Melanoma skyrockets among middle-aged women

Rochester, Minn. - A new study demonstrates that while melanoma diagnoses in both men and women are increasing, middle-aged women are being diagnosed with melanoma at staggering rates, alarming researchers.

The study suggests melanoma incidence has risen about 7.6-fold among men and women between ages 40 and 60 in the past three decades. What has really surprised researchers at the Mayo Clinic is that while men are about 4.5 times more likely to be diagnosed with the skin cancer today than in 1970, middle-aged women experienced a 24-fold jump in melanoma rates.

The findings are striking and have important implications for dermatologists, according to the study’s principal investigator, Jerry Brewer, M.D., associate professor of dermatology, Mayo Clinic, Rochester, Minn.n.

“One of the key messages for dermatologists is don’t disregard a younger person who might not seem to have that many risk factors, because we’re seeing a ton of melanoma in young people - especially young women in their 40s,” Dr. Brewer says.

Dr. Brewer and colleagues studied the medical records of 383 white, non-Hispanic adults, ages 40 to 60 in Olmsted County, Minn. The National Institutes of Health-funded study was published in the January issue of Mayo Clinic Proceedings.

Next: Incident trends in melanoma

What’s going on?

Dr. Brewer says he and his co-authors have only examined incident trends in melanoma; not causality. But he speculates tanning bed use has to do with the findings.

“There are things that are coming to the forefront of research saying that just one session in a tanning bed increases your chances of melanoma by 20 percent,” he says. “Certainly, the younger that you go and the more intense bursts of that ultraviolet light (especially, the UVA you get in tanning beds) … probably are key factors.”

Research also suggests those who go to tanning beds regularly before age 35 are up to 75 percent more likely to have melanoma, according to Dr. Brewer (Lazovich D, Vogel RI, Berwick M, et al. Cancer Epidem Biomar Prev. 2010;19(6):1557-1568).

Still other factors might be changes in what people wear outdoors. Bathing suits in the 1970s, for example, were less revealing than they are now, he says.

“What’s curious to me is the lag-time question,” Dr. Brewer says. “It’s hard to know how much time it takes for high-risk behavior like tanning bed use to catch up to a person. After seeing an eight-fold higher incidence in melanoma in women younger than 40, we thought the lag time was significantly shortened. But with this study that shows a 24-fold increase in middle-aged women, it makes you wonder if that full effect of intense sun and tanning bed exposure takes two or three decades to catch up to person fully.”

Dr. Brewer was among the authors of an April 2012 study published in Mayo Clinic Proceedings, suggesting a four-fold increase in melanoma rates among men ages 18 to 39 between 1970 and 2009, versus an eight-fold rise among young women.

Next: Practice implications

Practice implications

Looking more closely at the results, the researchers found women under age 50 showed a marked increase in melanoma. And the sharpest increase in melanoma occurred in the last decade covered by the study, from 2000 to 2009.

According to the study, each one-year increase in the age at diagnosis was associated with an increased risk of death from any cause, but was not significantly associated with disease-specific death. The authors reported gender was not significantly associated with death from any cause or death from melanoma. And no patients with malignant melanoma in situ died from disease. Patients with stages 2, 3 and 4 disease were more than 14 times more likely to die from disease than were patients with stage 0 or 1 disease.

And there was a silver lining.

“At least in the population we looked at, every one-year increase was associated with a 7 percent higher chance of surviving melanoma,” Dr. Brewer says.

Dermatologists should see this as an opportunity to send a strong message about tanning bed use to their patients.

“If we can somehow send a message to the younger generation that really causes behavior modification, then, we can significantly decrease the incidence of melanoma 20 to 30 years from now,” Dr. Brewer says.

The challenge, he says, will be to impact teenagers - many who think they’re invincible. Dr. Brewer says a survey conducted by the Minnesota Department of Health in January 2014 reflects this thinking. It found 34 percent of 11th graders use tanning beds - many use tanning beds more than 10 times a year.

Dr. Brewer and colleagues plan to look at causality in future research. Next, they’ll track melanoma incidence in the elderly population.

“Melanoma in the elderly is probably associated with different risk factors than melanoma in young individuals, so it will be interesting to see what we find,” he says.

Disclosures: Dr. Brewer reports no relevant financial interests.

More on melanoma risks

Gene profiling test identifies melanoma tumors likely to metastasize

Advanced malignatn melanoma treatment enters new era

Melanoma screening efforts in flux