Skin Cancer : Burden of Disease

Key Points

The burden of skin cancer is measured by incidence and cost, and by newer approaches such as non-traditional measures that take into account the impact of skin cancer on the psychological, social, and economical aspects on an affected individual's life.
Costs associated with treatment significantly increase with advanced disease.
With the rising rates of skin cancer, the burden of this disease will continue to increase.

Introduction

The burden of a skin disease is defined as the effect of the disease on the overall welfare of a population, which encompasses the adverse impact of skin diseases on physical health, psychological health, social functioning, quality of life (QoL), and economic well-being. Skin diseases are among the most common health problems worldwide, with over 3000 known diseases classified, and they are associated with a considerable burden. Moreover, burden of disease can be assessed from the viewpoints of the individual, the family, and society. Chronic and incurable skin diseases, such as psoriasis and eczema, are associated with significant morbidity in the form of physical discomfort and impairment of patients' quality of life; whereas skin cancers, such as malignant melanoma, can carry a substantial mortality.

Although the traditional epidemiological measures of burden of disease remain important in the assessment of the public health burden of skin cancer, they do not indicate the overall degree of impairment and cost associated with the skin malignancies. In this era of economic concerns, skin cancer expenses have become an important measure. The total cost of skin cancer in Sweden in 2005 was estimated at euro 142.4 million (euro 15/inhabitant), of which euro 79.6 million (euro 8/inhabitant) was spent on health services and euro 62.8 million (euro 7/inhabitant) was due to loss of production. The main cost driver was resource utilization in outpatient care, amounting to 42.2% of the total cost. Melanoma was the most costly skin cancer diagnosis. Non-melanoma skin cancer was, however, the main cost driver for health services alone.

In addition, in attempts to more thoroughly describe the burden of disease, recent focus has been on non-traditional measures that take into account the impact of skin cancer on the psychological, social, and economical aspects of an affected individual's life, notably financial costs and the impact on patients' QoL. With the availability of a wide range of health status and quality-of-life measures, the effects of skin cancer on patients' lives can be measured efficiently. This chapter will focus on the overall burden of disease of skin cancers in order to highlight the magnitude of the associated problem and also to suggest ways to better quantify this issue.

Melanoma

Epidemiology

Important epidemiologic measures of the burden of melanoma include incidence and mortality. The Surveillance, Epidemiology and End Results (SEER) registries maintained by the National Cancer Institute since the 1970s provide epidemiologic data on melanoma. . Melanoma is one of the fastest growing cancers worldwide; studies from Europe, Singapore, Canada, and the United States (US) suggest that its incidence is continuing to increase, especially amongst light-skinned racial groups, by 3–7% annually. The highest incidence rates overall are observed among white males 65 years of age and over (120.6 per 100,000), followed by white females 65 and over (46.9 per 100,000). The lowest incidence is among African Americans, with a rate of 1.0 per 100,000. Thus, in the US, melanoma is more than 20 times more common among whites than among blacks. As a group, ethnic minorities represent <5% of all diagnosed cases. Men carry a larger proportion of the burden of disease, with a male:female ratio of 3:2. From 2002 to 2006, the median age at diagnosis for melanoma of the skin was 59 years, reflecting a relatively long latent period of the disease (see Chapter 5 for further analysis).

In terms of prevalence, in 2006 in the US there were approximately 758,688 men and women alive who had a history of melanoma of the skin, 367,925 men and 390,763 women, which is roughly 0.25% of the US population.

Although melanoma accounts for only 4% of diagnoses of skin cancer, it accounts for 80% of skin cancer-related deaths. According to data from the SEER registry, the age-adjusted death rate was 2.7 per 100,000 men and women per year based on patients who died in 2002–2006 in the Unites States, with a median age at death of 68 years. Lesser increases in mortality rates in the face of dramatic increases in incidence are not thought to be attributable to improvements in treatment but may be due in part to earlier detection.

For men and women over 65 years of age, mortality increased by 3.0% annually, reaching 13.0 deaths per 100,000 in 2006. Men over 65 years had the fastest increase in mortality over this period (APC 3.9%), reaching 20.8 deaths per 100,000 in 2004. Melanoma in the elderly may have a different biology and altered host immune response, both of which could contribute to increased incidence and mortality. According to these trends, melanoma will soon become an increasingly major concern for the aging population and their healthcare providers and warrants public health attention.

Costs

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