Home

Monday, June 16, 2014

More People Walk to Better Health

More than 145 million adults now include walking as part of a physically active
lifestyle. More than 6 in 10 people walk for transportation or for fun, relaxation, or
exercise, or for activities such as walking the dog. The percentage of people who report
walking at least once for 10 minutes or more in the previous week rose from 56% (2005) to
62% (2010).
 
Physical activity helps control weight, but it has other benefits. Physical activity such as walking can help improve health even without weight loss. People who are physically active live longer and have a lower risk for heart disease, stroke, type 2 diabetes, depression, and some cancers. Improving spaces and having safe places to walk can help more people become physically active.
 
What Can Be Done?
US government is...
  • Working with partners to carry out the National Prevention Strategy to make physical activity easier where people live, work, and play 
  • www.healthcare.gov/prevention/ 
  • nphpphc/strategy/index.html
  • Helping people get active through programs like Community Transformation Grants and Nutrition, Physical Activity, and Obesity state programs, and by working with partners like Safe Routes to Schools
  • www.cdc.gov/obesity/
  • stateprograms/cdc.html
  • www.saferoutespartnership.org/
  • Studying ways that communities can make it easy and convenient for people to be
  • more active. State and local government can
  • Considering walking when creating long-range community plans.
  • Consider designing local streets and roadways that are safe for people who walk and other
  • road users.
  • Consider opportunities to let community residents use local school tracks or gyms after
  • classes have finished.
  • Make sure existing sidewalks and walking paths are kept in good condition, well lit and
  • free of problems such as snow, rocks, trash, and fallen tree limbs.
  • Promote walking paths with signs that are easy to read, and route maps that the public can
  • easily find and use.
Employers can...
  • Create and support walking programs for employees.
  • Identify walking paths around or near the work place and promote them with signs
  • and route maps.
  • Provide places at work to shower or change clothes, when possible.
Individuals can...
  • Start a walking group with friends and neighbors.
  • Help others walk more safely by driving the speed limit and yielding to people who walk.
  • Use crosswalks and crossing signals when crossing streets and not jaywalk.
  • Participate in local planning efforts that identify best sites for walking paths and sidewalks.
  • Work with parents and schools to encourage children to walk to school where safe
Posted by at No comments:

Monday, June 2, 2014

Facts About Skin Cancer

GENERAL
  • Skin cancer is the most common form of cancer in the United States. More than 3.5 million skin cancers in over two million people are diagnosed annually.1
     
  • Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.2
     
  • Treatment of nonmelanoma skin cancers increased by nearly 77 percent between 1992 and 2006.1
     
  • Over the past three decades, more people have had skin cancer than all other cancers combined.3
     
  • One in five Americans will develop skin cancer in the course of a lifetime.5
     
  • 13 million white non-Hispanics living in the US at the beginning of 2007 had at least one nonmelanoma skin cancer, typically diagnosed as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC).3
     
  • Basal cell carcinoma is the most common form of skin cancer; an estimated 2.8 million are diagnosed annually in the US. BCCs are rarely fatal, but can be highly disfiguring if allowed to grow.6
     
  • Squamous cell carcinoma is the second most common form of skin cancer. An estimated 700,000 cases of SCC are diagnosed each year in the US.6,7
     
  • The incidence of squamous cell carcinoma has been rising, with increases up to 200 percent over the past three decades in the US.54
     
  • About 2 percent of squamous cell carcinoma patients – between 3,900 and 8,800 people – died from the disease in the US in 2012.54
     
  • Between 40 and 50 percent of Americans who live to age 65 will have either BCC or SCC at least once.4
     
  • Actinic keratosis is the most common precancer; it affects more than 58 million Americans.8
     
  • Approximately 65 percent of all squamous cell carcinomas and 36 percent of all basal cell carcinomas arise in lesions that previously were diagnosed as actinic keratoses.9
     
  • About 90 percent of nonmelanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun.10
     
