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Green

  1. 1. Harmful effects of UVR exposure in childhood:  epidemiological evidence Adele Green Queensland Institute of Medical Research, Australia & University of Manchester, UK
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. Skin cancer incidence in childhood• Melanoma – rare < 20 years: accounts for 2% of all melanomas• BCC, SCC – negligible sporadic
  6. 6. 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
  7. 7. Melanoma in Females <25 Years by site
  8. 8. Melanoma at ages 10-24 years: England vs AustraliaAnnual incidence rates per million in 2006 England Australia Males 15 43 Females 24 51
  9. 9. Causal pathways to melanomaGenes Environment
  10. 10. Genetic susceptibility• Mutations in “direct effect” genes eg CDKN2A - rare•**Multiple genes controlling pigmentation in skin, hair, eyes•**Tendency to multiple naevi (moles)
  11. 11. 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
  12. 12. 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
  13. 13. UVR causes melanoma Sun exposureArtificial tanning devicesClass 1 carcinogens (IARC 2009)
  14. 14. Latitude gradient for (childhood)melanoma6050403020100 y A LD K Z an S N U Q U m er G
  15. 15. 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
  16. 16. Childhood a susceptible window?
  17. 17. 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
  18. 18. 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
  19. 19. Melanoma incidence trends among children aged 0-14 yrs in Australia, 1983-2006, by sex Queensland
  20. 20. Melanoma incidence trends for children 10-14 yrs in Australia, 1983-2006Source: Australian Paediatric Cancer Registry Queensland
  21. 21. 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
  22. 22. 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

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