Mortality from cutaneous melanoma: evidence for contrasting trends betweenpopulations

In recent years several reports have been published concerning trends in me lanoma mortality in different countries, some of which have indicated that rates are beginning to fall. Many of these reports, however, have been base d on small populations and have used different forms of statistical analysi s. Our objective was to analyse systematically to what degree the epidemic of melanoma mortality had evolved similarly in different populations and wh ether there were any divergent trends that might increase our understanding . Instead of using all available data, we focused on countries with a minim um time series of 30 years and a minimum of 100 deaths annually in at least one sex from melanoma. We first inspected sex-specific age-standardized mo rtality rates and then performed age-period-cohort modelling. We found that the increase in mortality observed after 1950 was more pronounced in the a ge group 60-79. Statistical modelling showed a general increase in mortalit y rates in generations born after the turn of the century. Downturns in mor tality, essentially in women and starting with generations born just before World War II, were found in Australia (where the earliest decreases were n oted), the Nordic countries and the USA. Small decreases in rates in more r ecent generations were found in the UK and Canada. However, in France, Ital y and Czechoslovakia mortality rates were seen to be still increasing in re cent cohorts. Our analysis suggests that populations are at different place s on the melanoma mortality epidemic curve. The three trend patterns we obs erved are in agreement with time differences between populations with respe ct to the promotion of sun protection and the surveillance of pigmented ski n lesions. (C) 2000 Cancer Research Campaign.