Incidence of cutaneous malignant melanoma in Israel, 1960-1989

Abstract

Background: The cutaneous malignant melanoma (CMM) incidence rate in most affluent countries has increased over the last three or four decades. Despite specific attention, evidence for a role of factors other than sun and ultraviolet exposure is weak. Objective: To update time trends of CMM in Israel. Method: A population-based cancer registry data base of CMM among Jews and non-Jews by age and gender was analyzed. A quality control survey was conducted to insure complete coverage and data validation for the period 1960-1989. Results: The incidence rate of CMM in All Jews increased throughout the study period, with a monotonic annual increase of 4.8% for males and 4.3% for females. There was a steep increase in incidence until the mid-1970s, with an a posteriori levelling-off. Also, incidence was higher in females than in males. There were variations in incidence among Jewish subpopulations. Israel-born Jews are the highest incidence subgroup (average age-adjusted incidence rate (AAIR) 7.8 and 9.4 per 100,000 for males and females, respectively), followed by Jews born in Europe and America (AAIR, 6.1 and 7.3 per 100,000 for males and females, respectively). The lowest rate was for Jews born in Africa and Asia (AAIR, 1.3 per 100,000 for both males and females). Analysis of age-truncated rates reveals that Jews born in Europe, America, and Israel, mainly at age 45-64, have increasing CMM incidence. Non-Jews have a stable rate which could either be real or an artifact of underdiagnosis. Conclusions: The different time trend incidence patterns between subpopulations could be due to differing cumulative sun exposure over the last 40-50 years, mainly in those at age 45 and over. The levelling-off of the invasive CMM incidence rate, mainly in native Israeli Jews under age 45, could be attributed to increasing awareness and early diagnosis.