While throughout the world, there are reports of an increase in malignant melanoma incidence rates, in Israel there has been stability in the incidence rates and there has been an observed decrease in mortality rates - 30% among men, as well as a 20% drop among women.
In keeping with tradition, hundreds of examination clinics will open tomorrow to perform free skin examinations in all healthcare funds across Israel.
Dr. Lital Keinan-Boker presented new National Cancer Registry and Center for Disease Control statistics of the Ministry of Health, indicating that in 2011, 1,469 new patients were diagnosed with malignant melanoma and 188 succumbed to the disease.
5-year relative survival rates for invasive malignant melanoma continue to rise: 85.8% of men diagnosed from 2003-2006, and 89.7% of women diagnosed in those same years.
Melanoma incidence rates and mortality rates among Israeli Arabs are very low.
A new ICA telephone survey, in the representative sample of adults and teens, demonstrates that awareness concerning the harmful effects of sun exposure has increased, mainly regarding the significant risk, as a result of sun burns, and concomitantly, awareness of the importance of being "sun smart" and using various protective sunscreens has also risen.
There has been a decrease in the percentage of teens who go to the beach at "unsafe hours", as well as a drop in the percentage of young respondents who were sunburned due to uncontrolled sun exposure, alongside the increase in awareness of the inherent risk associated with sunburn, which constitutes a significant risk factor, mainly among teens, for the development of melanoma-malignant skin cancer.
Over two thirds of the respondents were exposed to Israel Cancer Association "Sun Smart" © information and the awareness of the sun's harmful effects. Teens have been exposed to this information mainly during lectures at schools, and adults have been exposed through ICA public service announcements via the various media channels.
Prof. Michal Lotem in an initial report on a preventative vaccine for melanoma patients at high risk of recurrence, using genetic engineering techniques.
Prof. Yaakov Shechter reports on innovative treatments for metastatic melanoma.
Mrs. Rinat Becher presents a new Ministry of Health procedure for the inspection and labelling of sunscreen products.
A new Israel Cancer Association initiative in collaboration with the Israel National Hairdressers Association. The ICA constructed a unique training program for hairdressers to enable them to identify suspicious lesions on the neck and scalp, in order to refer clients for a preventative skin examination performed by a dermatologist. The training program will take place this July, and will be led by ICA Advisor and Director of the Plastic Surgery Unit at Meir Hospital in Kfar Saba, Prof. Shalom Avshalom, who will train the hairdressers on a volunteer basis.
Marking Skin Cancer Prevention and Detection Awareness Week, the ICA published a new and eye-catching coloring book, geared towards preschool and primary school children. This coloring book delivers important "sun smart" messages to young children in the form of an entertaining, friendly and easy-to-understand story. The coloring book will be distributed free of charge to preschools and schools. The coloring book was illustrated by Mr. Uri Fink, a well-known comic book artist.
The "Get set and go get that beauty mark checked", describing risk groups in the population, as well as the signs that should be noted during a mole check-up and more. This booklet has been updated, and is distributed free of charge to anyone interested in receiving a copy.
The ICA has opened a new Melanoma and Skin Cancer Forum on its website. The forum is managed on a volunteer basis by Prof. Jacob Schachter, Director of 'Ella Institute' for the Treatment and Research of Melanoma and Skin Cancer at Sheba Medical Center, Tel Hashomer, and a member of the Special Advisory Committee on Dermatology. Forum members are welcome to post questions and are able to receive up-to-date professional-level information.
A seminar on Melanoma and Basalioma - BCC basal cell carcinoma - will be held on Wednesday 18 June at ICA Headquarters in Givatayim. The seminar is geared towards patients, survivors and their families; admission is free.
The seminar will be held courtesy of Roche Pharmaceuticals Israel Ltd.
Super Pharm and Life brand have enlisted in a special initiative, to assist the ICA in promoting the fight against skin cancer: the company will be donating one shekel from the proceeds of Life sunscreen product sales for the second consecutive year. The funds collected by Super-Pharm will be dedicated to ICA's extensive activity in the fight against skin cancer and in promoting prevention and early detection methods; additionally, Super-Pharm will sell bottles of mineral water bearing the "sun smart"© logo. All proceeds from all these sales will go to the ICA.
Public information booklets published courtesy of Super Pharm, and prepared by the ICA in collaboration with the Pharmacology Division at the Ministry of Health and experts in the field, will also be distributed at Super-Pharm. These booklets are designed to instruct the public on how to apply sunscreen products correctly.
Dr. Lital Keinan-Boker - Deputy Director of the National Center for Disease Control of the Ministry of Health, presents new and up-to-date statistics of the National Cancer Registry of the Ministry of Health, with the approach of Skin Cancer Awareness:
In 2011, 1,469 new patients were diagnosed with malignant melanoma. As per the end of 2011, there were 4,200 invasive malignant melanoma survivors in Israel, and 2,205 malignant melanoma in-situ survivors.
Incidence rates - Invasive cutaneous melanoma
In 2011, 993 new patients were diagnosed with invasive melanoma. Invasive melanoma morbidity has been stable, with a decrease in incidence in both sexes in recent years.
Cutaneous Melanoma In-Situ
Early detection of melanoma in-situ (early-stage melanoma) enables higher cure rates. In 2011, 476 new patients were diagnosed with melanoma in-situ in Israel. The melanoma in-situ incidence rates have been on an upward trend, and have stabilized in recent years.
