Melanoma: Coebergh JW

van Everdingen JJ, van der Rhee HJ, Koning CC, Nieweg OE, Kruit WH, Coebergh JW, Ruiter DJ, Anonymous00197. · Kwaliteitsinstituut voor de Gezondheidszorg CBO, Postbus 20.064, 3502 LB Utrecht. · Ned Tijdschr Geneeskd. · Pubmed #16128181 No free full text.

Abstract: The guidelines 'Melanoma' (3rd revision) are evidence-based in nature. A number of outcomes are summarised in this article. Dermatoscopy deserves a standard role in the clinical diagnosis of pigmented skin abnormalities. Pathological findings from a diagnostic excision should be recorded meticulously to include anatomical localisation, type of intervention used, excision margin, diagnosis, Breslow thickness, and the completeness of the removal. The sentinel node procedure should be reserved for patients who want to be as informed as possible about their prognosis. The procedure is not considered a part of standard diagnosis. Sentinel node assessment should include stains for specific markers and should be conducted in multiple sections. The following margins of non-affected skin are recommended for therapeutic re-excision of melanoma: in situ melanoma, 0.5 cm; Breslow thickness < or = 2 mm, 1 cm; Breslow thickness > 2 mm, 2 cm. Pathological assessment of a re-excised specimen depends on the completeness of the first excision. Systematic adjuvant treatment of patients with melanoma is not recommended outside the context of a clinical study. Patients with metastatic melanoma are preferably treated within a clinical study. Outside of a clinical study, these patients should be treated with dacarbazine. There is no evidence to suggest that survival is improved by frequent follow-up. However, follow-up can be a useful way to meet the information needs of patients and care requirements for physicians.

de Vries E, Coebergh JW, van der Rhee H. · Erasmus MC, afd Maatschappelijke Gezondheidszorg, Rotterdam. · Ned Tijdschr Geneeskd. · Pubmed #16756222 No free full text.

Abstract: The annual incidence of the three main forms of skin cancer has increased rapidly over the past few decades by 2.4% in men and 3.9% in women for basal-cell carcinoma, 3.9% in men and 3.1% in women for melanoma and 1.2% in men and 3.4% in women for squamous-cell carcinoma. The mortality rate has increased less rapidly. There has been an increase of 1.8% per year in rates of melanoma and a decrease of 1.9% in squamous cell carcinoma. The mortality rate for melanoma in younger people appears to have stabilized, however the death rate in older men continues to increase. Possible causes of the increase include excessive exposure to ultraviolet rays, immunosuppression and viruses. Early detection continues to offer the best chance of a cure. Screening older men for melanoma should be considered. Rising incidence and improved survival rates mean that there are likely to be more new patients with skin cancer in the future. Problems in balancing the availability of preventative and curative care may be offset by the timely planning of available manpower, by optimizing medical policy and by implementing new technological developments such as dermatoscopy.

Kroon BB, Bergman W, Coebergh JW, Ruiter DJ. · Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek ziekenhuis, Amsterdam. · Melanoma Res. · Pubmed #10465575 No free full text.

Abstract: In 1996 the Dutch Melanoma Working Party, in co-operation with the National Organization for Quality Assurance in Hospitals in the Netherlands and the Dutch Association of Comprehensive Cancer Centres, organized the third consensus conference on the management of melanoma of the skin. The following guidelines were approved. The recommended margin for diagnostic excision is 2 mm of macroscopically normal skin around the lesion; the margins for therapeutic excision are 1 cm of normal skin for a Breslow thickness of < or = 2 mm and 2 cm for a Breslow thickness of > 2 and < or = 4 mm. A margin of at least 2 cm also appears to be justified for thicker melanomas. Elective lymph node dissection is not recommended. Sentinel node biopsy appears to be a promising method to detect occult metastases in the regional lymph nodes. If regional lymph node metastases are present, therapeutic regional lymph node dissection must be conducted. Isolated regional perfusion is indicated for inoperable tumour growth in an extremity. Radiotherapy can be applied curatively (for example, if surgery is not possible), palliatively (if desired in combination with hyperthermia) or postoperatively (if non-radical resection is suspected). Adjuvant systemic therapy for melanoma patients is still experimental. Atypical (dysplastic) naevi and congenital naevi are major risk factors for melanoma. No consensus has been reached about the prophylactic excision of all congenital naevi. A follow-up period of 5 years is sufficient for patients with a melanoma of < or = 1.5 mm Breslow thickness (provided there are no histological signs of regression) and of 10 years when the Breslow thickness is > 1.5 mm. The patient should be actively involved in the follow-up (inspection, palpation). Regular routine blood tests, radiological examination and ultrasound scanning are not considered to be worthwhile. There is no evidence that the growth of micro-metastases is stimulated by hormonal changes during pregnancy or contraceptive pill use. Excessive exposure to ultraviolet radiation should be discouraged. Regular population screening for melanoma is not considered to be worthwhile, owing to the relatively low frequency and the predominantly favourable stage at the time of diagnosis, particularly in young people.

van der Rhee HJ, Coebergh JW. · Ziekenhuis Leyenburg, afd. Dermatologie, Den Haag. · Ned Tijdschr Geneeskd. · Pubmed #10416492 No free full text.