  • Half of all adults report at least one sunburn in the past 12 months.47 
MELANOMA
  • One person dies of melanoma every hour (every 57 minutes).2
     
  • An estimated 76,690 new cases of invasive melanoma will be diagnosed in the US in 2013.2
     
  • An estimated 9,480 people will die of melanoma in 2013.2
     
  • Melanoma accounts for less than five percent of skin cancer cases, but the vast majority of skin cancer deaths.2
     
  • Of the seven most common cancers in the US, melanoma is the only one whose incidence is increasing. Between 2000 and 2009, incidence climbed 1.9 percent annually.11
     
  • 1 in 50 men and women will be diagnosed with melanoma of the skin during their lifetime.11
     
  • In 2009, there were approximately 876,344 men and women alive in the U.S. with a history of melanoma.11
     
  • Survival with melanoma increased from 49 percent (1950 – 1954) to 92 percent (1996 – 2003).12
     
  • About 86 percent of melanomas can be attributed to exposure to ultraviolet (UV) radiation from the sun.13
     
  • Melanoma is one of only three cancers with an increasing mortality rate for men, along with liver cancer and esophageal cancer.14
     
  • Survivors of melanoma are about nine times as likely as the general population to develop a new melanoma.15
     
  • The vast majority of mutations found in melanoma are caused by ultraviolet radiation.16
     
  • Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old.17
     
  • The overall 5-year survival rate for patients whose melanoma is detected early, before the tumor has spread to regional lymph nodes or other organs, is about 98 percent in the US. The survival rate falls to 62 percent when the disease reaches the lymph nodes, and 15 percent when the disease metastasizes to distant organs.2
     
  • A person’s risk for melanoma doubles if he or she has had more than five sunburns.19
     
  • One or more blistering sunburns in childhood or adolescence more than double a person’s chances of developing melanoma later in life.20
     
  • Regular daily use of an SPF 15 or higher sunscreen reduces the risk of developing squamous cell carcinoma by 40 percent and the risk of developing melanoma by 50 percent.56, 57
MEN/WOMEN
  • Young men account for 40 percent of melanoma cases, but more than 60 percent of melanoma deaths.53
     
  • From ages 15-39, men are 55 percent more likely to die of melanoma than women in the same age group.53
     
  • An estimated 45,060 new cases of invasive melanoma in men and 31,630 in women will be diagnosed in the US in 2013.2
     
  • An estimated 6,280 men and 3,200 women in the US will die from melanoma in 2013.2
     
  • Melanoma is the fifth most common cancer for males and seventh most common for females.2
     
  • Five percent of all cancers in men are melanomas; four percent of all cancers in women are melanomas.2
     
  • Up until age 40, significantly more women develop melanoma than men (1 in 391 women vs. 1 in 691 men). After age 40, significantly more men develop melanoma than women. Overall, one in 35 men and one in 54 women will develop melanoma in their lifetimes.2
     
  • Women aged 39 and under have a higher probability of developing melanoma than any other cancer except breast cancer.2
     
  • The majority of people diagnosed with melanoma are white men over age 50.11
     
  • Caucasian men over age 65 have had an 5.1 percent annual increase in melanoma incidence since 1975, the highest annual increase of any gender or age group.21
     
  • The number of women under age 40 diagnosed with basal cell carcinoma has more than doubled in the last 30 years; the incidence of squamous cell carcinoma among women under age 40 has increased almost 700 percent.22
     
  • Adults over age 40, especially men, have the highest annual exposure to UV.23
TANNING
  • Ultraviolet radiation (UVR) is a proven human carcinogen.24
     
  • The International Agency for Research on Cancer, an affiliate of the World Health Organization, includes ultraviolet (UV) tanning devices in its Group 1, a list of the most dangerous cancer-causing substances. Group 1 also includes agents such as plutonium, cigarettes, and solar UV radiation.25
     
  • Currently tanning beds are regulated by the FDA as Class I medical devices18, the same designation given elastic bandages and tongue depressors.26
     
