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Neale RE, Lucas RM, Byrne SN, Hollestein L, Rhodes LE, Yazar S, Young AR, Berwick M, Ireland RA, Olsen CM. The effects of exposure to solar radiation on human health. Photochem Photobiol Sci 2023:10.1007/s43630-023-00375-8. [PMID: 36856971 PMCID: PMC9976694 DOI: 10.1007/s43630-023-00375-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/13/2023] [Indexed: 03/02/2023]
Abstract
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.
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Affiliation(s)
- R. E. Neale
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD Australia ,School of Public Health, University of Queensland, Brisbane, QLD Australia
| | - R. M. Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT Australia
| | - S. N. Byrne
- School of Medical Science, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - L. Hollestein
- Erasmus MC Cancer Institute, Rotterdam, The Netherlands ,Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - L. E. Rhodes
- Dermatology Research Centre, School of Biological Sciences, University of Manchester, Salford Royal Hospital, Northern Care Alliance NHS Trust, Manchester, UK
| | - S. Yazar
- Garvan Medical Research Institute, Sydney, NSW Australia
| | | | - M. Berwick
- University of New Mexico Comprehensive Cancer Center, Albuquerque, USA
| | - R. A. Ireland
- School of Medical Science, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - C. M. Olsen
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD Australia ,Frazer Institute, University of Queensland, Brisbane, QLD Australia
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Lacson JCA, Doyle SH, Del Rio J, Forgas SM, Carvajal R, Gonzalez-Calderon G, Ramírez Feliciano A, Kim Y, Roetzheim RG, Sutton SK, Vadaparampil ST, Soto-Torres B, Kanetsky PA. A randomized clinical trial of precision prevention materials incorporating MC1R genetic risk to improve skin cancer prevention activities among Hispanics. CANCER RESEARCH COMMUNICATIONS 2022; 2:28-38. [PMID: 35845857 PMCID: PMC9286490 DOI: 10.1158/2767-9764.crc-21-0114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose Skin cancer incidence is increasing among Hispanics, who experience worse outcomes than non-Hispanic Whites. Precision prevention incorporating genetic testing for MC1R, a skin cancer susceptibility marker, may improve prevention behavior. Patients and Methods Hispanic participants (n=920) from Tampa, FL and Ponce, PR, were block-randomized within MC1R higher- and average-risk groups to precision prevention or generic prevention arms. We collected baseline information on demographics, family history of cancer, phenotypic characteristics, health literacy, health numeracy, and psychosocial measures. Participants reported weekday and weekend sun exposure (in hours), number of sunburns, frequency of five sun protection behaviors, intentional outdoor and indoor tanning, and skin examinations at baseline, three months, and nine months. Participants also reported these outcomes for their eldest child ≤10 years old. Results Among MC1R higher-risk participants, precision prevention increased sunscreen use (OR=1.74, p=0.03) and receipt of a clinical skin exam (OR=6.51, p=0.0006); and it decreased weekday sun exposure hours (β=-0.94, p=0.005) and improved sun protection behaviors (β=0.93, p=0.02) in their children. There were no significant intervention effects among MC1R average risk participants. The intervention did not elevate participant cancer worry. We also identified moderators of the intervention effect among both average- and higher-risk participants. Conclusions Receipt of MC1R precision prevention materials improved some skin cancer prevention behaviors among higher-risk participants and their children and did not result in reduced prevention activities among average-risk participants. Despite these encouraging findings, levels of sun protection behaviors remained suboptimal among participants, warranting more awareness and prevention campaigns targeted to Hispanics.
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Affiliation(s)
- John Charles A. Lacson
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Scarlet H. Doyle
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Jocelyn Del Rio
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Stephanie M. Forgas
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Rodrigo Carvajal
- Biostatistics and Bioinformatics Shared Resources, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Guillermo Gonzalez-Calderon
- Biostatistics and Bioinformatics Shared Resources, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Richard G. Roetzheim
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Steven K. Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Susan T. Vadaparampil
- Department of Health and Behavioral Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Brenda Soto-Torres
- Public Health Program, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Peter A. Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida.,Corresponding Author: Peter A. Kanetsky, Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612-9416. Phone: 813-745-2299; E-mail:
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Age and Cohort Trends of Malignant Melanoma in the United States. Cancers (Basel) 2021; 13:cancers13153866. [PMID: 34359766 PMCID: PMC8345588 DOI: 10.3390/cancers13153866] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The occurrence of melanoma in the United States is increasing over time. We examined trends in melanoma by birth year and age groups to determine if individuals born more recently experience higher rates of melanoma as they age. We examined these trends separately among men and women and by the location on the body that the melanoma occurred. Melanoma incidence has continued to increase across more recent birth years and varies by body site and sex. Melanoma incidence will likely continue to increase as younger individuals age. While these are mostly thin melanomas, treatment to prevent cancer progression is still costly, both economically and emotionally, for patients. Abstract The incidence of malignant melanoma in the United States is increasing, possibly due to changes in ultraviolet radiation (UVR) exposure due to lifestyle or increased awareness and diagnosis of melanoma. To determine if more recent birth cohorts experience higher rates of melanoma as they age, we examined age and birth cohort trends in the United States stratified by anatomic site and cancer type (in situ vs. malignant) of the melanoma diagnosed from 1975–2017. Poisson regression of cutaneous melanoma cases per population for 1975–2017 from the Surveillance, Epidemiology, and End Results (SEER) cancer registries was used to estimate age adjusted incidence for five-year birth cohorts restricted to Whites, ages 15–84. The rate of melanoma incidence across birth cohorts varies by anatomic site and sex. Melanomas at all anatomic sites continue to increase, except for head and neck melanomas in men. Much of the increase in malignant melanoma is driven by cases of thin (<1.5 mm) lesions. While increased skin exams may contribute to the increased incidence of in situ and thin melanoma observed across birth cohorts, the shifts in anatomic site of highest melanoma incidence across birth cohorts suggest changes in UVR exposure may also play a role.
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