incidence of cutaneous malignant melanoma in granada (spain) 1985-1992 ricardo ocaña-riola, phd...
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Incidence of cutaneous malignant melanoma in Granada (Spain)
1985-1992
Ricardo Ocaña-Riola, PhD
Andalusian School of Public HealthGranada - Spain
© Ricardo Ocaña-Riola
The authorThe author
Address for correspondenceRicardo Ocaña-RiolaEscuela Andaluza de Salud PúblicaCampus Universitario de Cartuja, s/nApdo de Correos 207018080 Granada (Spain)
Ricardo Ocaña-RiolaProfessor of Biostatistics
Andalusian School of Public Health
Webwww.easp.es
Escuela Andaluza de Salud Pública
References
© Ricardo Ocaña-Riola
FrameworkFrameworkFrameworkFramework
Tumours derived from melanocytes– The commonest in humans– Most of them are benign– They sometimes are converted into
malignant melanomasRelevance of malignant melanoma
– High incidence among younger cohorts– Increase in its incidence
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FrameworkFramework
0% 2% 4% 6% 8% 10%
HUNGARY, Szabolcs-Szatmar
SLOVENIA
NEW ZEALAND, No Maoris
DENMARK
NORWAY
EEUU, Hawai
Increase of incidence (1960-1985)
Female MaleSource: Armstrong and Kricker, 1994
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FrameworkFramework
Results from international studies– Different world wide incidence rates– Different world wide survival rates– Different risk and prognosis factors
Why population-based studies?– Knowledge of our population– Contribution to improve health care
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ObjectivesObjectivesObjectivesObjectives
Main objective
Specific objectives1. To estimate the standardised incidence rates2. To describe the incidence trends3. To study the incidence geographical pattern4. To describe the characteristics of the incident cases
Population-based study of cutaneous malignant melanoma in the Granada province , 1985-1992
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© Ricardo Ocaña-Riola
MethodologyMethodologyMethodologyMethodology
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Scope of the studyScope of the study
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Design, patients and sourcesDesign, patients and sources
Descriptive studyPatients
– All cases diagnosed from 1985 to 1992– 247 incident cases of melanoma– All of them live in the Granada province
Source of information– Granada Cancer Registry
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VariablesVariables
SexAge (years)Anatomic siteHistological type (ICD-O)Clark level (I-V)Breslow thickness (mm)
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Statistical data analysisStatistical data analysisStatistical data analysisStatistical data analysis
World population standardised incident rates– ASRW (x100.000 inhabitants)– To compare different populations
Univariate and bivariate analysis– Descriptive tables– Chi-squared test– T-Student test
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Statistical data analysisStatistical data analysis
Trend analysis– Smoothing (moving averages)
• To see the real trend of incidence• To delete random fluctuations into the time
series
– Standardised rates by periods• 1985-87, 1988-1990 y 1991-1992• To quantify the incidence rates change
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Statistical data analysisStatistical data analysis
Geographical analysis– Standardised Incidence Rate (SIR)
• Calculated by the Indirect method• SIR=Observed/Expected• Population of reference: Granada province
– Bayesian models• Smoothing SIR • To control extra-Poisson variability• To detect clusters
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Statistical softwareStatistical software
S-PLUS– Descriptive analysis– Trends analysis
WinBUGS– Bayesian models
EpiMap– Smoothing incidence maps
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Results and DiscussionResults and DiscussionResults and DiscussionResults and Discussion
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Incidence ratesIncidence rates
Incidence Mortality
Males Females Males Females
Cases 105 142 45 34
Crude Rate 3.4 4.4 0.9 0.6
ASRW 2.9 3.7 0.7 0.5
Cutaneous Malignant MelanomaGranada, 1985-1992.
