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Skin cancer is the most prevalent cancer in the United States today; it is also the most preventable. Texas ranks third in the nation for incidence of malignant melanoma, the most deadly of all skin cancers, suggesting the urgent need for an examination of the problems of prevention, detection, and treatment of skin cancer in Texas. The Texas Cancer Council's Action Plan on Skin Cancer for the State of Texas identifies current skin cancer education, prevention, detection, and treatment resources. It recommends approaches and resources that need to be developed to thoroughly evaluate and reduce the incidence of skin cancer in the state, so that the trend of steadily increasing morbidity and mortality associated with skin cancer in Texas may be reduced. | ||||
I. Incidence, mortality, and impact on society |
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A . Incidence and mortality nationwide Half of all new cancers in the United States are skin cancers, and about 1.3 million new cases of skin cancer will be diagnosed in the coming year. [ 1 ] One in five individuals in this country will develop skin cancer in his or her lifetime. [ 2 ] The incidence is even higher in the Sunbelt states, including Texas, where the lifetime risk of developing skin cancer is one in three . [ 3 ] The
three most prevalent types of skin cancer in the United States today are
basal cell carcinoma (BCC), squamous cell carcinoma (SCC),
and malignant melanoma (MM). Within this group, BCC accounts for
80%, SCC represents 16%, and the remaining 4% are MM. The nationwide incidence
of MM tripled between 1980 and 2000. [ 4 ]
Caucasians have the highest age-adjusted incidence and mortality rates
for melanoma, followed by Hispanics, and then African-Americans. (Appendix
i) Of these three groups, African-Americans have the lowest survival
rate. (Appendix ii ) [ 5 ]
The American Cancer
Society (ACS) projects that in 2000 there will be 47,700 new MM cases
in the United States. Unless diagnosed and appropriately treated early,
MM invades other parts of the body, and this metastatic involvement is
responsible for the high mortality rate. MM accounts for 79% of skin cancer
deaths; the ACS currently estimates that the nation will experience 7,700
deaths from melanoma this year, [ 1 ]
approximately 1 MM death every hour. [
4 ] B
. Incidence in Texas C
. Impact on society |
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1
. Years of productive life lost The National Cancer Institute estimates that the average years of productive life lost (PLL) for persons dying from melanoma is 19.8 years. (Appendix iii) [ 9 ] This number reflects an increase of more than 2 1 /2 years of PLL since the previous estimate less than 5 years earlier. These figures are based on the fact that MM is occurring in an ever-younger population. A recent National Cancer Data Base analysis of the demographic characteristics of individuals diagnosed with MM found that that 21% were under 40 years old, and an additional 17% were between 40 and 49 years old. (Appendix iv) [ 8 ] It is clear that the years of productive life lost due to MM are significant. |
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2
. Economic toll A 1997 study estimated that the total annual cost of treating newly diagnosed MM in the United States was $563 million. The major portion of this cost was attributed to the treatment of advanced disease. The study concluded that, "aggressive primary prevention through sun protection and intensive screening to enhance earlier detection should reduce the economic burden of melanoma care." [ 11 ] |
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1 Based on the percentage breakdown within the classification of the three most prevalent types of skin cancer: 80% basal cell carcinoma (BCC), 16% squamous cell carcinoma (SCC), and 4% malignant melanoma (MM). (American Academy of Dermatology, 2000) |
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