Senior Citizens major targets of skin cancer; bout
one in five 70-year-olds have had non-melanoma skin cancers, and most
who were affected have had more than one
March 15, 2010 Non-melanoma skin cancer already
affects more people than all other cancers combined but there is new
evidence that its growth rate is increasing. One reason is the increase
in senior citizens, the primary targets of skin cancers. Treatments for
skin cancer in the Medicare population increased 76.9 percent from 1992
to 2006, when they reached 2 million. A series of new studies published
this week expose the magnitude of the skin cancer problem melanoma and
non-melanoma - among seniors in particular. A final article says skin
cancer should be declared a chronic disease.
Couples encouraged to examine each other for
suspicious moles that could be skin cancer. Researchers estimate that 40
50% of people in the U.S. who live to age 65 will have nonmelanoma
skin cancer at least once.
Both new diagnoses and those in patients with a
history of non-melanoma skin cancer appear to have become increasingly
common, and the disease affects more individuals than all other cancers
combined, according to two of the reports in the March issue of
Archives of Dermatology, one of the JAMA/Archives journals.
These are among several articles in the issue
focusing on skin cancers, and is being published in conjunction with a
Journal of the American Medical Association (JAMA) theme issue on
cancer.
The March issues of Archives of Pediatrics &
Adolescent Medicine, Archives of Neurology, Archives of Internal
Medicine, Archives of Ophthalmology, Archives of Surgery, Archives of
Facial Plastic Surgery and Archives of OtolaryngologyHead & Neck
Surgery will also publish articles on this topic.
Non-melanoma skin cancer is the most common
malignant disease in the United States, according to background
information in one of the articles. The disease is associated with
substantial illness and cost, and a death rate that is lower than other
cancers but still significant.
However, non-melanoma skin cancer is not typically
reported to cancer registries, and the most recent peer-reviewed,
published national estimates date back to 1994.
"Understanding skin cancer incidence and treatment
is important for planning prevention strategies and allocating resources
for treatment," the authors write.
In one article, Robert S. Stern, M.D., of Beth
Israel Deaconess Medical Center and Harvard Medical School, Boston,
developed a mathematical model to estimate the prevalence of
non-melanoma skin cancer in 2007.
"This model used age-specific incidence data
adjusted to reflect changes in incidence from 1957 to 2006, the age
distribution of the population from 1957 to 2006 and the likelihood that
an incident tumor was the first ever for that person," Dr. Stern writes.
Based on the model, Dr. Stern estimates that
approximately 13 million white, non-Hispanic Americans had had at least
one non-melanoma skin cancer by 2007. About one in five 70-year-olds
have had non-melanoma skin cancers, and most who were affected have had
more than one.
"The prevalence of a history of skin cancer is far
higher than that of any other cancer and exceeds that of all other
cancers diagnosed since 1975," and is about five times higher than that
of breast or prostate cancer, he writes.
In another article, Howard W. Rogers, M.D., Ph.D.,
of Advanced Dermatology, Norwich, Conn., and colleagues analyzed data
from two Medicare databases and national surveys to estimate the
incidence and treatment rates of non-melanoma skin cancer in 2006.
The total number of procedures to treat skin cancer
in the Medicare population increased 76.9 percent from an estimated
approximately 1.6 million procedures in 1992 to approximately 2 million
procedures in 2006.
Between 2002 and 2006, when database linkages
allowed more detailed analyses, procedures to treat non-melanoma skin
cancer increased 16 percent, the number of procedures per affected
person increased 1.5 percent and the number of individuals undergoing at
least one procedure increased by 14.3 percent.
Based on the results, the researchers estimate that
in 2006 there were more than 3.5 million non-melanoma skin cancers in
the United States and that approximately 2.1 million patients were
treated for the disease.
"There is an epidemic of non-melanoma skin cancer
in the United States, as illustrated by comparison with the previously
published estimates and the 4.2 percent yearly average increase in cases
in the Medicare population from 1992 to 2006," the authors conclude.
"To date, educational programs emphasizing sun
protection have mainly been disappointing in slowing skin cancer rates.