Abstract: Cutaneous melanoma exhibited a rapidly increasing incidence during the 70 s and 80 s. As a consequence primary and secondary prevention campaigns were developed, starting in Australia, where the incidence was by far the highest, but later also in the Netherlands. Mortality from melanoma in the Netherlands is stable at a rate of 2.4 per 100,000 person years since 1980. The melanoma incidence has stabilized since 1989 at a level of about 11 per 100,000. In the development of the melanoma it is not so much the accumulated exposure to sun that is of importance, as in squamous carcinoma, but rather incidental serious sunburn. It is especially exposure at an early age that increases the risk of melanoma as well as that of basal cell carcinoma. Primary prevention must be focussed on avoiding sunburn in young people. Secondary prevention can be realised by frequent controls of risk groups and a raised awareness for changing moles in the general population but also in physicians who see patients' skins for whatever reason.

Soerjomataram I, Louwman WJ, Lemmens VE, Coebergh JW, de Vries E. · Department of Public Health, Erasmus MC, Rotterdam, the Netherlands. · Am J Epidemiol. · Pubmed #18424428 links to  free full text

Abstract: Ultraviolet exposure may reduce the risk of colorectal and breast cancer as the result of rising vitamin D levels. Because skin cancer is positively related to sun exposure, the authors hypothesized a lower incidence of breast and colorectal cancer after skin cancer diagnosis. They analyzed the incidence of colorectal and breast cancer diagnosed from 1972 to 2002 among 26,916 Netherlands skin cancer patients (4,089 squamous cell carcinoma (SCC), 19,319 basal cell carcinoma (BCC), and 3,508 cutaneous malignant melanoma (CMM)). Standardized incidence ratios were calculated. A markedly decreased risk of colorectal cancer was found for subgroups supposedly associated with the highest accumulated sun exposure: men (standardized incidence ratio (SIR) = 0.83, 95% confidence interval (CI): 0.71, 0.97); patients with SCC (SIR = 0.64, 95% CI: 0.43, 0.93); older patients at SCC diagnosis (SIR = 0.59, 95% CI: 0.37, 0.88); and patients with a SCC or BCC lesion on the head and neck area (SIR = 0.59, 95% CI: 0.36, 0.92 for SCC and SIR = 0.78, 95% CI: 0.63, 0.97 for BCC). Patients with CMM exhibited an increased risk of breast cancer, especially advanced breast cancer (SIR = 2.20, 95% CI: 1.10, 3.94) and older patients at CMM diagnosis (SIR = 1.87, 95% CI: 1.14, 2.89). Study results suggest a beneficial effect of continuous sun exposure against colorectal cancer. The higher risk of breast cancer among CMM patients may be related to socioeconomic class, both being more common in the affluent group.

Schaapveld M, Visser O, Louwman MJ, de Vries EG, Willemse PH, Otter R, van der Graaf WT, Coebergh JW, van Leeuwen FE. · Comprehensive Cancer Center North-Netherlands (CCCN), P.O. Box 330, 9700 AH Groningen, The Netherlands. · J Clin Oncol. · Pubmed #18323547 No free full text.

Abstract: PURPOSE: To assess the risk of secondary nonbreast cancers (SNBCs) in a recently treated population-based cohort of breast cancer patients focused on the association with treatment and prognostic implications. PATIENTS AND METHODS: In 58,068 Dutch patients diagnosed with invasive breast cancer between 1989 and 2003, SNBC risk was quantified using standardized incidence ratios (SIRs), cumulative incidence, and Cox regression analysis, adjusted for competing risks. RESULTS: After a median follow-up of 5.4 years, 2,578 SNBCs had occurred. Compared with the Dutch female population at large, in this cohort, the SIR of SNBCs was increased (SIR, 1.22; 95% CI, 1.17 to 1.27). The absolute excess risk was 13.6 (95% CI, 9.7 to 17.6) per 10,000 person-years. SIRs were elevated for cancers of the esophagus, stomach, colon, rectum, lung, uterus, ovary, kidney, and bladder cancers, and for soft tissue sarcomas (STS), melanoma, non-Hodgkin's lymphoma, and acute myeloid leukemia (AML). The 10-year cumulative incidence of SNBCs was 5.4% (95% CI, 5.1% to 5.7%). Among patients younger than 50 years, radiotherapy was associated with an increased lung cancer risk (hazard ratio [HR] = 2.31; 95% CI, 1.15 to 4.60) and chemotherapy with decreased risk for all SNBCs (HR = 0.78; 95% CI, 0.63 to 0.98) and for colon and lung cancer. Among patients age 50 years and older, radiotherapy was associated with raised STS risk (HR = 3.43; 95% CI, 1.46 to 8.04); chemotherapy with increased risks of melanoma, uterine cancer, and AML; and hormonal therapy with all SNBCs combined (HR = 1.10; 95% CI, 1.01 to 1.21) and uterine cancer (HR = 1.78; 95% CI, 1.40 to 2.27). An SNBC worsened survival (HR = 3.98; 95%CI 3.77 to 4.20). CONCLUSION: Breast cancer patients diagnosed in the 1990 s experienced a small but significant excess risk of developing an SNBC.