  • More than 170,000 cases of non-melanoma skin cancer in the US each year are associated with indoor tanning. 55
     
  • One indoor UV tanning session increases users’ risk of developing squamous cell carcinoma by 67 percent and basal cell carcinoma by 29 percent.55
     
  • The risk of basal cell carcinoma is increased by 73 percent if one tans six times per year.27 
  • Indoor tanners have a 69 percent increased risk of early-onset basal cell carcinoma.28 
  • Approximately 25 percent of early-onset basal cell carcinomas could be avoided if individuals have never tanned indoors.28 
  • Frequent tanners using new high-pressure sunlamps may receive as much as 12 times the annual UVA dose compared to the dose they receive from sun exposure.24
     
  • One minute in the average indoor tanning machine in England is twice as cancer-causing (carcinogenic) as one minute in the midday Mediterranean sun.50
     
  • Just one indoor tanning session increases users’ chances of developing melanoma by 20 percent, and each additional session during the same year boosts the risk almost another two percent.46
     
  • Of melanoma cases among 18-to-29-year-olds who had tanned indoors, 76 percent were attributable to tanning bed use.48
     
  • Indoor tanners have a 69 percent increased risk of early-onset basal cell carcinoma.28
     
  • People who first use a tanning bed before age 35 increase their risk for melanoma by 75 percent.29
    •  
  • Nearly 30 million people tan indoors in the U.S. every year.31 Two to three million of them are teens.32
     
  • The indoor tanning industry has annual estimated revenue of $5 billion.32
     
  • People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.33
     
  • Seventy-one percent of tanning salon patrons are females.34
     
  • On an average day, more than one million Americans use tanning salons.35
ETHNICITY
  • The overall 5-year melanoma survival rate for African Americans is only 77 percent, versus 91 percent for Caucasians.14
     
  • Skin cancer represents approximately two to four percent of all cancers in Asians.36
     
  • Skin cancer comprises one to two percent of all cancers in African Americans and Asian Indians. 36
     
  • Melanomas in African Americans, Asians, Filipinos, Indonesians, and native Hawaiians most often occur on non-exposed skin with less pigment, with up to 60-75 percent of tumors arising on the palms, soles, mucous membranes and nail regions.36
     
  • Basal cell carcinoma (BCC) is the most common cancer in Caucasians, Hispanics, Chinese Asian and the Japanese.36
     
  • Squamous cell carcinoma (SCC) is the most common skin cancer among African Americans and Asian Indians.36
     
  • Squamous cell carcinomas in African Americans tend to be more aggressive and are associated with a 20-40 percent risk of metastasis (spreading).36
     
  • Late-stage melanoma diagnoses are more prevalent among minority patients than Caucasian patients; 52 percent of non-Hispanic black patients and 26 percent of Hispanic patients receive an initial diagnosis of advanced stage melanoma, versus 16 percent of non-Hispanic white patients.37
     
  • Asian American and African American melanoma patients have a greater tendency than Caucasians to present with advanced disease at time of diagnosis.38
     
  • While melanoma is uncommon in African Americans, Latinos, and Asians, it is frequently fatal for these populations.38
PEDIATRICS
  • Pediatric melanoma increased by an average of two percent per year from 1973 to 2009.51
  • Melanoma is nine times more common between the ages of 10 and 20 than it is between birth and 10 years.39
     
  • Ninety percent of pediatric melanoma cases occur in patients aged 10-19.39
     
  • 6.5 percent of pediatric melanomas occur in non-Caucasians, which is a higher percentage than that seen in adults.44
     
  • Melanoma accounts for up to three percent of all pediatric cancers.40
     
  • Between 1973 and 2001, melanoma incidence in those under age 20 rose 2.9 percent.41
     
  • Diagnosis and treatment is delayed in up to 40 percent of childhood melanoma cases.40
SKIN AGING
  • More than 90 percent of the visible changes commonly attributed to skin aging are caused by the sun.42
     
