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    Green Green Presentation Transcript

    • Harmful effects of UVR exposure in childhood:  epidemiological evidence Adele Green Queensland Institute of Medical Research, Australia & University of Manchester, UK
    • Outline1. Levels of UVR exposure in childhood2. Childhood skin effects: Benign to cancer3. Risk factors – genetic, solar UVR4. Is childhood a susceptible window?5. Primary prevention
    • Levels of UVR exposure in childhood• Estimated mean summer sun exposure 2-4 hours/day: similar across studies -summer in Europe/Canada; year round in Australia• Estimated average UV exposure - 8 times greater in Australia than Denmark• Estimated % of life-UVR (up to 60 y) received by children <20 y - 50%: Australia 25%: Denmark
    • Benign skin effects of UVR in childhood• Photoaging- prevalence in 13-15 yr olds (assessed  by skin surface microtopography) -in Scotland: 33% with mild skin damage-in Australia: 40-70% (Fritschi et al 1995)• Melanocytic naevi (moles)- median counts Germany Tropical Queensland (Bauer et al 2005) (Harrison et al 2005)Age 2: 3 20Age 5: 7 60Age 6-7: 17 70
    • Skin cancer incidence in childhood• Melanoma – rare < 20 years: accounts for 2% of all melanomas• BCC, SCC – negligible sporadic
    • Melanoma in Females by Age in England CUTANEOUS MELANOMA INCIDENCE IN FEMALES BY AGE GROUP IN ENGLAND (1979-2006) 400INCIDENCE RATE (PER 10^6 PERSO 350 300 YEARS AT RISK) 250 <25 25-44 200 45-64 150 65-89 100 50 0 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 YEAR OF DIAGNOSIS
    • Melanoma in Females <25 Years by site
    • Melanoma at ages 10-24 years: England vs AustraliaAnnual incidence rates per million in 2006 England Australia Males 15 43 Females 24 51
    • Causal pathways to melanomaGenes Environment
    • Genetic susceptibility• Mutations in “direct effect” genes eg CDKN2A - rare•**Multiple genes controlling pigmentation in skin, hair, eyes•**Tendency to multiple naevi (moles)
    • Youth Melanoma -pigmentary risk factors OR 95% CI Brown 1.0Eye Hazel 3.7 1.0-13.5Colour Green 3.8 0.9-16.5 Blue 4.5 1.5-13.6 Brown/Black 1.0Hair Blonde 1.7 0.8-3.7Colour Red 5.4 1.0-28.4 Dark 1.0Tanning Medium 3.4 0.7-16.5Ability Mild 3.9 1.0-16.0 No Tan 4.7 0.9-24.6
    • Youth Melanoma - freckling and family history OR 95% CI None 1.0Facial Few 0.6 0.2-1.7Freckling Some 1.0 0.4-2.9 Many 3.2 0.9-12.3Relative No 1.0withmelanoma Yes 4.0 0.8-18.9 Youl et al, Int J Cancer 2002
    • UVR causes melanoma Sun exposureArtificial tanning devicesClass 1 carcinogens (IARC 2009)
    • Latitude gradient for (childhood)melanoma6050403020100 y A LD K Z an S N U Q U m er G
    • Cohort study of melanocytic nevi in adolescentsMethods N= 110, aged 12-14 yr, followed 4 yrs All melanocytic nevi on body mapped photographedResults Amount of school lunch Naevi: Face & Neck Shoulder & Back time in sun OR 95%CI OR 95%CI Very little 1.0 1.0 Some 1.8 1.2-2.6 1.7 1.1-2.5 All 1.7 1.2-2.6 1.8 1.2-2.8 Darlington et al, Arch Dermatol, 2002
    • Childhood a susceptible window?
    • Migration studies Relative Risk native-bornhigh exposure 1.0 0.9 “forward” migration 0.4 0.3 Relative Risk 4.0 “reverse” 2.5 migration 1.5 native-born low exposure 1.0 birth death
    • UVR Protection campaigns in high-risk populations Underlying trends in Melanoma awareness Australia• 1960s – Melanoma public and professional education• 1980s – Prevention campaign “Slip, slop, slap”• 1990s – “SunSmart” Campaign Emphasis on sun protection in children
    • Melanoma incidence trends among children aged 0-14 yrs in Australia, 1983-2006, by sex Queensland
    • Melanoma incidence trends for children 10-14 yrs in Australia, 1983-2006Source: Australian Paediatric Cancer Registry Queensland
    • Trends in melanoma incidence among children in Australia (and Sweden)Possible influence of sun protection programsSince late 1980s/early 1990s:• community education programs on sun protection (shirts, hats, sunscreen) I G I N A L R E P O R T OR• policy emphasis eg accreditation programs for pre- , primary schoolsFrom mid-1990s:• melanoma incidence rates among children aged 10-14 years have decreased significantly by 8.5% per year Baade et al 2011
    • ng p eople in you mela noma vention ofPre Increase Awareness- Personal; Professional; Policymakers..•Avoidance of intense sun, including sunbeds•Use of clothes &Sunscreen in summer…in childhood