Karim-Kos HE, de Vries E, Soerjomataram I, Lemmens V, Siesling S, Coebergh JW. · Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Room: AE-107, P.O. Box 2040, 3000 CA Rotterdam, Netherlands. · Eur J Cancer. · Pubmed #18280139 No free full text.

Abstract: INTRODUCTION: We present a comprehensive overview of most recent European trends in population-based incidence of, mortality from and relative survival for patients with cancer since the mid 1990s. METHODS: Data on incidence, mortality and 5-year relative survival from the mid 1990s to early 2000 for the cancers of the oral cavity and pharynx, oesophagus, stomach, colorectum, pancreas, larynx, lung, skin melanoma, breast, cervix, corpus uteri, ovary, prostate, testis, kidney, bladder, and Hodgkin's disease were obtained from cancer registries from 21 European countries. Estimated annual percentages change in incidence and mortality were calculated. Survival trends were analyzed by calculating the relative difference in 5-year relative survival between 1990-1994 and 2000-2002 using data from EUROCARE-3 and -4. RESULTS: Trends in incidence were generally favorable in the more prosperous countries from Northern and Western Europe, except for obesity related cancers. Whereas incidence of and mortality from tobacco-related cancers decreased for males in Northern, Western and Southern Europe, they increased for both sexes in Central Europe and for females nearly everywhere in Europe. Survival rates generally improved, mostly due to better access to specialized diagnostics, staging and treatment. Marked effects of organised or opportunistic screening became visible for breast, prostate and melanoma in the wealthier countries. Mortality trends were generally favourable, except for smoking related cancers. CONCLUSION: Cancer prevention and management in Europe is moving in the right direction. Survival increased and mortality decreased through the combination of earlier detection, better access to care and improved treatment. Still, cancer prevention efforts have much to attain, especially in the domain of female smoking prevalence and the emerging obesity epidemic.

Siesling S, van der Aa MA, Coebergh JW, Pukkala E, Anonymous00166. · Comprehensive Cancer Centre Stedendriehoek Twente (IKST), Department of Research and Registration, Enschede, The Netherlands. · Int J Cancer. · Pubmed #18183593 No free full text.

Abstract: Incidence of cancer may vary within a country and over time because of previous differences in exposure to risk factors or interventions for early detection (screening). This study describes time-space trends of incidence of common cancer sites across the Netherlands during the period 1989-2003 and speculates on the reasons for the observations. From the Netherlands Cancer Registry, World standardized incidence rates per municipality were smoothed calculating weighted averages for each 2 km by 2 km grid of the population mid-points of neighbouring municipalities and presented as map animations. Spatial relative changes in incidence were estimated by comparing the periods 1989-1994 and 1998-2003. Complete time-space trends can be found as map animations on http://maps.ikcnet.nl. The incidence of cervical and stomach cancer (for both sexes) decreased, being higher in the cities than in the rural areas during all periods and contrasting the trends in colorectal and breast cancer. The relative increase in incidence of lung cancer among females was highest in the rural north, but the incidence remained higher in the cities of the mid-west Netherlands. For males, there was a marked decrease in lung cancer incidence across the country since 1991. Incidence of melanoma increased, rates being twice as high in the coastal area than in the cities. Prostate cancer maps largely replicated the known history of PSA-testing in the Netherlands. Time-space cancer incidence patterns gave insight into effects of changes in exposure to risk determinants and early detection. The maps illustrate marked potential for cancer prevention at the national and regional level.

de Vries E, Nijsten TE, Visser O, Bastiaannet E, van Hattem S, Janssen-Heijnen ML, Coebergh JW. · Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. · Ann Oncol. · Pubmed #17974555 links to  free full text

