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Understanding Melanoma:
From Prevention to Cure
Primary Prevention–
A National Call to Action
31January 2015
Jeffrey E. Gershenwald, MD
Professor, Dept of Surgical Oncology
Professor, Dept of Cancer Biology
Medical Director, Melanoma & Skin Center
Co-Chair, Melanoma Cancer Genome Atlas Program
Chair, AJCC Melanoma Expert Panel
Melanoma: A Rapidly Growing Problem
0
2
4
6
8
10
12
14
1950 1960 1970 1980 1990
Rat
e/1
00
,00
0
Incidence
Death
2000
16
18
1950-2000↑ 619% Incidence↑ 165% Mortality
While the rate of almost all major cancers is decreasing, the annual incidence of melanoma continues to rise ~3%/yr
The Challenge
• ≈ 80,000 individuals expected to be diagnosed with invasive melanoma in 2014
• Most aggressive form of skin cancer
• <5% of skin cancers diagnosed• >75% of skin cancer deaths (~9,000/year)
• Ranks second among all cancers in years of productive life lost
• Affected patients often young/otherwise healthy• 2nd most common cause of cancer in women 20-29yo
• Increasing mortality in men >50yo
• Cost of lost productivity estimated $3.5B/yr in US
1Linos et al., J Invest Dermatol. 2009;129:1666-1674; 2 American Cancer Society. Cancer Facts & Figures 2013; 3 Cust et al., Int J Cancer. 2011;128:2425-2435; 4 Boniol et al, BMJ. 2012;345:e4757
The Challenge
• Early-stage disease – overall prognosis favorable, albeit heterogeneous
• Historical long-term survival for stage IV disease –very poor
1Linos et al., J Invest Dermatol. 2009;129:1666-1674; 2 American Cancer Society. Cancer Facts & Figures 2013; 3 Cust et al., Int J Cancer. 2011;128:2425-2435; 4 Boniol et al, BMJ. 2012;345:e4757
The Challenge
• UVR exposure from the sun and indoor tanning devices is a major independent risk factor for melanoma
• When controlling for multiple factors, tanning bed exposure <18 years old increased melanoma risk by 85%
• Half of U.S. children & adolescents ≥ 1 sunburns per year• 1 blistering sunburn in childhood 2X lifetime melanoma risk• ≥5 blistering sunburns between ages 15-20 years associated
with 80% increased risk of melanoma
1 Cust et al., Int J Cancer. 2011;128:2425-2435; 2 Boniol et al, BMJ. 2012;345:e4757; 3 Lazovich et
al., CEBP 2010;19:1557-1568; 4 Guy et al., JAMA Dermatol. 2014;150:501-511; 5Linos et al., J
Invest Dermatol. 2009;129:1666-1674; 6American Cancer Society. Cancer Facts & Figures 2014
Radiation exposures classified as Carcinogens by WHO/IARC
Lancet Oncology , August 2009
However….tanning facilities exceed number of Starbucks and McDonalds in >100 major US cities
Collaborative NIH/NCI/NHGRI effort to create a comprehensive collection of maps that chart genomic changes that occur in each type of cancer
Indoor Tanning Device Use Among US High School Students (N=14,590)
Guy GP Jr, et al. Prev Chronic Dis 2011;8(5):A116;
www.cdc.gov/pcd/issues/2011/sep/10_0261.htm
Frequency of Indoor Tanning Device Use Among US High School Students (N=2,026)
Guy GP Jr, et al. Prev Chronic Dis 2011;8(5):A116;
www.cdc.gov/pcd/issues/2011/sep/10_0261.htm
By age 17:
• > 35% of white females use tanning beds
• 62% of whom use them ≥ 10 times per year
• Nearly all salons denied the known risks of indoor tanning.
• 4 out of 5 salons falsely claimed that indoor tanning is beneficial to a young person’s health.
• Salons used many approaches to minimize the health risks of indoor tanning.
• Tanning salons fail to follow FDA recommendations on tanning frequency.
• Tanning salons target teenage girls in their advertisements.
Food and Drug Administration (FDA) proposal to reclassify ultraviolet (UV) lamps: May 2013
https://www.federalregister.gov/articles/2013/05/09/2013-10982/general-and-plastic-surgery-devices-reclassification-of-ultraviolet-lamps-for-tanning-henceforth-to#h-14
FDA Classification of Medical Devices
Balk, Fisher, Geller. Pediatrics 2013;131;772
Proposal: Class I Class II
2014 Tanning Bed Prohibition
Legislation Across U.S.
