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The Geographic and Demographic Distribution of Melanoma Throughout the United States: Implications for Primary and Secondary Prevention. Bertina Backus 1 , Myles Cockburn 2 , Bruce Caldwell 1 , Laurie MacDougall 1 , and Susan Gershman 1

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  1. The Geographic and Demographic Distribution of Melanoma Throughout the United States: Implications for Primary and Secondary Prevention Bertina Backus1, Myles Cockburn2, Bruce Caldwell1, Laurie MacDougall1, and Susan Gershman1 1Massachusetts Cancer Registry, MA Dept. of Public Health, Boston, MA 2University of Southern California/Keck School of Medicine, Los Angeles, CA

  2. Abbreviations These abbreviations will be noted throughout the presentation: • NCI/SEER: National Cancer Institute / Surveillance, Epidemiology and End Results Program • CDC/NPCR: Centers for Disease Control and Prevention / National Program of Cancer Registries • NAACCR/CINA: North American Association of Central Cancer Registries / Cancer Incidence in North America • USCS: United States Cancer Statistics

  3. Background • Historically, national cancer incidence data for the United States have been based on information from the NCI/SEER Program. • In more recent years, the CDC/NPCR has led to the establishment of central cancer registries in all U.S. states and territories. • Data from both these programs are made available via NAACCR/CINA and USCS.

  4. Overview of Relationships Between Funding Sources, Programs, and Data Sets NCI/ SEER CDC/ NPCR Registry Funding Sources SEER Cancer Incidence Statistics NAACCR Cancer Incidence in North America United States Cancer Statistics (collaboration of NCI, CDC, and NAACCR) Program CINA+ Online (2001-2005) Cancer Query System (CANQUES): SEER Cancer Incidence Statistics (1973-2005) USCS Expanded Dataset on CDC WONDER (1999-2004) Data Sets and Reports Cancer in North America 2001-2005, Vol. One: Combined Cancer Incidence for the U.S. and Canada United States Cancer Statistics: 2004 Incidence & Mortality SEER Cancer Statistics Review, 1975-2005

  5. Goals • To compare these programs and determine which one best represents the U.S. in order to evaluate incidence rates for melanoma. • To examine how geographic differences in the racial/ethnic distribution of the U.S. population and in regional ground level ultraviolet (UV) radiation affect regional and national incidence rates for melanoma.

  6. Coverage of U.S. Cancer Incidence Data Sets

  7. Distribution of Covered Populations by Race/Ethnicity

  8. Data Sources for Maps • Cancer Data: NAACCR/CINA, 2001-2005 • Population Data: same • UV Radiation Data: National Solar Radiation Database • Exclusions • 10 states that were not included in CINA • 2 states for which UV data were not available • 1 state with problematic data  37 states in final data set

  9. Median Ground Level Ultraviolet Radiation Levels

  10. Melanoma Incidence, 2001-2005: All Races

  11. Percent White non-Hispanic

  12. Melanoma Incidence, 2001-2005: White non-Hispanics

  13. Discussion • It is critical that incidence data for cancers with strong racial/ethnic variation, such as melanoma, be stratified by race. • We must recognize that rates of melanoma are best predicted by population structure, not UV level. • In order to effectively target cancer control programs, we must ensure that we are using the right data.

  14. Limitations Project Limitation: • Missing study data Data Limitations: • Errors/missing information in the medical record • Unstable rates for non-white populations • Non-standardized race/ethnicity coding • Underreporting/completeness of reporting

  15. Implications for Prevention Activities • Melanoma prevention programs need to be implemented across all U.S. states and territories, since the incidence of melanoma is not solely dependent on UV radiation. • Programs need to be aware of which populations are at risk and to focus on demography rather than geography.

  16. Acknowledgements • Thanks to my co-authors • We acknowledge the Centers for Disease and Prevention for its support of the staff and the development of this presentation under cooperative agreement number 1 U58 DP000821-02 awarded to the Massachusetts Department of Public Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

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