Abstract: BACKGROUND: Worldwide, female melanoma patients have superior survival compared with males, which is usually ascribed to earlier detection among women and/or a more favorable site distribution. We studied gender difference in melanoma survival in a large population-based setting after adjusting for tumor-related variables and offer clues for further research. PATIENTS AND METHODS: A total of 10,538 patients diagnosed with melanoma from 1993 to 2004 in The Netherlands were included. Multivariate analyses were carried out to estimate adjusted relative excess risk (RER) of dying for men compared with women, adjusted for the patient and tumor characteristics. RESULTS: Univariate relative survival analyses showed a RER of dying of 2.70 [95% confidence interval (CI) 2.38-3.06] for men compared with women. After adjusting for time period of diagnosis, region, age, Breslow thickness, histologic subtype, body site, nodal and metastatic status, a significant excess mortality risk was still present for males (RER 1.87, 95% CI 1.65-2.10). Among patients with advanced disease and in those < 45 or > or = 60, the adjusted risk estimates were similar. CONCLUSIONS: The superior survival of women compared with men persisted after adjusting for multiple confounding variables indicating that factors other than stage at diagnosis and body site reduce mortality risk in female melanoma patients.

Berrino F, De Angelis R, Sant M, Rosso S, Bielska-Lasota M, Lasota MB, Coebergh JW, Santaquilani M, Anonymous00007. · Department of Preventive and Predictive Medicine, Fondazione Istituto Nazionale dei Tumori, Milan, Italy. · Lancet Oncol. · Pubmed #17714991 No free full text.

Abstract: BACKGROUND: EUROCARE is the largest population-based cooperative study on survival of patients with cancer. The EUROCARE project aims to regularly monitor, analyse, and explain survival trends and between-country differences in survival. This report (EUROCARE-4) presents survival data for eight selected cancer sites and for all cancers combined, diagnosed in adult (aged >/=15 years) Europeans in 1995-99 and followed up until the end of 2003. METHODS: We analysed data from 83 cancer registries in 23 European countries on 2 699 086 adult cancer cases that were diagnosed in 1995-99 and followed up to December, 2003. We calculated country-specific and mean-weighted age-adjusted 5-year relative survival for eight major cancers. Additionally, case-mix-adjusted 5-year survival for all cancers combined was calculated by countries ranked by total national expenditure on health (TNEH). Changes to survival were analysed relative to cases diagnosed in 1990-94. FINDINGS: Mean age-adjusted 5-year relative survival for colorectal (53.8% [95% CI 53.3-54.1]), lung (12.3% [12.1-12.5]), breast (78.9% [78.6-79.2]), prostate (75.7% [75.2-76.2]), and ovarian (36.3% [35.7-37.0]) cancer was highest in Nordic countries (except Denmark) and central Europe, intermediate in southern Europe, lower in the UK and Ireland, and worst in eastern Europe. Survival for melanoma (81.6% [81.0-82.3]), cancer of the testis (94.2% [93.4-95.0]), and Hodgkin's disease (80.0% [79.0-81.0]) varied little with geography. All-cancer survival correlated with TNEH for most countries. Denmark and UK had lower all-cancer survival than countries with similar TNEH; Finland had high all-cancer survival, but moderate TNEH. Survival increased and intercountry survival differences narrowed between the data for 1990-94 and 1995-99 for, notably, Hodgkin's disease (range 66.1-82.9 [IQR 72.2-78.6] vs 74.0-83.9 [78.6-81.9]), colorectal (29.4-56.7 [45.8-54.1] vs 38.8-59.7 [50.7-57.5]), and breast (61.7-82.7 [72.3-78.3] vs 69.3-87.6 [76.6-82.7]) sites. INTERPRETATION: Increases in survival and decreases in geographic differences over time, which are mainly due to improvements in health-care services in countries with poor survival, might indicate better cancer care. Wealthy countries with high TNEH generally had good cancer outcomes, but those with conspicuously worse outcomes than those with similar TNEH might not be allocating health resources efficiently.

Janssen-Heijnen ML, Houterman S, Lemmens VE, Brenner H, Steyerberg EW, Coebergh JW. · Eindhoven Cancer Registry, Comprehensive Cancer Centre South, AE Eindhoven, The Netherlands. · Ann Oncol. · Pubmed #17693654 links to  free full text

Abstract: BACKGROUND: Many cancer patients who have already survived some time want to know about their prognosis, given the pre-condition that they are still alive. We described and interpreted population-based conditional 5-year relative survival rates. PATIENTS AND METHODS: The long-standing Eindhoven Cancer Registry collects data on all patients diagnosed with cancer in the southern part of the Netherlands. Patients aged 25-74 years, diagnosed between 1960 and 2004, were included. Conditional 5-year relative survival was computed for every additional year survived (follow-up period 1980-2004). RESULTS: For patients with colorectal cancer, cutaneous melanoma or stage I breast cancer, conditional 5-year relative survival was >95% after having survived 3-15 years. However, for stomach, lung, stage II or III breast, prostate cancer or Hodgkin lymphoma, conditional 5-year relative survival did not exceed 75-94%. Initial differences in survival at diagnosis between age, gender and stage groups largely disappeared after having survived for 5-10 years. CONCLUSION: Prognosis for patients with cancer generally improved with each year survived. Patients with colorectal cancer, cutaneous melanoma or stage I breast cancer hardly exhibit any excess mortality after 3-15 years, whereas for patients with other tumours survival remained poorer than for the general population. Insight into conditional survival is especially useful for (ex)patients, who may use this information to plan their remaining life.

