CDC pushes prevention as melanoma rates double

PHOENIX — Rates of melanoma, the deadliest form of skin cancer, have doubled in the United States in the past 30 years and will continue to climb unless people minimize exposure to ultraviolet light, according to the Centers for Disease Control and Prevention.

The report comes as rising temperatures send sunseekers outside for the allure of bronzed skin.

But sunbathers are in denial if they don't realize the danger posed by ultraviolet light, said Robin Harris, a professor of epidemiology and co-director of the University of Arizona Cancer Skin Cancer Institute in Tucson. More than 90% of melanomas are due to skin-cell damage from ultraviolet radiation exposure. Most of that exposure comes from the sun.

"There's still a belief that 'It's not going to happen to me and this is something I don't have to worry about,' " Harris said.

Getting skin cancer wasn't something Glendale resident Tara Beye, 42, ever thought about growing up in Arizona.

"It was the time when everyone put on baby oil outside to tan. We never heard about sunblock,'' she said.

So she was shocked in 2003 when tests on a mole the size of a pencil eraser on her left arm revealed she had melanoma.

Over the next 12 years, she had several surgeries and treatments but the cancer spread to other parts of her body, including lymph nodes and pancreas. Currently, she undergoes immunotherapy at Cancer Treatment Centers of America in Goodyear, a treatment that uses her own immune system to fight the disease. At times she's been so weak, she had to rely on someone for a ride. Today, she is able to drive herself.

Beye became an advocate for skin-cancer prevention. She said she's even scolded people with a sunburn. "It's helped get people in to see their doctors, so I'm glad I've yelled,'' she said and smiled.

Prevention efforts are key toward reversing melanoma rates, the latest CDC report indicates. Without increased prevention, medical experts predict this cancer will escalate during the next 15 years, with 112,000 new cases projected in 2030.

The report states that melanoma rates in the USA increased from 11.2 per 100,000 people in 1982 to 22.7 per 100,000 in 2011.

But Arizona experts say the problem may be more acute because cases were underreported here for years and likely were by other states as well.

Arizona experts became suspicious five years ago after analyzing CDC data on melanoma rates in the 2000s. In 2003, Arizona's melanoma rate was 3.6% higher than the U.S. That made sense, Harris said, because Arizona's climate is often a draw to spending time outside.

But in CDC reports that followed, the state's rate was never above the nation's again. By 2010, Arizona was 4.2% below.

Harris said the drop didn't make sense. "We had heard from individual dermatologists in the state that they had been seeing more melanoma cases than they had in the past."

In 2011, the Arizona Melanoma Task Force, a group of researchers, physicians and staff members from the Arizona Cancer Registry, organized to explore the discrepancies. The task force found that medical providers were underreporting cases to the state Department of Health Services.

Tucson dermatologist Nancy Silvis, who chairs the task force, said some medical providers were confused about who should do the reporting, so they never did.

"Any physician involved with diagnosis of a melanoma is required by Arizona law to report it," she said. "This would include the doctor who did the initial biopsy, the pathologist who read it, the surgeon who did the excision."

Jessica Rigler, bureau chief of Epidemiology and Disease Control Services with the Arizona Department of Health Services, said the state is sending out health notices to medical providers to improve reporting and also is working with residency programs to update doctors on the requirements before they start practicing medicine.

Rigler thinks the efforts of the task force have paid off. Arizona's reported melanoma cancer rates went up between 2010 and 2012 — from 15.4% per 100,000 to 18.6%. Individual cases reported in that same period also rose, from 1,418 to 2,138.

John Ebner, a doctor of osteopathic medicine at Arizona Dermatology, agrees that many doctors did not know to report melanoma cases to the state. "The thought was that it was just voluntary,'' he said.

Ebner said he is seeing more cases of melanoma and finding many people don't equate the risk of getting the cancer to their personal behavior. "Many young people don't see that their life will ever end,'' he said, adding that melanomas might not show up until years after overexposure to ultraviolet light.

"The reality is that tan skin is damaged skin," Ebner said. "The tan is your body's way of trying to fight against ultraviolet exposure."

The CDC recommends several cancer-prevention strategies, including reducing UV exposure from both sunbathing and from indoor tanning booths.

Effective community skin-cancer programs could prevent an estimated 230,000 melanoma skin cancers by 2030, the CDC reports. Communities are encouraged to help by increasing shade on playgrounds, pools and other public spaces and educating children about sun safety and skin protection.

In Arizona, children in kindergarten through eighth grade can participate in the state's SunWise Skin Cancer Prevention School Program, which provides free curriculum and staff training to schools.

Beye hopes more parents will explain the dangers of the sun and tanning booths to their children and encourage them to wear hats and sunscreen. "If they can get in that habit now, it may save their lives,'' she said. "I wouldn't wish what I have on anyone."