© 2005 Oxford University Press
CORRESPONDENCE |
RESPONSE: Re: Sun Exposure and Mortality From Melanoma
Affiliations of authors: University of New Mexico, Albuquerque, NM (MB); University of Sydney, Sydney, Australia (BA, AK); University of Connecticut Health Center, Farmington, CT (JF); Albert Einstein College of Medicine, New York, NY (CE); University of Miami, Miami, FL (RB)
Correspondence to: Marianne Berwick, PhD, MPH, Internal Medicine, University of New Mexico, 2325 Camino del Salud, Albuquerque, NM 87131 (e-mail: mberwick{at}salud.umn.edu).
Fears and Tucker point out that survival after a diagnosis of melanoma does not vary with ambient UV radiation across 11 geographically dispersed Surveillance, Epidemiology and End Results centers in the United States (1). At face value, this observation is inconsistent with the association we reported between survival from melanoma and measures of personal sun exposure. It is, however, consistent with other descriptive data that led us to hypothesize that melanomas that occur in association with high sun exposure have a better outcome than those that do not (2–4).
Figures 1 and 2 show 5-year relative survival from melanoma against incidence in men and women from 29 countries for which incidence and survival were both published for the late 1980s or early 1990s (5). Survival increased with increasing incidence until it reached approximately 90% in males and 95% in females. Survival did not increase further with increasing incidence beyond about 15 per 100 000. If we consider population incidence of melanoma to be a surrogate for ambient UV, as also seems reasonable from Fears and Tucker's Fig. 1 (1), the results suggest that melanoma survival is sensitive to ambient UV exposure up to the level that will give an incidence of approximately 15 per 100 000. All the populations in Fears and Tucker's Fig. 1 (1) had incidence rates for melanoma equal to or greater than 15 per 100 000. Thus, their observations are not necessarily inconsistent with our findings with respect to personal sun exposure and survival from melanoma.
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That said, we support their cautionary advice not to encourage people who have been diagnosed with melanoma to increase their sun exposure and encourage everyone to continue to avoid excessive sun exposure to reduce their melanoma risk. The evidence for an inverse association between sun exposure and cancer incidence and mortality in individuals is just emerging; more data and a careful accounting of risks and benefits of sun exposure at different levels are required before any major change is made to the current sun protection advice.
REFERENCES
(1) Fears TA, Tucker MA. Re: Sun exposure and mortality from melanoma. J Natl Cancer Inst 2005;97:1789–90.
(2) Lemish WM, Heenan PJ, Holman CD, Armstrong BK. Survival from preinvasive and invasive malignant melanoma in Western Australia. Cancer 1983;52:580–5.[CrossRef][Web of Science][Medline]
(3) Heenan PJ, English DR, Holman CD, Armstrong BK. Survival among patients with clinical stage I cutaneous malignant melanoma diagnosed in Western Australia in 1975/76 and 1980/81. Cancer 1991;68:2079–87.[CrossRef][Web of Science][Medline]
(4) Barnhill RL, Fine JA, Roush GTC, Berwick M. Predicting five-year outcome for patients with cutaneous melanoma in a population-based study. Cancer 1996;78:427–32.[CrossRef][Web of Science][Medline]
(5) Armstrong B. Epidemiology of melanoma and current trends. In: Tompson JF, Morton DL, Droonbin BR, editors. Textbook of melanoma. London (U.K.): Martin Dunitz; 2004. p. 65–80.
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J Natl Cancer Inst 2005 97: 1789-1790.
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