  • Daily sunscreen use by adults under age 55 can reduce skin aging. 52
  • People who use sunscreen daily show 24 percent less skin aging than those who do not use sunscreen daily.52
  • Contrary to popular belief, 80 percent of a person’s lifetime sun exposure is not acquired before age 18; only about 23 percent of lifetime exposure occurs by age 18.23


Lifetime UV Exposure in the United States

AgesAverage Accumulated Exposure*
1-18 22.73 percent
19-40 46.53 percent
41-59 73.7 percent
60-78 100 percent

*Based on a 78 year lifespan
 
TREATMENT
  • In adults 65 or older, melanoma treatment costs total about $249 million annually. About 40 percent of the annual cost for melanoma goes to treating stage IV (advanced) cancers, though they account for only three percent of melanomas.43
     
  • The estimated cost of treating melanoma in 2010 was $2.36 billion.49
     
  • The number of nonmelanoma skin cancers in the Medicare population went up an average of 4.2 percent every year between 1992 and 2006.1
     
  • In 2004, the total direct cost associated with the treatment for nonmelanoma skin cancer was $1.4 billion.8
REFERENCES
  1. Rogers, HW, Weinstock, MA, Harris, AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol 2010; 146(3):283-287.
  2. American Cancer Society. Cancer Facts & Figures 2013. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf. Accessed January 31, 2013.
  3. Stern, RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol 2010; 146(3):279-282.
  4. Sun Protection. Cancer Trends Progress Report – 2009/2010 Update. National Cancer Institute. http://progressreport.cancer.gov/doc_detail.asp?pid=1&did=2007&chid=71&coid=711&mid.  Accessed November 1, 2010.
  5. Robinson, JK. Sun exposure, sun protection, and vitamin D. JAMA 2005; 294:1541-43.
  6. Rogers, Howard. “Your new study of nonmelanoma skin cancers.” Email to The Skin Cancer Foundation. March 31, 2010.
  7. Squamous Cell Carcinoma.  American Academy of Dermatology. http://www.aad.org/skin-conditions/dermatology-a-to-z/squamous-cell-carcinoma.  Accessed August 27, 2012
  8. The Lewen Group, Inc. The burden of skin diseases 2005. The Society for Investigative Dermatology and The American Academy of Dermatology Association. 2005.
  9. Criscione, VD, Weinstock, MA, Naylor, MF, Luque, C, Eide, MJ and Bingham, SF. Actinic keratoses natural history and risk of malignant transformation in the Veterans Affairs Tropical Tretinoin Chemoprevention Trial. Cancer 2009; 115: 2523-2530.
  10. Koh HK, Geller AC, Miller DR, Grossbart TA, Lew RA. Prevention and early detection strategies for melanoma and skin cancer: Current status. Archives of Dermatology. 1996; 132: 436-442
  11. Howlader N, Noone AM, Krapcho M, et al (eds). SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations). Bethesa, MD: National Cancer Institute; http://seer.cancer.gov/csr/1975_2009_pops09/; Accessed August 22, 2012.
  12. Ries LAG, Melbert D, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975-2004. Bethesda, MD: National Cancer Institute; http://seer.cancer.gov/csr/1975_2004/. Accessed January 24, 2011.
  13. Parkin DM, Mesher D, P Sasieni. Cancers attributable to solar (ultraviolet) radiation exposure in the UK in 2010. Br J Cancer. 2011; 105:S66-S69.
  14. Ahmedin J, Siegel R, Xu J, Ward E. Cancer Statistics, 2010. CA Cancer J Clin 2010; 60:288-296
  15. Bradford PT, Freedman DM, Goldstein AM, Tucker MA. Increased risk of secondary primary cancers after a diagnosis of melanoma. Arch Dermatol 2010; 146(3):265-272.