de Vries E, Houterman S, Janssen-Heijnen ML, Nijsten T, van de Schans SA, Eggermont AM, Coebergh JW. · Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands. · Ann Oncol. · Pubmed #17434898 links to  free full text

Abstract: BACKGROUND: We present survival outcomes of patients registered in the Dutch population-based Eindhoven Cancer Registry (ECR). PATIENTS AND METHODS: Data on patients diagnosed with a melanoma between 1980 and 2002 were obtained from the ECR. Data on vital status up to 1 January 2005 were obtained, up-to-date survival rates were calculated using period analysis. Multivariate analyses were carried out using Cox proportional hazards model. RESULTS: Ten-year crude survival rates were 82% for women and 60% for men (P < 0.05). Thin melanomas (Breslow thickness <or= 2.0 mm) had 5-year crude survival rates >74%, for melanomas >4.0 mm these rates were <65% (P < 0.05). In the early 1980s, 5-year relative survival rates were 84% and 62% for young (<60 years) women and men, and 66% and 69%, respectively, for the elderly (aged 60+). In the period 2000-2002, these rates had improved to >90% for females and to >72% for males. Multivariate analyses showed increased hazard ratios with increasing age and Breslow thickness, being male, having a melanoma on the trunk or unknown sites and having a nodular melanoma. CONCLUSIONS: Despite the absence of improvements in treatment options for melanoma, survival improved significantly, except for elderly males.

de Vries E, Soerjomataram I, Houterman S, Louwman MW, Coebergh JW. · Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands. · Am J Epidemiol. · Pubmed #17255116 links to  free full text

Abstract: Ultraviolet radiation causes skin cancer but may protect against prostate cancer. The authors hypothesized that skin cancer patients had a lower prostate cancer incidence than the general population. In the southeastern part of the Netherlands, a population-based cohort of male skin cancer patients diagnosed since 1970 (2,620 squamous cell carcinomas, 9,501 basal cell carcinomas, and 1,420 cutaneous malignant melanomas) was followed up for incidence of invasive prostate cancer until January 1, 2005, within the framework of the Eindhoven Cancer Registry. The incidence rates of prostate cancer among skin cancer patients were compared with those in the reference population, resulting in standardized incidence ratios. Skin cancer patients were at decreased risk of developing prostate cancer compared with the general population (standardized incidence ratio (SIR) = 0.89, 95% confidence interval (CI): 0.78, 0.99), especially shortly after diagnosis. The risk of advanced prostate cancer was significantly decreased (SIR = 0.73, 95% CI: 0.56, 0.94), indicating a possible antiprogression effect of ultraviolet radiation. Patients with a skin cancer in the chronically ultraviolet radiation-exposed head and neck area (SIR = 0.84, 95% CI: 0.73, 0.97) and those diagnosed after the age of 60 years (SIR = 0.86, 95% CI: 0.75, 0.97) had decreased prostate cancer incidence rates. These results support the hypothesis that ultraviolet radiation protects against prostate cancer.

de Vries E, Steliarova-Foucher E, Spatz A, Ardanaz E, Eggermont AM, Coebergh JW. · Department of Public Health, Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands. · Eur J Cancer. · Pubmed #16919779 No free full text.

Abstract: Patterns and trends of melanoma and skin carcinoma incidence and survival of European children (age 0-14 years) and adolescents (age 15-19 years) were investigated. Between 1978 and 1997, a total of 1419 melanoma and 485 skin carcinoma cases were recorded in the cancer registries contributing to the Automated Childhood Cancer Information System (ACCIS) study. During 1988-1997, the incidence of melanoma was 0.7 per million children and 12.9 per million adolescents; corresponding rates for skin carcinomas were 0.3 and 3.7 per million, respectively. The British Isles had the highest incidence of skin cancers in children and adolescents. For Europe, in adolescents melanomas were more common in the North and West, skin carcinomas in the South and East. Between 1978 and 1997 incidence increased annually in adolescents, by 4.1% for melanoma and 2.5% for skin carcinoma. Differences in aetiology between childhood and adolescent skin cancers cannot be excluded. Survival was relatively high and the geographical variations in incidence and survival seem to be associated.