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Incidence ratesIncidence rates
Medium-low rates world-wideDifferent to other countriesDifferent risk factors
– Skin type (Zanetti et al, 1992)– Sun exposure (Aase and Bentham, 1996)
Incidence similar to rates in other Spanish cancer registries
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World wide incidence ratesWorld wide incidence rates
0 5 10 15 20 25 30 35
SINGAPUR, Indios (1988-1992)
BIELORUSIA (1988-1992)
ALBACETE (1991-1992)
ASTURIAS (1988-1992)
ZARAGOZA (1986-1990)
MURCIA (1988-1992)
PAIS VASCO (1988-1991)
GRANADA (1985-1992)
NAVARRA (1987-1991)
TARRAGONA (1988-1992)
MALLORCA (1988-1992)
NORUEGA 1988-1992)
AUSTRALIA, Nueva Gales del Sur (1988-1992)
MALES
ASRW (x100.000)
World maximum
European maximum
World minimum
European minimum
Spain
Source: Cancer Incidence in Five Continents
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World wide incidence ratesWorld wide incidence rates
0 5 10 15 20 25 30
SINGAPUR, Indias (1988-1992)
ITALIA, Ragusa (1988-1992)
ALBACETE (1991-1992)
TARRAGONA (1988-1992)
ZARAGOZA (1986-1990)
NAVARRA (1987-1991)
ASTURIAS (1988-1991)
GRANADA (1985-1992)
MALLORCA (1988-1991
PAIS VASCO (1988-1991)
MURCIA (1988-1992)
AUSTRIA, Tirol 1988-1992)
NUEVA ZELANDA: No Maoríes (1988-1992)
FEMALES
ASRW (x100.000)
World maximum
European maximum
World minimum
European minimum
Spain
Source: Cancer Incidence in Five Continents
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Trends in melanoma incidenceTrends in melanoma incidence
1985-87 1988-90 1991-92Males 2.2 2.9 3.2
Females 3.0 3.4 4.7
Cutaneous Malignant Melanoma (ASRW)Granada, 1985-1992.
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Trends in melanoma incidenceTrends in melanoma incidence
Increasing trendsAverage annual increase around 4%Similar increase in other countriesHypothesis for this fact
– Change in sun exposure (Pukkala, 1995)– Change in health care practices
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GEOGRAPHICAL PATTERNCutaneous melanoma (Granada, 1985-1992)
SIR
© Ricardo Ocaña-Riola
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Menos de 0.01
0.01 - 0.61
0.62 - 0.82
0.83 - 0.89
0.90 - 1.07
1.08 - 1.31
1.32 - 2.15
Ms de 2.15
© Ricardo Ocaña-Riola
Characteristics of incident casesCharacteristics of incident cases
Males Females
Cases 105 142
Age (mean) 57 years old 53 years old
Anatomic site Trunk (34%)Head (32%)
Low. limbs (44%)Head (23%)
Cutaneous Malignant MelanomaGranada, 1985-1992
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Characteristics of incident casesCharacteristics of incident cases
Males Females
Histological type Superfic. (35%)Nodular (26%)
Superfic. (39%)Nodular (25%)
Clark level III (32%)IV (18%)
II (31%)III (29%)
Breslow (mean) 3.3 mm 2.4 mm
Cutaneous Malignant MelanomaGranada, 1985-1992
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Characteristics of incident casesCharacteristics of incident cases
Incidence among younger cohorts– 1/3 of cases under 45 years– Contrast to other skin tumours– Melanoma non related to cumulative
dosage of sun exposure (Zanetti et al, 1992)Higher incidence among females
– Similar to other European Registries– Different to EEUU
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Characteristics of incident casesCharacteristics of incident cases
Male and female dissimilarities– Anatomic site
• Trunk in males
• Lower limbs in females
• Are the differences due to clothes? (Aase et al, 1996)
– Clark level and Breslow• Lower in females
• Cultural differences between gender
• Early diagnosis (Armstrong et al, 1994)
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ConclusionsConclusions
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ConclusionsConclusions
Medium incidence rates world-wideThe highest incidence rates are
located in the city of Granada and all the municipalities around it
There was an increasing trend in the incidence of melanoma from 1985 to 1992
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ConclusionsConclusions
FEMALES53 years oldMS SuperficialLower limbsLow-MediumLow-Medium
MALES57 years oldMS SuperficialTrunkMedium-HighMedium-High
CHARACTERISTICAgeHistological typeAnatomic siteClark levelBreslow
More frequent characteristics of incident casesCutaneous malignant melanoma
Granada, 1985-1992
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This information, which corresponds to the province’s whole population, might guide health policies contributing to disease prevention and to a better care. Because of the increase in incidence rates and the high percentage of cases diagnosed at advanced stages, it is advised that prevention campaigns are addressed to the Granada population.
ConclusionsConclusions
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