MD Anderson has reached out directly to assist
efforts in CO, KS, SC, WA, IA, and MD
The Surgeon General’s Call to Action to Prevent Skin Cancer – July 2014
http://www.surgeongeneral.gov/library/calls/prevent-skin-cancer/index.html
The Surgeon General’s Call to Action to Prevent Skin Cancer – July 2014
• Calls on partners in prevention from various sectors across the nation to address skin cancer as a major public health problem
• Goal: Increase awareness of skin cancer & call for actions to reduce the risk of skin cancer
• Road map
http://www.surgeongeneral.gov/library/calls/prevent-skin-cancer/index.html
The Surgeon General’s Call to Action to Prevent Skin Cancer – July 2014
• Five strategic goals:
1) Increase Opportunities for Sun Protection in Outdoor
Settings
2) Provide Individuals with the Information They Need to
Make Informed, Healthy Choices About UV Exposure
3) Promote Policies that Advance the National Goal of
Preventing Skin Cancer
4) Reduce Harms from Indoor Tanning
5) Strengthen Research, Surveillance, Monitoring, and Evaluation Related to Skin Cancer Prevention
http://www.surgeongeneral.gov/library/calls/prevent-skin-cancer/index.html
Joint Position Statement on Indoor Tanning
• State and federal legislation to ban the use of indoor tanning by minors under 18,
• Educational efforts that effectively communicate the risks of indoor tanning to teens and their parents, and
• Counter-advertising to de-normalize the perceived ‘beauty’ of tanned skin.
Impending Announcement!
The Melanoma Moon Shot:
A Comprehensive Plan to Reduce the
Incidence & Mortality of Melanoma
Jeffrey E. Gershenwald, MD
Michael A. Davies, MD, PhD
Melanoma Moon Shot Co-Leaders
Melanoma Moon Shot Team Roster
Jeffrey E. Gershenwald Lauren Haydu Catherine Roca
Michael Davies Zachary Cooper Charuta Kale
Mary Tripp Tiffany Calderone Payal Pandit Talati
Ellen Gritz Sheila Duncan Mandy Jo Euresti
Elizabeth Burton Paula Orban Sara Kanoff
Irma Wintle Chantale Bernatchez Elizabeth Winters
Jennifer Wargo Marie Forget Carmen Galvan
Rodabe Amaria Shruti Malu Ousswa Kudia
Victor Prieto Julie Gardner Andy Futreal
Michael Tetzlaff Silva Frankian Guilio Draetta
Jonathan Curry Emily Casey Lynda Chin
Veera Balandayuthapani Rhiannon Dodge James Allison
Francesco Stingo Elizabeth Sirman Pam Sharma
Patrick Hwu Kody Milburn Carlo Toniatti
Elizabeth Grimm Sakara Waller Tim Heffernan
Merrick Ross Christine Spencer Sam Hanash
Jeff Lee Kerri Fernandes Keith Perry
Ernie Hawk Brenna Matejka Gordon Mills
Mark Moreno Carla Werneke Kenna Shaw
Integrated Analysis and Targeting of Oncogenic Drivers and the Anti-Tumor
Immune Response
Michael A. Davies, MD, PhDAssociate Professor
Departments of Melanoma Medical Oncology and Systems Biology
Jeffrey E. Gershenwald, MDProfessor
Departments of Surgical Oncology and Cancer Biology
Primary Prevention of Melanoma Through UV Radiation Protection in Youth
Mary Tripp, PhDInstructor
Department of Behavioral Science
Ellen Gritz, PhDProfessor
Department of Behavioral Science
Increase ultraviolet radiation (UVR) protection, decrease
sun exposure, and decrease tanning behavior in youths
in order to reduce the incidence of melanoma
Support, facilitate and evaluate legislative activities
Maximize reach and impact of evidence-based interventions
Melanoma Prevention Flagship
Goals
Provide Individuals with the Information They Need to Make Informed, Healthy Choices About
UV Exposure
• Strategy 2A: Develop effective messages and interventions for specific audiences
• Strategy 2B: Support skin cancer prevention education in schools
• Current focus on child care and early learning centers, to teach children healthy sun protection behaviors from an early age curriculum, teacher training, parent education, technical assistance
1 Gritz, Tripp, et al., Health Educ Behav. 2007;34:562-77; 2 Gritz, Tripp, et al., Prev Med. 2005;41:357-66
Provide Individuals with the Information They Need to Make Informed, Healthy Choices About
UV Exposure, continued
• Current focus on collaboration with MDA’s Cancer Prevention & Control Platform (CP&CP) to disseminate pre-K-12 sun protection programs
• Strategy 2C: Integrate sun safety into workplace health education and promotion programs.• Engage corporate partnerships in collaboration with CP&CP
Promote Policies that Advance the National Goal of Preventing Skin Cancer, continued
• Strategy 3A: Support inclusion of sun protection in school policies, construction of school facilities, and school curricula
• Strategy 3C: Incorporate sun safety into workplace policies and safety trainings
Reduce Harms from Indoor Tanning
• Strategy 4B: Continue to develop, disseminate, and evaluate tailored messages to reduce indoor tanning among populations at high risk• Research to examine the effects of UV photography on UV
protection/exposure behavior
• Strategy 4C: Support organizational policies that discourage indoor tanning by adolescents and young adults• Discourage school-sponsored debit cards that pay for tanning services
• Strategy 4D: Enforce existing indoor tanning laws and consider adopting additional restrictions• Research to examine compliance with Texas SB 329
Strengthen Research, Surveillance, Monitoring, and Evaluation Related to Skin Cancer
Prevention
• Strategy 5B: Evaluate the effect of interventions and policies on behavioral and health outcomes• Dissemination and implementation research on sun protection
intervention for child care and early learning centers• Research to examine the effects of UV photography on UV
protection/exposure behavior
• Plan and convene Prevention Summit at MDA