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43 Melanoma trends in black americans and white americans – inferences on overdiagnosis
  1. Adewole Adamson1,2,
  2. Elizabeth Suarez3,
  3. H Gilbert Welch4
  1. 1University of Texas at Austin, Austin, TX, USA
  2. 2Dell Medical School, Austin, TX, USA
  3. 3University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
  4. 4N/A, Thetford, VT, USA


Objectives The incidence of cutaneous melanoma has been rising rapidly among white Americans. A commensurate increase in melanoma mortality, however, has not been observed. To gauge potential overdiagnosis, we explored comparable data for black Americans.

Method We used Joinpoint regression of 1975–2014 Surveillance, Epidemiology, and End Results data to determine melanoma incidence and mortality trends in blacks and whites. Using two distinct approaches, black incidence trends as a marker for changes in underlying (true) disease burden and black mortality trends as a marker for improvements in medical care, we estimated the expected underlying incidence in whites and the proportion of cases overdiagnosed. All analyses were stratified by sex.

Results Between 1975 and 2014 melanoma incidence increased approximately 4-fold in white women and 6-fold in white men, while it increased less than 25% in black women and men. Based on these incidence trends we estimate 70% (95% CI: 62–76%) of white women and 80% (95% CI: 70–87%) of white men were overdiagnosed in 2014. Melanoma mortality was stable in white women and rose almost 50% in white men, while it fell approximately 25% in black women and men. Based on these mortality trends we estimate 59% (95% CI: 45–70%) of white women and 60% (95% CI: 32–75%) of white men were overdiagnosed in 2014.

Conclusions Because overdiagnosis cannot be directly observed in an individual, its identification requires indirect observations of epidemiological data. The forgoing discrepant incidence and mortality trends are best explained by considerable melanoma overdiagnosis among white Americans.

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