The epidemiology of malignant melanoma, squamous cell carcinoma and basal cell carcinoma in the UK from 2004 to 2014: a population-based cohort analysis using the Clinical Practice Research Datalink

The effects of exposure to solar radiation on human health

This assessment by the Environmental Effects Assessment Panel (EEAP) of the Montreal Protocol under the United Nations Environment Programme (UNEP) evaluates the effects of ultraviolet (UV) radiation on human health within the context of the Montreal Protocol and its Amendments. We assess work published since our last comprehensive assessment in 2018. Over the last four years gains have been made in knowledge of the links between sun exposure and health outcomes, mechanisms, and estimates of disease burden, including economic impacts. Of particular note, there is new information about the way in which exposure to UV radiation modulates the immune system, causing both harms and benefits for health. The burden of skin cancer remains high, with many lives lost to melanoma and many more people treated for keratinocyte cancer, but it has been estimated that the Montreal Protocol will prevent 11 million cases of melanoma and 432 million cases of keratinocyte cancer that would otherwise have occurred in the United States in people born between 1890 and 2100. While the incidence of skin cancer continues to rise, rates have stabilised in younger populations in some countries. Mortality has also plateaued, partly due to the use of systemic therapies for advanced disease. However, these therapies are very expensive, contributing to the extremely high economic burden of skin cancer, and emphasising the importance and comparative cost-effectiveness of prevention. Photodermatoses, inflammatory skin conditions induced by exposure to UV radiation, can have a marked detrimental impact on the quality of life of sufferers. More information is emerging about their potential link with commonly used drugs, particularly anti-hypertensives. The eyes are also harmed by over-exposure to UV radiation. The incidence of cataract and pterygium is continuing to rise, and there is now evidence of a link between intraocular melanoma and sun exposure. It has been estimated that the Montreal Protocol will prevent 63 million cases of cataract that would otherwise have occurred in the United States in people born between 1890 and 2100. Despite the clearly established harms, exposure to UV radiation also has benefits for human health. While the best recognised benefit is production of vitamin D, beneficial effects mediated by factors other than vitamin D are emerging. For both sun exposure and vitamin D, there is increasingly convincing evidence of a positive role in diseases related to immune function, including both autoimmune diseases and infection. With its influence on the intensity of UV radiation and global warming, the Montreal Protocol has, and will have, both direct and indirect effects on human health, potentially changing the balance of the risks and benefits of spending time outdoors.

Cardiovascular and cancer risk factors analysis for 2001–2020 from the global research output and European newspapers

Cancer and cardiovascular disease (CVD) are now two of the leading components of the global burden of disease, especially in high- and upper-middle-income countries. Causes of the diseases that are amenable to intervention are multiple: tobacco control closely followed by obesity treatment, including promotion of a healthy diet and physical exercise, remain the global priorities. We interrogated the Web of Science (WoS) from 2001 to 2020 to determine the numbers of papers describing research into 14 different possible risk factors causing the two diseases. These ranged in relative importance from tobacco and being overweight to the consumption of excessively hot drinks (linked to oesophageal cancer), pollution (linked to lung cancer particularly) and also non-interventional genetic risks. The risks varied between different continental regions, and obesity has increased as a risk factor for CVD in some of these regions. Because many of these factors are subject to human behavioural choices, we also investigated how such research was being presented to the European public through newspaper reportage. About 40% of the factors that influence the cancer burden can be attributed to particular causes, and more than 85% of those factors influencing CVD can also be so attributed. They are led by tobacco use as a risk factor for cancer, but this is slowly declining in most high-income settings. For CVD, the major risks are metabolic, such as high systolic blood pressure and high body-mass index, but also from tobacco use. Research outputs on some of these different factors in the continental regions correlated positively with their influence on the disease burdens. The selection of European newspaper stories was biased towards those risk factors that could be considered as being under the control of their readers. Reports of research in the mass media have an important role in the control of both cancer and CVD, and should be regarded by public health authorities as a useful means to promulgate health education. This paper is based on one presented at the ISSI conference in Leuven in July 2021 (Pallari and Lewison, in: Glänzel et al (eds) Proceedings of the 18th international conference on scientometrics and informetrics, 2021), but has been extended to cover CVD as well as cancer. The geographical analysis of risk factors and research publications has also been modified.

Implementation of artificial intelligence algorithms for melanoma screening in a primary care setting

Skin cancer is currently the most common type of cancer among Caucasians. The increase in life expectancy, along with new diagnostic tools and treatments for skin cancer, has resulted in unprecedented changes in patient care and has generated a great burden on healthcare systems. Early detection of skin tumors is expected to reduce this burden. Artificial intelligence (AI) algorithms that support skin cancer diagnoses have been shown to perform at least as well as dermatologists' diagnoses. Recognizing the need for clinically and economically efficient means of diagnosing skin cancers at early stages in the primary care attention, we developed an efficient computer-aided diagnosis (CAD) system to be used by primary care physicians (PCP). Additionally, we developed a smartphone application with a protocol for data acquisition (i.e., photographs, demographic data and short clinical histories) and AI algorithms for clinical and dermoscopic image classification. For each lesion analyzed, a report is generated, showing the image of the suspected lesion and its respective Heat Map; the predicted probability of the suspected lesion being melanoma or malignant; the probable diagnosis based on that probability; and a suggestion on how the lesion should be managed. The accuracy of the dermoscopy model for melanoma was 89.3%, and for the clinical model, 84.7% with 0.91 and 0.89 sensitivity and 0.89 and 0.83 specificity, respectively. Both models achieved an area under the curve (AUC) above 0.9. Our CAD system can screen skin cancers to guide lesion management by PCPs, especially in the contexts where the access to the dermatologist can be difficult or time consuming. Its use can enable risk stratification of lesions and/or patients and dramatically improve timely access to specialist care for those requiring urgent attention.