  16. Pleasance ED, Cheetham RK, Stephens PJ, et al. A comprehensive catalogue of somatic mutations from a human cancer genome. Nature 2009; 463:191-196.
  17. Bleyer A, O’Leary M, Barr R, Ries LAG (eds): Cancer epidemiology in older adolescents and young adults 15 to 29 years of age, including SEER incidence and survival: 1975-2000. Bethesda, MD: National Cancer Institute; 2006.
  18. Felton R. Introduction to FDA’s regulation and classification of tanning lamps. U.S. Food and Drug Administration. http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/GeneralandPlasticSurgeryDevicesPanel/UCM211206.pdf. Accessed Sept 3, 2012.
  19. Pfahlberg A, Kolmel KF, Gefeller O.  Timing of excessive ultraviolet radiation and melanoma: epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation-induced melanoma. Brit J Dermatol March 2001; 144:3:471.
  20. Lew RA, Sober AJ, Cook N, Marvell R, Fitzpatrick TB. Sun exposure habits in patients with cutaneous melanoma: a case study. J Dermatol Surg Onc 1983; 12:981-6.
  21. National Cancer Institute. A snapshot of melanoma. National Cancer Institute. http://www.cancer.gov/aboutnci/servingpeople/snapshots/melanoma.pdf. updated Oct 2011; accessed Aug 27, 2012.
  22. Christenson LJ, Borrowman TA, Vachon CM, et al. Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA 2005; 294(6):681-690.
  23. Godar DE, Urbach F, Gasparro FP, Van der Leun JC. UV doses of young adults. Photochem Photobiol 2003; 77(4):453-457.
  24. National Toxicology Program. Report on Carcinogens, Twelfth Edition. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. 2011: 429-430. http://ntp.niehs.nih.gov/ntp/roc/twelfth/profiles/UltravioletRadiationRelatedExposures.pdf. Accessed February 12, 2012.
  25. El Ghissassi, F. et al., Special report: policy. A review of human carcinogens—part D: radiation. The Lancet 2009; 10(8):751-752.
  26. US Food and Drug Administration. Learn if a medical device has been cleared by FDA for marketing. FDA. http://www.fda.gov/MedicalDevices/ResourcesforYou/Consumers/ucm142523.htm.   Accessed October 25, 2010.
  27. Zhang M, Qureshi AA, Geller AC, Frazier L, Hunter DJ, Han J. Use of tanning beds and incidence of skin cancer. J Clin Oncol 2012; 30(14):1588-93.
  28. Ferrucci LM, Cartmel B, Molinaro AM, Leffell DJ, Bale AE, Mayne ST. Indoor tanning and risk of early-onset basal cell carcinoma. Journal of American Academy of Dermatology. 2011.
  29. Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM. Indoor tanning and risk of melanoma: a case-control study in a highly-exposed population. Cancer Epidem Biomar Prev 2010 June; 19(6):1557-1568.
  30. World Health Organization. Sunbeds. World Health Organization. 2010. http://www.who.int/uv/faq/sunbeds/en/index5.html. Accessed October 25, 2010.
  31. Kwon HT, Mayer JA, Walker KK, Yu H, Lewis EC, Belch GE.  Promotion of frequent tanning sessions by indoor tanning facilities: two studies.  J Am Acad Dermatol 2003; 46:700-5.
  32. Demierre MF.  Time for the national legislation of indoor tanning to protect minors.  Arch Dermatol 2003; 139:520-4.
  33. Karagas MR, Stannard VA, Mott LA, Slattery MJ, Spencer SK, and Weinstock MA. Use of tanning devices and risk of basal cell and squamous cell skin cancers. J Natl Cancer Inst 2002; 94:224; doi:10.1093/jnci/94.3.224.
  34. Swerdlow AJ, Weinstock MA.  Do tanning lamps cause melanoma? An epidemiologic assessment. J Amer Acad Dermatol 1998; 38:89-98.
  35. Spencer JM, Amonette RA. Indoor tanning: Risks, benefits, and future trends. J Am Acad Dermatol 1995; 33:288-98.
  36. Gloster HM, Neal K. Skin cancer in skin of color. J Amer Acad Dermatol 2006; 55:741-60.