Houterman S, Janssen-Heijnen ML, van de Poll-Franse LV, Brenner H, Coebergh JW. · Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven, The Netherlands. · Ann Oncol. · Pubmed #16418307 links to  free full text

Abstract: BACKGROUND: The aim was to compare long-term survival rates for different types of cancer estimated by means of up to date period analysis with those from more traditional cohort analysis. PATIENTS AND METHODS: Data from the Eindhoven Cancer Registry were used. In total 140,137 newly diagnosed patients diagnosed between 1980 and 2002 and followed until 1 January 2005 were included. Five-, 10- and 20-year relative survival rates were calculated. RESULTS: For total cancer in men and women, childhood cancer, rectal cancer, melanoma in women, breast cancer, prostate cancer and all leukaemias, much higher 10-year survival rates were found with period analyses (differences with cohort analyses were 5.1%, 3.6%, 7.4%, 5.6%, 6.5%, 4.0%, 5.1% and 10.5%, respectively). For laryngeal and bladder cancer the 10-year survival rates estimated with period analyses were about 7.5% lower compared with those estimated by means of cohort analyses. CONCLUSIONS: Period analysis, based on the most recent period of diagnosis, enabled us to show higher survival rates for total cancer, childhood cancer, rectal cancer, melanoma, breast cancer, prostate cancer and acute leukaemia, but also lower rates for laryngeal and bladder cancer. Period analysis should be the preferred tool for showing up-to-date survival rates to cancer patients and their physicians.

Haniff J, de Vries E, Claassen AT, Looman CW, van Berlo Ch, Coebergh JW. · Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands. · Eur J Surg Oncol. · Pubmed #16289645 No free full text.

Abstract: AIM: To evaluate causes and consequences of not adhering to the clinical practice guideline for cutaneous malignant melanoma. METHODS: We conducted a retrospective cohort study of the clinical records of 454 subjects whose pathological reports were obtained from a population-based cancer registry to assess determinants and effects of non-compliance of physicians with the excision policy and the related clinical practice guideline for patients with primary localized cutaneous malignant melanoma (CMM). A comparative analysis was performed of patients who did and did not undergo re-excision (compliance versus non-compliance with the guideline). Subjects diagnosed in 1988, 1993 and 1997, just 1 year after publication of the (adapted) guideline, were followed until death due to any cause or until July 1st 2003. RESULTS: Old age was the most important determinant of non-compliance. After adjusting for age at diagnosis, gender, subsite and Breslow thickness there was no significant difference in overall survival between the compliance group and the non-compliance group. CONCLUSIONS: Non-compliance to the guideline is more common in older patients and in patients with melanoma in the head and neck region. After adjusting for confounders, a significant effect of complying with the guidelines on overall survival could not be observed.

de Vries E, Boniol M, Severi G, Eggermont AM, Autier P, Bataille V, Doré JF, Coebergh JW. · Department of Public Health, Erasmus MC, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. · Eur J Cancer. · Pubmed #16139499 No free full text.

Abstract: In a large case-control study we found no association between sunbed use and melanoma risk, but indications for potential recall and recruitment biases made the interpretation of the results difficult. Associations with skin phototype (adj OR for skin type I vs. IV: (2.6, 95% CI 1.5-4.8)), hair colour (adj OR red/blond vs. brown/black 2.0 (95% CI 1.4-2.8)) and number of naevi on both arms (OR>10 vs. 10 3.13 (95% CI: 2.47; 3.97)) were comparable to previous studies, but negative associations were found between sun exposure and melanoma risk (adj. OR 0.87 (95% CI: 0.65-1.18)) and in cases between sun exposure and naevus count. These observations led us to speculate that cases may have underreported their sun exposure and, most likely, their sunbed exposure. High percentages of sunbed use among controls indicated possible recruitment bias: eligible controls who were sunbed users were probably more likely to accept the invitation to participate than non-users, possibly due to a feeling of 'guilt' or 'worry' about their habits. Such selective participation may have strongly influenced the risk estimates of sunbed use in our study.

Bataille V, Boniol M, De Vries E, Severi G, Brandberg Y, Sasieni P, Cuzick J, Eggermont A, Ringborg U, Grivegnée AR, Coebergh JW, Chignol MC, Doré JF, Autier P. · Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary, London, UK. · Eur J Cancer. · Pubmed #16125927 No free full text.