In the face of ongoing increases in skin cancer incidence, continued
national research and programs on treatment, education and prevention
are critical.".
Other articles featured in this issue include the
following:
Survivors of one melanoma appear approximately nine
times as likely as the general population to develop a second melanoma.
Porcia T. Bradford, M.D., and colleagues at the National Cancer
Institute, Bethesda, Md., used nine cancer registries to identify 89,515
patients who survived at least two months after an initial melanoma
diagnosis between 1973 and 2006.
Of these, 10,857 (12.1 percent) developed one or
more additional primary cancers, such that their overall risk of another
cancer increased by 28 percent. One-fourth of these subsequent cancers
were primary melanomas. Women with head and neck melanoma and patients
younger than 30 had additionally increased risks of a subsequent
melanoma.
"The risk remains elevated more than 20 years after
the initial melanoma diagnosis. This increased risk may be owing to
behavioral factors, genetic susceptibility or medical surveillance," the
authors conclude. "Melanoma survivors should remain under surveillance
not only for recurrence but also for future primary melanomas and other
cancers."
Treating melanoma in older adults is estimated to
cost approximately $249 million annually. Anne M. Seidler, M.D., M.B.A.,
Emory University School of Medicine, Atlanta, and colleagues used
national databases to assess health care resource consumption by a total
of 1,858 patients age 65 and older with melanoma during fiscal years
1991 to 1996.
Melanoma-related charges for older patients totaled
an estimated $2,200 per month during the first four months of treatment,
close to $4,000 monthly during the last six months and about $900 per
month in the interim phase.
Per patient, lifetime disease-related costs totaled
up to $28,210 from the time of diagnosis to the time of death.
"Although relatively few patients actually die of
this condition, the per-patient expenditures have particular
significance in late-stage disease," the authors write.
"The majority of consumption is attributable to
advanced-stage disease and the terminal phase of treatment. If all
patients were diagnosed and effectively treated in stage 0 or 1, we
estimate that the annual direct costs for the population 65 years or
older would be between $99 million and $161 million, or 40 percent to 65
percent of their current value of $249 million.
Policy guidelines for melanoma screening should
consider that patients 65 years or older represent an increased risk,
and thus, economic burden, for later-stage melanoma."
Early detection of melanoma appears more common
among younger patients, those living in areas with high concentrations
of dermatologists and those whose cancer is detected by dermatologists.
Frιdιrique Durbec, M.D., of Hτpital Robert Debrι,
France, and colleagues studied new cases of cutaneous melanoma in five
regions of northeastern France in 2004.
Of the 652 patients who had cancers detected,
● 45.1 percent were diagnosed among those who consulted dermatologists
directly,
● 26.1 percent were referred to dermatologists by general
practitioners,
● 14.1 percent were diagnosed when consulting a dermatologist for
another disease and
● 8.4 percent were diagnosed during a follow-up visit for skin
lesions.
Patients who were referred to dermatologists were
older and had the highest frequency of thick, or more advanced,
melanomas, whereas those diagnosed on a follow-up visit had no thick or
ulcerated melanomas.
"Easy access of patients to dermatologists,
information campaigns targeting elderly people and education of general
practitioners are complementary approaches to improving early
detection," the authors write.
"To manage the future costs and quality of care for
patients with skin cancer, a revised health strategy is needed," write
Simone van der Geer, M.D., of Erasmus University Medical Center,
Rotterdam, and colleagues in a special article.
"These new strategies should be combined into a
disease management system that organizes health care for one
well-documented health care problem using a systematic approach."
"By applying the disease management systems
approach, multiple opportunities for chronic skin cancer care become
apparent in prevention, education, multidisciplinary care, information
technology and management," they continue.
"The disease management system is embedded within a
supportive overall organization structure, which is based on firm
financial support that must be available for all aspects of the system,
including prevention-based efforts."
"Skin cancer needs to be regarded as a chronic
disease and should not be considered a solitary event requiring the
treatment of one tumor," they conclude.
"Combining these strategies in a disease management
system will lead to efficient, evidence-based, high-quality care to help
dermatologists deal proactively with chronic diseases such as skin
cancer."
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