Changing trends in the epidemiology of malignant melanoma: gender differences and their implications for public health.

Abstract

Skin cancer has been identified as a key area in the English health strategy. Review of trends in the epidemiology of melanoma by age, sex and social class can contribute to ensuring that preventive efforts are targeted appropriately and subsequently to monitoring the effects of campaigns. Descriptive epidemiological study using data for both sexes from cancer registrations by age (England & Wales 1971-1989), and from mortality statistics by age (England & Wales 1951-1970, England 1969-1992) and by social class (England & Wales 1970-1972 for men and women, England & Wales 1979-1980, 1982-1983 for men and Great Britain 1979-1980, 1982-1983 for women). Analysis used age-standardized and age-specific registration rates by sex, age-standardized and age-specific mortality rates by sex and standardized mortality ratios by sex and by social class. Cohort effects are presented based on model fitting of age- and cohort-specific mortality rates for the period 1950-1989. Registration rates of new cases of malignant melanoma increased sharply in both sexes between 1971 and 1989 by 190% in men and 137% in women. Between 1970/1972 and 1990/1992 age-standardized mortality rates increased by 92% in men and 43% in women. In the 15-34 age group mortality rates have declined in women since the late 1970s whilst remaining level in men. The pattern of significantly higher mortality for both men and women in non-manual occupational groups had by the early 1980s diminished in women although it remained in men. In non-manual groups the mortality rate was higher in men than in women whilst for manual groups the opposite was true. A difference in trends in mortality from malignant melanoma between the sexes was demonstrated. Men are an important target group for preventive efforts despite their lower incidence of melanoma. They have a higher mortality rate which is increasing, less knowledge about appropriate primary and secondary preventive measures, present later with disease and respond less to traditional health education approaches. The findings have implications for the planning of primary and secondary prevention programmes.