Trends for in situ and invasive melanoma in Queensland, Australia, 1982-2002
Trends for in situ and invasive melanoma in Queensland, Australia, 1982-2002
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DOI：
10.1007/s10552-005-3637-4
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发表时间：
2006-02-01
影响因子：
2.3
通讯作者：
Ring, I
中科院分区：
文献类型：
--
作者：
Coory, M;Baade, P;Ring, I
目的澳大利亚东北部的昆士兰州是世界上黑色素瘤发病率最高的地区。这里的控制措施可能比世界上任何其他地方都要早;早期发现方案始于1960年代，初级预防始于1980年代。因此，从人口为基础的昆士兰州癌症登记处的数据提供了一个国际上独特的数据源，以评估原位和浸润性黑色素瘤的趋势，并考虑早期发现和一级prevention.Methods的影响，我们使用泊松回归估计在原位和浸润性病变的发病率数据，按年龄和性别分层21年的年变化率的百分比。结果原位黑色素瘤在男性中每年增加10.4%（95%CI：10.1%，11.1%），在女性中每年增加8.4%（7.9%，8.9%）。浸润性病变的发生率也增加，但没有那么快;男性2.6%（2.4%，2.8%），女性1.2%（0.9%，1.5%）。仅1991年至2002年的有效厚度数据可用，在此期间，薄浸润性病变的增长速度快于厚浸润性病变（例如，男性：薄3.8%，厚2.0%）。我们发现一些提示性证据表明，近年来原位和浸润性病变的比例增加较低，但这并没有达到统计学意义。在35岁以下的人群中，侵袭性黑色素瘤的发病率是稳定的，并且从1958年左右开始就有出生队列效应的建议。死亡率稳定在所有年龄段，并有一个建议，年轻女性的发病率下降，虽然这并没有达到统计significance.Conclusion标准化的发病率继续增加，这与转移到proportionalmore原位病变相结合，表明稳定的死亡率是由于，在很大程度上，早期检测。在初级预防方面，经过昆士兰州长时间的持续努力，有一些暗示性但非决定性的证据表明正在取得进展。35岁以下人群的发病率趋于稳定，与以往相比，最近一段时间原位和浸润性病变的比例增加似乎较低。然而，即使对这些趋势采取最有利的观点，一级预防也不太可能导致黑色素瘤的总体发病率至少在未来20年内下降。因此，初级预防计划面临的挑战将是保持长期势头。如果能够实现这一点，最终的公共卫生效益可能是巨大的。
Objectives Queensland, the north-eastern state of Australia, has the highest incidence of melanoma in the world. Control measures started earlier here than probably anywhere else in the world; early detection programmes started in the 1960s and primary prevention in the 1980s. Data from the population-based Queensland Cancer Registry therefore provide an internationally unique data source with which to assess trends for in situ and invasive melanomas and to consider the implications for early detection and primary prevention.Methods We used Poisson regression to estimate the annual percentage change in rates across 21 years of incidence data for in situ and invasive lesions, stratified by age and sex. Joinpoint analyses were used to assess whether there had been a statistically significant change in the trends.Results In situ melanomas increased by 10.4% (95% CI: 10.1%, 11.1%) per year among males and 8.4% (7.9%, 8.9%) per year among females. The incidence of invasive lesions also increased, but not as quickly; males 2.6% (2.4%, 2.8%), females 1.2% (0.9%, 1.5%). Valid data on thickness was only available for 1991 to 2002 and for this period thin-invasive lesions were increasing faster than thick-invasive lesions (for example, among males: thin 3.8%, thick 2.0%). We found some suggestive evidence of lower proportionate increase for the most recent years for both in-situ and invasive lesions, but this did not achieve statistical significance. Among people younger than 35 years, the incidence of invasive melanoma was stable and there was a suggestion of a birth cohort effect from about 1958. Mortality rates were stable across all ages, and there was a suggestion of decreasing rates among young women, although this did not achieve statistical significance.Conclusion Age-standardised incidence is continuing to increase and this, in combination with a shift to proportionately more in situ lesions, suggests that the stabilisation of mortality rates is due, in large part, to earlier detection. For primary prevention, after a substantial period of sustained effort in Queensland, there is some suggestive, but not definitive, evidence that progress is being made. Incidence rates are stabilising in those younger than 35 years and the proportionate increase for both in situ and invasive lesions appears to be lower for the most recent period compared with previous periods. However, even taking the most favourable view of these trends, primary prevention is unlikely to lead to decreases in the overall incidence rate of melanoma for at least another 20 years. Consequently, the challenge for primary prevention programmes will be to maintain momentum over the long term. If this can be achieved, the eventual public-health benefits are likely to be substantial.