Abstract: A large European case-control study investigated the association between sunbed use and cutaneous melanoma in an adult population aged between 18 and 49 years. Between 1999 and 2001 sun and sunbed exposure was recorded in 597 newly diagnosed melanoma cases and 622 controls in Belgium, France, The Netherlands, Sweden and the UK. Fifty three percent of cases and 57% of controls ever used sunbeds. The overall adjusted odds ratio (OR) associated with ever sunbed use was 0.90 (95% CI: 0.71-1.14). There was a South-to-North gradient with high prevalence of sunbed exposure in Northern Europe and lower prevalence in the South (prevalence of use in France 20%, OR: 1.19 (0.68-2.07) compared to Sweden, prevalence 83%, relative risk 0.62 (0.26-1.46)). Dose and lag-time between first exposure to sunbeds and time of study were not associated with melanoma risk, neither were sunbathing and sunburns (adjusted OR for mean number of weeks spent in sunny climates >14 years: 1.12 (0.88-1.43); adjusted OR for any sunburn >14 years: 1.16 (0.9-1.45)). Host factors such as numbers of naevi and skin type were the strongest risk indicators for melanoma. Public health campaigns have improved knowledge regarding risk of UV-radiation for skin cancers and this may have led to recall and selection biases in both cases and controls in this study. Sunbed exposure has become increasingly prevalent over the last 20 years, especially in Northern Europe but the full impact of this exposure on skin cancers may not become apparent for many years.

de Vries E, van de Poll-Franse LV, Louwman WJ, de Gruijl FR, Coebergh JW. · Department of Public Health, Erasmus Medical Centre, PO Box 1738, 3000 DR Rotterdam, Netherlands. · Br J Dermatol. · Pubmed #15787817 No free full text.

Abstract: BACKGROUND: Skin cancer is an important, growing public health problem among white caucasians, causing a heavy burden on dermatologists and general practitioners. OBJECTIVES: To predict the future incidence of skin cancer in the Netherlands up to 2015. METHODS: Expected numbers of skin cancer cases in the Netherlands up to 2015 were calculated by trend modelling of observed rates for melanoma and squamous cell carcinoma (SCC) between 1989 and 2000 obtained from the Netherlands Cancer Registry and for basal cell carcinoma (BCC) obtained from the Eindhoven Cancer Registry; these rates were then multiplied by the predicted age distributions. Incidence rates were fitted to four different models, and predictions were based on the best fitting model. RESULTS: An increase of 80% in the total number of skin cancer patients is expected in the Netherlands: from 20 654 in 2000 to 37 342 in 2015. The total number of melanoma cases is expected to increase by 99%, with the largest increase for males (males aged 35-64, 111%; males aged > or = 65, 139%). Numbers of patients with SCC will increase overall by 80%, mainly among older males and females (increase of 79%) and females aged 35-64 (increase of 93%). The number of cases of BCC will increase by 78%, with the largest increase for the combined groups, those aged 15-64 (males, 66% increase; females, 94% increase), especially for sites other than the head and neck. The contribution of demographic changes (ageing effect) was largest for males with BCC and SCC (35-44%). CONCLUSIONS: If incidence rates for skin cancers in the Netherlands continue to increase and population growth and ageing remain unabated, a rise in annual demand for care of more than 5% could occur, putting a heavy burden on general practitioners and dermatologists. In the absence of marked changes in current ultraviolet radiation exposure, these increases will probably continue after 2015.

Reedijk AM, Janssen-Heijnen ML, Louwman MW, Snepvangers Y, Hofhuis WJ, Coebergh JW. · Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), P.O. Box 231, AE 5600 Eindhoven, The Netherlands. · Eur J Cancer. · Pubmed #15763653 No free full text.

Abstract: The aim of this study was to describe time trends in incidence, treatment and survival of children (0-14 years) and young adults (15-24 years) with cancer in an area in the Netherlands with a long registration period. Between 1973 and 1999, the population-based Eindhoven Cancer Registry (ECR) recorded 852 children and 1162 young adults with a malignancy and they were actively followed up until 1 July, 2003. The world standardised incidence rates for both children and young adults showed an increasing trend until 1997 and this flattened off afterwards (estimated annual percentage change [EAPC]=3.1%, P=0.66 for children and EAPC=3.6%, P=0.06 for young adults). Lymphomas in children and testicular malignancies and melanomas in young adults seemed to increase in particular. Better detection probably led to higher completeness for gliomas. Initial treatment for leukaemias and lymphomas in children has changed, protocols prescribe more chemotherapy and less radiotherapy. For all cancers combined, the 10-year survival rate for children significantly improved from 53% (95% confidence interval [95% CI] 45-61%) in 1973-1982 to 75% (95% CI 69-81%) in 1993-1999 (P-value<0.05). The 10-year survival rate for young adults significantly improved from 57% (95% CI 49-65%) to 81% (95% CI 77-85%) (P-value<0.05). We demonstrated significantly higher five-year survival rates for children with Hodgkin's disease (HD) and young adults with HD, non-seminoma or melanoma diagnosed in 1993-1999.

Boniol M, De Vries E, Coebergh JW, Doré JF, Anonymous00112. · INSERM Unit 590, Centre Léon Bérard, 28 Rue Laennec, 69373, Lyon, Cedex 08, France. · Eur J Cancer. · Pubmed #15617997 No free full text.

