Meg, Hurley Susan, Haile Robert W, Glaser Sally L, Keegan Theresa H M, Swetter Susan M
Cancer Prevention Institute of California, Fremont, California, USA; Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California, USA.
Cancer Prevention Institute of California, Fremont, California, USA.
J Invest Dermatol. 2017 Nov;137(11):2282-2290. doi: 10.1016/j.jid.2017.06.024. Epub 2017 Jul 21.
Melanoma incidence has been increasing in light-skinned populations worldwide, but the reasons for the increase have been controversial. Our prior assessment in California non-Hispanic whites showed substantial increases in invasive melanoma incidence for tumors of all thicknesses in all neighborhoods categorized by socioeconomic status (SES) between 1988-1992 and 1998-2002. To understand whether these trends continued, we updated our assessment to include the diagnosis period 2008-2012 and more accurate pathologic stage at diagnosis. We used the California Cancer Registry to calculate age-adjusted incidence rates for over 58,000 newly diagnosed melanomas. Incidence rates not only continued to rise over the 10-year period from 1998-2002 and 2008-2012 but also showed significant increases in almost all groups defined jointly by tumor thickness or stage at diagnosis and a small area (census tract) SES measure. The largest relative rate increases were seen for regional, distant, and ulcerated disease, especially among males living in the lowest SES neighborhoods. Considering tumor thickness and stage as proxies for time to screening detection and neighborhood SES as a proxy for health care access, we interpret this pattern to indicate continued, true increases in melanoma occurrence as opposed to a thin tumor phenomenon simply driven by improved access to care.
全球范围内，浅肤色人群中的黑色素瘤发病率一直在上升，但其上升原因一直存在争议。我们之前对加利福尼亚州非西班牙裔白人的评估显示，在1988 - 1992年至1998 - 2002年期间，按社会经济地位（SES）分类的所有社区中，各厚度肿瘤的侵袭性黑色素瘤发病率均大幅上升。为了解这些趋势是否持续，我们更新了评估，纳入了2008 - 2012年的诊断期以及诊断时更准确的病理分期。我们使用加利福尼亚癌症登记处的数据计算了58000多例新诊断黑色素瘤的年龄调整发病率。发病率不仅在1998 - 2002年至2008 - 2012年的10年期间持续上升，而且在几乎所有由诊断时的肿瘤厚度或分期以及小区域（普查区）SES测量共同定义的组中都有显著增加。区域、远处和溃疡型疾病的相对发病率上升幅度最大，尤其是生活在SES最低社区的男性。将肿瘤厚度和分期视为筛查检测时间的替代指标，将社区SES视为医疗保健可及性的替代指标，我们将这种模式解释为表明黑色素瘤发病率持续真实上升，而不是仅仅由改善医疗可及性驱动的薄肿瘤现象。
