White and Hispanic individuals are being diagnosed with melanoma more frequently in recent years, whereas Hispanic and black patients continue to have advanced skin cancer at diagnosis, according to a report in the December issue of Archives of Dermatology, one of the JAMA/Archives journals.
Nationwide, the incidence (rate of new cases diagnosed) of melanoma increased 2.4 percent per year in the last decade, according to background information in the article. “Research and public education efforts have focused on melanoma prevention in white populations because of their higher risk of developing melanoma,” the authors write. “Improved secondary prevention measures with earlier detection of thin (early-stage) melanoma likely account for the improved survival among whites from 68 percent in the early 1970s to 92 percent in recent years. Such advances, however, have not occurred in other racial and ethnic groups in the United States.”
Shasa Hu, M.D., of the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, and colleagues analyzed data extracted from the Florida Cancer Data System, a state-wide, population-based cancer incidence registry. Of 41,072 cases of melanoma diagnosed from 1990 to 2004, 39,670 were diagnosed in white non-Hispanic individuals, 1,148 in white Hispanics and 254 in blacks.
In the timeframe studied, incidence rates increased by 3 percent per year among white non-Hispanic men and 3.6 percent per year among white non-Hispanic women, increased 3.4 percent among white Hispanic women and 0.9 percent among white Hispanic men, and remained relatively stable among black men and women.
However, both white Hispanics and black individuals had more advanced melanoma when they were diagnosed. Eighteen percent of white Hispanic patients and 26 percent of black patients had disease that had spread either regionally or to distant parts of their bodies, compared with 12 percent of white non-Hispanic patients. The proportion of distant-stage disease diagnosed among white Hispanic and black patients did not change significantly from 1990 to 2004, compared with a steady decrease in such advanced cases among white non-Hispanic patients.
“Melanoma among darker-skinned populations has received little attention, partly reflecting their overall lower risk compared with white non-Hispanics,” the authors write. “The lowest survival rates and delayed melanoma diagnosis is often seen in blacks. With the readily expanding population and increasing melanoma rate of 2.9 percent per year, melanoma among Hispanics also becomes an increasingly important public health issue.”
The improvement in melanoma diagnosis among whites is encouraging, suggesting that public education and health care provider efforts can help reduce the impact of the disease. “The results of our study should motivate the expansion of melanoma awareness and screening campaigns to the minority communities, which can ultimately alleviate the disparities in melanoma outcome in these populations,” the authors conclude.
Editorial: Targeted Efforts Needed to Improve Disparities
“This study adds to a growing body of literature that identifies a pervasive and persistent disparity in the stage of melanoma diagnosis between Hispanic and black patients vs. white patients,” write Claudia Hernandez, M.D., of the University of Illinois at Chicago, and Robin J. Mermelstein, Ph.D., in an accompanying editorial.
“It is likely that no single risk factor will be responsible for this growing problem,” they continue. “As our specialty moves forward, it is of vital importance that we not relegate our efforts exclusively to surveillance and database reviews but move quickly in an attempt to intervene. An effective education and outreach model that transcends cultural and language barriers must be formulated.”
“This article offers suggestions for a number of potential points of investigation and intervention,” they conclude. “It is important for physicians, researchers and the general public to realize that disparities are not inevitable. All population groups deserve equal access, equal care and an equal opportunity to enjoy good health.”
JAMA and Archives Journals