Cutaneous melanoma attributable to UVR exposure in Denmark and Germany.

Background: Increasing incidence rates of cutaneous melanoma (CM) observed during the last five decades in white populations are largely attributed to increased exposure to solar ultraviolet radiation (UVR), often expressed as population attributable fraction (PAF). Thus, many CMs could be prevented by reducing UVR exposure. The aim of this study was to estimate the PAF of CM attributable to UVR exposure and demographic changes in Denmark and Saarland/Germany for the period 1943 to 2036.
Material and Methods: CM incidence data (ICD-10, C43) for Denmark (1943-2016) and the German Federal State of Saarland (1972-2016) were retrieved from the NORDCAN database and from the Saarland Cancer Registry. The number of CMs attributable to UVR exposure was calculated by comparing contemporary or predicted CM incidence rates with CM rates in Denmark during the years 1943-1946.
Results: In Denmark, the proportion of CM cases attributable to UVR exposure increased from around 20% in 1947-1951 to 96% in 2012-2016; in the Federal State of Saarland, it increased from 50% in 1972-1976 to 90% in 2012-2016. Until 2032-2036, the PAF is expected to rise in Denmark to 97% and in the Saarland to 92%. The demographic influence, on the other hand, is rather small.
Conclusions: More than 90% of all CM in Germany and Denmark are attributable to UVR exposure, and in principle, preventable. These findings underline the need for primary prevention strategies, aiming to increase the awareness of melanoma and its risk factors and to promote behavioural changes that decrease sun exposure.
Competing Interests: Conflict of interest statement The authors declare the following financial interests/personal relationships, which may be considered as potential competing interests: Dr. Garbe reports personal fees from Amgen, grants and personal fees from BMS, personal fees from MSD, grants and personal fees from Neracare, grants and personal fees from Novartis, personal fees from Philogen, grants and personal fees from Roche, grants and personal fees from Sanofi, outside the submitted work. Dr. Amaral reports grants from Neracare, grants from Novartis, grants from SkylineDx, personal fees and travel support from BMS, travel support from Novartis, personal fees from CeCaVa, outside the submitted work. Dr. Flatz reports grants from Swiss Cancer League, grants from Hookipa Pharma, other from Novartis, other from Sanofi, other from Bristol-Myers Squibb, outside the submitted work; In addition, Dr. Flatz has a patent Arenavirus Particles to treat solid tumours licensed to WO2018/185307A1, a patent Prime-boost vaccination for viral infections licensed to WO2012162428A1, and a patent Replication-defective arenavirus vectors licensed to WO2009083210A1, outside the submitted work. Dr. Leiter reports personal fees from Roche, Novartis and Sanofi, grants and personal fees from MSD, outside the submitted work. Dr. Whiteman reports grants from National Health and Medical Research Council of Australia, personal fees from Pierre Fabre, outside the submitted work. All remaining authors have declared no conflict of interest.
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