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Reflections on smart phones, tablets, and ultraviolet (UV) light: Should we worry?
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All cancers carry somatic mutations. A subset of these somatic alterations, termed driver mutations, confer selective growth advantage and are implicated in cancer development, whereas the remainder are passengers. Here we have sequenced the genomes of a malignant melanoma and a lymphoblastoid cell line from the same person, providing the first comprehensive catalogue of somatic mutations from an individual cancer. The catalogue provides remarkable insights into the forces that have shaped this cancer genome. The dominant mutational signature reflects DNA damage due to ultraviolet light exposure, a known risk factor for malignant melanoma, whereas the uneven distribution of mutations across the genome, with a lower prevalence in gene footprints, indicates that DNA repair has been preferentially deployed towards transcribed regions. The results illustrate the power of a cancer genome sequence to reveal traces of the DNA damage, repair, mutation and selection processes that were operative years before the cancer became symptomatic.
Understanding skin cancer incidence is critical for planning prevention and treatment strategies and allocating medical resources. However, owing to lack of national reporting and previously nonspecific diagnosis classification, accurate measurement of the US incidence of nonmelanoma skin cancer (NMSC) has been difficult.
To estimate the incidence of NMSC (keratinocyte carcinomas) in the US population in 2012 and the incidence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in the 2012 Medicare fee-for-service population.
This study analyzes US government administrative data including the Centers for Medicare & Medicaid Services Physicians Claims databases to calculate totals of skin cancer procedures performed for Medicare beneficiaries from 2006 through 2012 and related parameters. The population-based National Ambulatory Medical Care Survey database was used to estimate NMSC-related office visits for 2012. We combined these analyses to estimate totals of new skin cancer diagnoses and affected individuals in the overall US population.
Incidence of NMSC in the US population in 2012 and BCC and SCC in the 2012 Medicare fee-for-service population.
The total number of procedures for skin cancer in the Medicare fee-for-service population increased by 13% from 2 048 517 in 2006 to 2 321 058 in 2012. The age-adjusted skin cancer procedure rate per 100 000 beneficiaries increased from 6075 in 2006 to 7320 in 2012. The number of procedures in Medicare beneficiaries specific for NMSC increased by 14% from 1 918 340 in 2006 to 2 191 100 in 2012. The number of persons with at least 1 procedure for NMSC increased by 14% (from 1 177 618 to 1 336 800) from 2006 through 2012. In the 2012 Medicare fee-for-service population, the age-adjusted procedure rate for BCC and SCC were 3280 and 3278 per 100 000 beneficiaries, respectively. The ratio of BCC to SCC treated in Medicare beneficiaries was 1.0. We estimate the total number of NMSCs in the US population in 2012 at 5 434 193 and the total number of persons in the United States treated for NMSC at 3 315 554.
This study is a thorough nationwide estimate of the incidence of NMSC and provides evidence of continued increases in numbers of skin cancer diagnoses and affected patients in the United States. This study also demonstrates equal incidence rates for BCC and SCC in the Medicare population.
Minimising exposure to ultraviolet (UV) radiation is an essential component of skin cancer prevention. Providing and using natural and built shade is an effective protection measure against harmful UV. This article describes the factors that must be addressed to ensure quality, effective, well designed shade and recommends best practice approaches to improving the protection factor (PF) of shade structures. It identifies examples of interventions to increase shade availability and use, and examples of effective shade based on measured protection factors or measured reductions in UV exposures. Finally, this article considers examples of best practice for undertaking shade audits. The article is based on refereed papers and reviews, reports, conference papers, and shade practice and policies from reports and on web sites. Articles for the Australian setting are considered first, followed by those in an international setting. This article is protected by copyright. All rights reserved.
Skin cancer represents an increasingly urgent worldwide public health problem.(1) Estimates project almost a million (or more) new cases each year in the United States; this number is roughly equal to that of all other cancers combined.(2) The incidence of cutaneous melanoma, which is mounting faster than that of any other cancer in white persons, nearly doubled from 1973 to 1990; in addition, the rise in melanoma mortality rates in white persons ranks second only to lung cancer.(3) While the overall 5-year melanoma survival rates in the United States rose from 49% (in the early 1950s) to 82% (in the early 1990s), death rates more than doubled during the same time; these rates were driven up by the rising incidence.(1,4) This year in the United States, melanoma will strike 34 000 persons and kill 7200-part of an estimated 90 000 cases diagnosed worldwide.(5,6) Despite exciting advances in innovative treatment approaches (eg, immuno-therapy and gene therapy), metastatic melanoma remains largely incurable.(1) Decades of research have not only crystallized an understanding of the epidemiology, risk factors, and natural history of skin cancer but also have begun to stimulate international efforts to promote its prevention and control, In theory, the public health burden of melanoma and skin cancer could be lowered through some combination of effective primary and secondary prevention measures. Reduction of excessive sun exposure (primary prevention) could theoretically reduce the incidence, since experts hypothesize that 90% of the cases of nonmelanoma skin cancer (NMSC) and two thirds of the cases of melanoma may be attributed to excessive sunlight exposure.(6,7) Primary prevention strategies can include personal behavior changes for individuals leg, minimizing UV exposure and using sunscreen), as well as policy and environmental interventions for populations leg, provision of shady areas and preservation of the ozone layer). Early detection (secondary prevention) should increase melanoma cure rates, since long-term survival figures of 92% for localized melanoma decline sharply to lower than 5% for metastatic disease.(3) Furthermore, these external, visible cancers have identifiable risk factors, should be readily recognizable by the public and health professionals alike, and are easily treated in the early stages.(8) We summarize the current state of melanoma and skin cancer control around the world.
As people become better informed about the harmful effects of prolonged exposure to solar ultraviolet radiation (UVR, 280-400 nm) they will seek the protection of shade, particularly in tropical locations such as Townsville (19 degrees south). Using broad-band radiation sensors for solar ultraviolet-B (280-315 nm), ultraviolet-A (315-400 nm) and daylight (400-800 nm) radiation, the exposure levels were measured in both the horizontal (shaded and unshaded) and vertical (shaded and unshaded) directions. The measurements were conducted at eight locations (shade settings) in Townsville during the period between December 1997 (summer) and May 1998 (beginning of winter). The quality of protection was assessed by the ratio of unshaded to shaded radiation exposure, the UVB/shade protection ratio (UVB-SPR). The UVB-SPR varies considerably between the different shade settings, with a beach umbrella showing the least protection and dense foliage the highest protection. The roof of a house verandah can provide only little protection if the verandah catches the afternoon sun. Increasing cloud cover decreases the UVB-SPR for all settings because of the increase in the diffuse fraction of the radiation. Only one setting provided a UVB-SPR of 15 or higher, as suggested for protective shading against solar UVB radiation. Shade from direct sunlight alone does not provide enough protection against high levels of solar UVR. Apart from the transmission qualities of the shading material, it is the construction of the whole shade setting that determines the exposure levels underneath. A shade structure with enough overhang is recommended so that high levels of scattered radiation do not reach the skin.