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Temporal and spatial melanoma trends in Austria: an ecological study.

Haluza D, Simic S, Moshammer H - Int J Environ Res Public Health (2014)

Bottom Line: As expected, incidence rates increased with altitude (about 2% per 10 m) and year (about 2%).In contrast, mortality rates decreased with altitude (for males: 0.4% per 10 m, for women: 0.7% per 10 m, respectively).Possible reasons for this finding include higher awareness of patients, better diagnostic performance of medical professionals working at higher altitudes, or slower tumor growth due to protective effects of sun light-associated vitamin D synthesis.

View Article: PubMed Central - PubMed

Affiliation: Center for Public Health, Institute of Environmental Health, Medical University of Vienna, Kinderspitalgasse 15, Vienna A-1090, Austria. daniela.haluza@meduniwien.ac.at.

ABSTRACT
Annual solar ultraviolet radiation (UVR) is mostly determined by latitude and altitude. Over the last decades, increasing UVR ground levels have been observed. Exposure to UVR is associated with a life-time risk to develop melanoma, a malign skin cancer. Thus, we hypothesized that melanoma incidence in Austria is associated with altitude of place of living and time of diagnosis. We investigated this hypothesis in an ecological study by district and year for Austrian melanoma incidence (1990-2010) and mortality (1970-2011) data. As expected, incidence rates increased with altitude (about 2% per 10 m) and year (about 2%). Additionally, melanoma incidence rates were about 50% higher in urban than in rural districts. In contrast, mortality rates decreased with altitude (for males: 0.4% per 10 m, for women: 0.7% per 10 m, respectively). The observed discrepancy between incidence and mortality data could partly be explained by melanoma diagnosis at earlier tumor stage in districts with higher altitude. Possible reasons for this finding include higher awareness of patients, better diagnostic performance of medical professionals working at higher altitudes, or slower tumor growth due to protective effects of sun light-associated vitamin D synthesis.

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Distribution of melanoma cancer stages at time of diagnosis (in %): Comparison of different types of districts (rural, urban, and Vienna).
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ijerph-11-00734-f006: Distribution of melanoma cancer stages at time of diagnosis (in %): Comparison of different types of districts (rural, urban, and Vienna).

Mentions: The discrepancy between the two outcomes (melanoma mortality and incidence rates) regarding the influence of altitude as well as observations regarding Viennese data was unexpected. Subsequently, we analyzed “stage at diagnosis” in order to get more insight into these striking findings. We compared rural, urban, and Viennese districts. According to Figure 6, more cancer cases in Vienna were diagnosed only after the death of the patient (Death Certificate Only, DCO), and also in the dissemination stage (stage 4). This finding could partly explain the reported lower melanoma incidence in Vienna. What is more, apart from behavioral differences, also a higher proportion of people with migratory background and thus darker skin types could be responsible for lower melanoma incidence rates in the capital Vienna. Nevertheless, these associations could not explain higher melanoma mortality rates.


Temporal and spatial melanoma trends in Austria: an ecological study.

Haluza D, Simic S, Moshammer H - Int J Environ Res Public Health (2014)

Distribution of melanoma cancer stages at time of diagnosis (in %): Comparison of different types of districts (rural, urban, and Vienna).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3924471&req=5

ijerph-11-00734-f006: Distribution of melanoma cancer stages at time of diagnosis (in %): Comparison of different types of districts (rural, urban, and Vienna).
Mentions: The discrepancy between the two outcomes (melanoma mortality and incidence rates) regarding the influence of altitude as well as observations regarding Viennese data was unexpected. Subsequently, we analyzed “stage at diagnosis” in order to get more insight into these striking findings. We compared rural, urban, and Viennese districts. According to Figure 6, more cancer cases in Vienna were diagnosed only after the death of the patient (Death Certificate Only, DCO), and also in the dissemination stage (stage 4). This finding could partly explain the reported lower melanoma incidence in Vienna. What is more, apart from behavioral differences, also a higher proportion of people with migratory background and thus darker skin types could be responsible for lower melanoma incidence rates in the capital Vienna. Nevertheless, these associations could not explain higher melanoma mortality rates.

Bottom Line: As expected, incidence rates increased with altitude (about 2% per 10 m) and year (about 2%).In contrast, mortality rates decreased with altitude (for males: 0.4% per 10 m, for women: 0.7% per 10 m, respectively).Possible reasons for this finding include higher awareness of patients, better diagnostic performance of medical professionals working at higher altitudes, or slower tumor growth due to protective effects of sun light-associated vitamin D synthesis.

View Article: PubMed Central - PubMed

Affiliation: Center for Public Health, Institute of Environmental Health, Medical University of Vienna, Kinderspitalgasse 15, Vienna A-1090, Austria. daniela.haluza@meduniwien.ac.at.

ABSTRACT
Annual solar ultraviolet radiation (UVR) is mostly determined by latitude and altitude. Over the last decades, increasing UVR ground levels have been observed. Exposure to UVR is associated with a life-time risk to develop melanoma, a malign skin cancer. Thus, we hypothesized that melanoma incidence in Austria is associated with altitude of place of living and time of diagnosis. We investigated this hypothesis in an ecological study by district and year for Austrian melanoma incidence (1990-2010) and mortality (1970-2011) data. As expected, incidence rates increased with altitude (about 2% per 10 m) and year (about 2%). Additionally, melanoma incidence rates were about 50% higher in urban than in rural districts. In contrast, mortality rates decreased with altitude (for males: 0.4% per 10 m, for women: 0.7% per 10 m, respectively). The observed discrepancy between incidence and mortality data could partly be explained by melanoma diagnosis at earlier tumor stage in districts with higher altitude. Possible reasons for this finding include higher awareness of patients, better diagnostic performance of medical professionals working at higher altitudes, or slower tumor growth due to protective effects of sun light-associated vitamin D synthesis.

Show MeSH
Related in: MedlinePlus