Abstract
Epidemiologic research has shown convincingly that certain phenotypic attributes are associated with increased relative risks of melanoma. Although such findings have intrinsic utility, there have been few attempts to translate such knowledge into estimates of disease burden suitable for framing public health policy. We aimed to estimate the population attributable fraction (PAF) for melanoma associated with melanocytic nevi using relative risk estimates derived from a systematic review and meta-analysis. We identified eligible studies using citation databases, followed by manual review of retrieved references. Of 49 studies identified, 25 and 23, respectively, were included in meta-analyses of atypical and common nevi. For people with > or =1 atypical nevi, the summary relative risk was 3.63 (95% confidence interval, 2.85-4.62), with a PAF of 0.25. The relative risk increased by 1.017 (95% confidence interval, 1.014-1.020) for each common nevus; however, significant heterogeneity in risk estimates was observed. We estimated that 42% of melanomas were attributable to having > or =25 common nevi (PAF 25-49 nevi = 0.15; PAF > or =50 nevi = 0.27), whereas PAFs for low nevus counts were modest (PAF 0-10 nevi = 0.04; PAF 11-24 nevi = 0.07). We modeled PAF under scenarios of varying nevus prevalence; the highest melanoma burden was always among those with high nevus counts (PAF range of 0.31-0.62 for > or =25 common nevi). Patients with > or =25 common nevi and/or > or =1 atypical nevi are a high-risk group, which might be targeted for identification, screening, and education. This work is the necessary first step in designing targeted preventive strategies for melanoma, which must now be overlaid with information about cost and utility.
Highlights
Cutaneous melanoma is an important public health problem; it is both increasing in incidence and as a cause of mortality in most Caucasian populations throughout the world [1]
When stratified by geographic location, the highest pooled relative risks (RR) was observed for the five studies conducted in North America, and the lowest was observed for those conducted in Central Europe
For studies that included cases with a family history of melanoma (n = 12), the pooled RR was 3.92 compared with 3.27 for studies that did not (n = 5); the remaining eight studies did not state whether they included cases with a family history of melanoma
Summary
Cutaneous melanoma is an important public health problem; it is both increasing in incidence and as a cause of mortality in most Caucasian populations throughout the world [1]. It may be important to identify individuals at higher than average risk who can be targeted for prevention and screening efforts. This will require an understanding of the magnitude of the risk associated with each factor, and of the public health effect of each factor. One widely used measure is the population attributable fraction (PAF), which considers both the strength of association between risk factor and outcome, as well as the prevalence of the factor in the community. The PAF estimates the proportion of all cases of a given disease in a population that is attributable to a particular factor
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