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Incidence of cutaneous malignant melanoma in Granada (Spain) 1985-1992 Ricardo Ocaña-Riola, PhD Andalusian School of Public Health Granada - Spain
© Ricardo Ocaña-Riola The author Address for correspondence Ricardo Ocaña-Riola Escuela Andaluza de Salud Pública Campus Universitario de Cartuja, s/n Apdo de Correos 2070 18080 Granada (Spain) Ricardo Ocaña-Riola Professor of Biostatistics Andalusian School of Public Health E-mail firstname.lastname@example.org Web www.easp.es Escuela Andaluza de Salud Pública References
© Ricardo Ocaña-RiolaFrameworkFramework Tumours derived from melanocytes –The commonest in humans –Most of them are benign –They sometimes are converted into malignant melanomas Relevance of malignant melanoma –High incidence among younger cohorts –Increase in its incidence Escuela Andaluza de Salud Pública
© Ricardo Ocaña-RiolaFramework Source: Armstrong and Kricker, 1994 Escuela Andaluza de Salud Pública
© Ricardo Ocaña-RiolaFramework 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 Escuela Andaluza de Salud Pública
© Ricardo Ocaña-RiolaObjectivesObjectives Main objective Specific objectives 1. To estimate the standardised incidence rates 2. To describe the incidence trends 3. To study the incidence geographical pattern 4. To describe the characteristics of the incident cases Population-based study of cutaneous malignant melanoma in the Granada province, 1985-1992 Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola MethodologyMethodology Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Scope of the study Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Design, patients and sources Descriptive study Patients –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 Escuela Andaluza de Salud Pública
© Ricardo Ocaña-RiolaVariables Sex Age (years) Anatomic site Histological type (ICD-O) Clark level (I-V) Breslow thickness (mm) Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Statistical 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 Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Statistical 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 Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Statistical 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 Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Statistical software S-PLUS –Descriptive analysis –Trends analysis WinBUGS –Bayesian models EpiMap –Smoothing incidence maps Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Results and Discussion Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Incidence rates Cutaneous Malignant Melanoma Granada, 1985-1992. Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Incidence rates Medium-low rates world-wide Different to other countries Different risk factors –Skin type (Zanetti et al, 1992) –Sun exposure (Aase and Bentham, 1996) Incidence similar to rates in other Spanish cancer registries Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola World wide incidence rates MALES ASRW (x100.000) World maximum European maximum World minimum European minimum Spain Source: Cancer Incidence in Five Continents Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola World wide incidence rates FEMALES ASRW (x100.000) World maximum European maximum World minimum European minimum Spain Source: Cancer Incidence in Five Continents Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Trends in melanoma incidence Cutaneous Malignant Melanoma (ASRW) Granada, 1985-1992. Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Trends in melanoma incidence Increasing trends Average annual increase around 4% Similar increase in other countries Hypothesis for this fact –Change in sun exposure (Pukkala, 1995) –Change in health care practices Escuela Andaluza de Salud Pública
GEOGRAPHICAL PATTERN Cutaneous melanoma (Granada, 1985-1992) SIR © Ricardo Ocaña-Riola Escuela Andaluza de Salud Pública 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 cases Cutaneous Malignant Melanoma Granada, 1985-1992 Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Characteristics of incident cases Cutaneous Malignant Melanoma Granada, 1985-1992 Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Characteristics 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 Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Characteristics 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) Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola Conclusions Escuela Andaluza de Salud Pública
© Ricardo Ocaña-RiolaConclusions Medium incidence rates world-wide The 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 Escuela Andaluza de Salud Pública
© Ricardo Ocaña-RiolaConclusions FEMALES 53 years old MS Superficial Lower limbs Low-Medium MALES 57 years old MS Superficial Trunk Medium-High CHARACTERISTIC Age Histological type Anatomic site Clark level Breslow More frequent characteristics of incident cases Cutaneous malignant melanoma Granada, 1985-1992 Escuela Andaluza de Salud Pública
© Ricardo Ocaña-Riola 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. Conclusions Escuela Andaluza de Salud Pública
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