Abstract: The aim of our study was to analyse seasonal variations in melanoma incidence in Europe. Data from 28117 cutaneous melanoma cases reported during 1978-1993 to the EUROCARE group of registries were analysed. There is a clear summer peak in incidence in Western countries (summer-winter ratio: 1.31 P < 0.0001; Nam's test), which was not observed in Central Europe (ratio: 1.06; P = 0.0699). The amplitude of seasonality is higher for females (ratio = 1.38, 95% Confidence Interval (CI) [1.31-1.44]) than for males (ratio = 1.21 95%CI [1.14-1.29]). It is also higher for upper and lower limbs (1.44 and 1.46, respectively), than for head and neck or trunk regions (1.09 and 1.20, respectively). The amplitude of seasonality also varies with latitude and increases with time: in a linear regression adjusting for age, gender and anatomical localisation, the date of diagnosis was significantly closer to summer solstice with decreasing latitude (P = 0.0005) and for more recent year of diagnosis (P = 0.0123). The effect of latitude on the amplitude of the seasonal variation in melanoma incidence in Europe may be an indicator of ultraviolet B (UVB) exposure. Furthermore, an increase in intentional sun exposure could lead to an increase in melanoma promotion and thus to an increase in the amplitude of seasonal variation.

Grange JM, Doré JF, Coebergh JW. · Centre for Infectious Diseases and International Health, Royal Free and University College Medical School, London, UK. · Eur J Cancer. · Pubmed #15617986 No free full text.

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de Vries E, Coebergh JW. · Erasmus Medical Centre, Department of Public Health, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. · Eur J Cancer. · Pubmed #15519506 No free full text.

Abstract: Cutaneous malignant melanoma is on the rise in fair skinned societies. Both its incidence and mortality rates have been increasing in Europe over the past decades, the latter seem to stabilise in Scandinavia. The main cause of melanoma is intermittent exposure to ultraviolet radiation, especially in combination with endogenous factors like skin type and genetic predisposition. Evidence on an association between sunbed use and melanoma is inconclusive, but seems to point to a slightly increased risk associated with sunbed use. Within Europe, considerably variation in patterns of melanoma incidence and mortality existed. In this paper, we discuss the possible explanations for the observed trends and options for primary and secondary prevention. Early detection seems the most promising way to combat the relatively poor survival rates in Southern and Eastern Europe.

de Vries E, Bray FI, Eggermont AM, Coebergh JW, Anonymous00043. · Unit of Descriptive Epidemiology, International Agency for Research on Cancer, Lyon, France. · Eur J Cancer Prev. · Pubmed #15452451 No free full text.

Abstract: Cutaneous malignant melanoma has been characterized by rapid and steady increases in incidence and mortality in white populations. Some reports mentioned declining trends in the mean thickness of these tumours, but other studies suggested a stable incidence of thick melanomas. The aim of this study was to describe the stage distribution of melanomas across Europe, with particular reference to temporal trends. Twenty-three cancer registries provided data sets containing information on stage and histology, 21 of which were used for a general description and nine for trends analyses. Despite a preponderance of missing data, interesting patterns emerged: a less favourable stage distribution in populations with relatively low incidence, but high case-fatality rates, and a favourable trend in stage and histology distribution over time, including a shift from later to earlier stages in recent years. Early detection campaigns raising awareness for thin lesions can potentially improve melanoma survival rates. Monitoring of stage-specific trends in melanoma incidence can assess the impact of such interventions. This paper demonstrates the potential utility of high-quality, timely cancer registry data in pursuing such public health objectives and addresses the need for more complete information on diagnostic features of melanoma patients. This will allow more informative evaluations of preventive strategies.

de Vries E, Boniol M, Doré JF, Coebergh JW, Anonymous00274. · Department of Public Health, Erasmus Medical Centre, Dr Molewaterplein 50, 3015 GD Rotterdam, The Netherlands. · Eur J Cancer. · Pubmed #15093581 No free full text.

Abstract: The objective of this study was to investigate the epidemiology of melanoma across Europe with regard to Breslow thickness and body-site distribution. Incidence data from Cancer Incidence in 5 Continents and the EUROCARE-melanoma database were used: 28?117 melanoma cases from 20 cancer registries in 12 European countries, diagnosed between 1978 and 1992. Regression analysis and general linear modelling were used to analyse the data. Melanomas in Eastern Europe were on average 1.4 mm thicker (P<0.05) than in Western Europe and appeared more often on the trunk. From 1978 to 1992, their Breslow thickness had decreased in Western but not Eastern Europe. There was a latitude gradient in incidence, with highest rates in southern regions in Eastern Europe and an inverse gradient in Western Europe, with highest rates in the North. Mortality:incidence ratios were less favourable in southern parts across Europe, especially in Eastern Europe. If Eastern European populations copy the sunbathing behaviour of the West it is likely that in the near future a higher melanoma incidence can be expected there.