  37. Hu S, Soza-Vento RM, Parker DF, Kirsner RS. Comparison of stage at diagnosis of melanoma among Hispanic, black, and white patients in Miami-Dade County, Florida. Arch Dermatol 2006 Jun; 142(6):704-8.
  38. Cress RD, Holly EA.  Incidence of cutaneous melanoma among non-Hispanic whites, Hispanics, Asians, and blacks: an analysis of California cancer registry data, 1988-93. Cancer Cause Control 1997; 8:246-52.
  39. Lange J, Palis BE, Chang DEC, Soong S, Balch CM. Melanoma in Children and Teenagers: An Analysis of Patients from the National Cancer Data Base. J Clin Oncol 2007; 25:1363-8.
  40. Ferrari A, Bono A, Baldi M, et al. Does melanoma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single institution. Pediatrics 2005; 115:649-57.
  41. Strous JJ, Fears TR, Tucker MA, Wayne AS. Pediatric melanoma: risk factor and survival analysis of the surveillance, epidemiology and end results database. J Clin Oncol 2005; 23:4735-41.
  42. Gilchrest BA. Skin and aging process. CRC Press. 1984; 124.
  43. Chen C, et al. Economic burden of melanoma in the elderly population. Population-based analysis of the surveillance, epidemiology, and end results (SEER)—Medicare data. Arch Dermatol 2010; 146(3):249-256.
  44. Worcester S. Possibility of melanoma in children often ignored. Skin & Allergy News. March 2008.
  45. Reference removed.
  46. Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ 2012; 345:e4757. doi: 10.1136/bmj.e4757 
  47. Centers for Disease Control and Prevention. Sunburn and sun protective behaviors among adults aged 18-20 years – United States, 2000-2010. MMWR Morb Mortal Wkly Rep 2012; 61:317-22.
  48. Cust AE, Armstrong BK, Goumas C, et al. Sunbed use during adolescence and early adulthood is associated with increased risk of early-onset melanoma. Int J Cancer 2010.
  49. The National Cancer Institute. The cost of cancer; 2011. http://www.cancer.gov/aboutnci/servingpeople/cancer-statistics/costofcancer
  50. Tierney P, Ferguson J, Ibbotson S, et al. Nine out of ten sunbeds in England emit ultraviolet radiation levels that exceed current safety limits. Br J Dermatol 2013; 168:602–08.
  51. Wong JR, Harris JK, Rodriguez-Galindo C, Johnson KJ, et al. Incidence of childhood and adolescent melanoma in the United States: 1973–2009. Pediatrics 2013 May; 131(5):846-54.
  52. Hughes MCB, Williams GM, Baker P, Green AC. Sunscreen and prevention of skin aging: a randomized trial. Ann Intern Med 2013 June; 158 (11):781-790.
  53. Fisher D, Geller A. Disproportionate burden of melanoma mortality in young US men. JAMA Dermatol 2013; 1-2.
  54. Karia PS, Han J, Schmults CD. Cutaneous squamous cell carcinoma: estimated incidence of disease, nodal metastasis, and deaths from disease in the United States, 2012. J Am Acad Dermatol 2013 June; 68(6):957-66.
  55. Wehner MR, Shive ML, Chren M-M, et al. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ 2012; 345:e5909.
  56. Green A, Williams G, Neale R, et al. Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinoma of the skin: a randomized controlled trial. Lancet 1999; 354(9180):723-729.
  57. Green A, Williams G, Logan V, Strutton G. Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol 2011; 29(3):257-263.
These facts and statistics have been reviewed by David Polsky, MD, Assistant Professor of Dermatology and Pathology, New York University Medical Center and Steven Q. Wang, MD, Director of Dermatologic Surgery and Dermatology, Memorial Sloan-Kettering Cancer Center, Basking Ridge, NJ.
The Skin Cancer Foundation, SkinCancer.org, 212 725-5176
Last Updated: October 9, 2013
Posted by at No comments:
Subscribe to: Posts (Atom)