Details of incidence rates by ethnic origin and age may be found in the attached report.
Survival Rates
The five-year relative survival rates for invasive malignant melanoma are 85.8% in men diagnosed from 2003-2006, and 89.7% in women diagnosed in those same years.
As anticipated, along with the improvement in early detection, there has been a significant increase in survival rates, as compared to survival rates of patient diagnosed in previous years.
Mortality Rates
In 2011, 188 people died of malignant melanoma in Israel (96 men, 92 women). Recently, there has been an estimated 30% decline in mortality rates in men and an estimated 20% drop in mortality rates in women.
International Comparison
According to global cancer statistics 2012 issued by the International Agency for Research on Cancer (IARC), compared to 20 countries with the highest melanoma incidence and mortality rates, it emerged that Israel ranked 13th for men and 20th for women.
New Zealand and Australia have the highest incidence rates from melanoma in the world.
In mortality rates, men in Israel are ranked 8th and women in Israel are ranked 10th (tying with Britain). The highest mortality rates are reported for men from New Zealand and Australia and for women from New Zealand and Australia.
The (estimated) age-standardized incidence and mortality rates per 100,000 for invasive cutaneous melanoma in the 20 countries with the highest rates in the world, 2012.
Please click here to read the attached complete report.
New ICA telephone survey on sun exposure knowledge, awareness and behavior
The survey was conducted by Mutagim Yifat Gat Ltd. Research Institute, among 600 respondents: 500 individuals aged 18 or older, and 100 15-17 year olds.
Awareness of the damage that may be incurred by skin cells as a result of uncontrolled sun exposure:
Most of the respondents asserted that the main damage incurred by skin cells as a result of uncontrolled sun exposure was "skin cancer" - 77%. This was followed by "sunburns" - 32%, "skin spots" - 30% "wrinkles" - 20%.
A higher percentage of individuals aged 18 or older indicated "skin cancer", "skin spots", "wrinkles" and "premature aging" as the main damage incurred as a result of sun exposure, as opposed to 15-17 year old teens.
In comparison with previous surveys: There has been a significant increase in awareness of "sunburns" as a main risk factor for the development of melanoma - 32%, compared to 8% in the 2012 survey, "skin diseases" - 15%, compared to 1% in 2012, and freckles - 10%, compared to 0.4% in 2012.
Awareness of ways skin can be protected from UV rays:
The highest skin protection awareness involves "sunscreens" 81%, followed by awareness of the need to wear a hat 35%, "to wear clothing that covers most of the body - long-sleeves and long pants" - 33%, "staying in the shade" - 32% and "remaining indoors at unsafe hours" - 31%.
In comparison with previous surveys:
There is stability in awareness of the need for sunscreens (79% in the 2004 survey).
There has been a significant increase in the awareness of additional means that may protect the skin from sun exposure, for example, awareness of the need to wear a hat - 35%, compared to 23% in 2004, staying in the shade - 32%, compared to 26% in 2004.
What is more dangerous - a tanning bed or the sun?
Over the past decade, awareness of the dangers inherent in tanning beds has increased, and a third of the respondents said that using a tanning bed and the sun are dangerous to the same degree, compared to 29% in the 2012 survey, and a mere 7% in the 2004 survey.
Among 15-17 year olds, there has been an increase in the percentage of those who assert that the sun and tanning beds are dangerous to the same extent - 34%, as opposed to 20% in 2012.
26% of the respondents asserted that the sun is more dangerous than a tanning bed, compared to 47% of the respondents in the 2004 survey, who believed that the sun is more dangerous than a tanning bed.
40% of 15-17 year olds consider tanning beds to be more dangerous than the sun, compared to 24% among older respondents.
Behavior
What means of protection do people use when they are out in the sun?
The most commonly reported means of protection was "staying in the shade", about 75% asserted that they always make sure and/or make an effort to stay in the shade, followed by 58% who reported the use of sunscreen, and 54% who reported wearing a hat.
Protective measures against the sun were reported in higher percentages among respondents aged 18 or older.
In comparison with the survey conducted in 2004, a higher percentage of adults reported the use of means of protection. For example, a higher percentage of adults wore a "hat" as a means of protection against the sun - 56% today, compared to 44% in 2004.
Why do you think people who are aware of the harmful effects of the sun do not protect themselves?
The main reasons that were given by the participants were: 34% asserted, "that they don't care/take it lightly", 33% thought that it is because of "lack of awareness/lack of attention", 27% thought that people do not protect themselves, because they think that a tan is beautiful, and about a fourth asserted that it derives from thinking that "it won't happen to me" and/or because people prefer to ignore the problem.
As for the question as to what would make them personally protect themselves from uncontrolled sun exposure:
Among those aged 18 or older, 22% referred to the damage or diseases incurred by the sun, 21% referred to the impact of evidence-based medical information, or scientific literature and publications on this subject in the media. Teens aged 15-17 referred more frequently to the information regarding possible damage - 21%, acquaintance with someone close who has the disease - 21%, if they personally suffered from the sun's harmful effects - 15%. Publications and ads in the newspapers - were indicated by 14%, as a factor that has an impact on controlled sun exposure.
Compared to the 2004 survey, the factors which have an impact on people's decision to protect themselves are mainly information from research studies and scientific articles as well as related ads in the media.
An increase has also been demonstrated in references to the suffering of people with whom they are acquainted, as a result of the sun's harmful effects, as a factor influencing behavior - 16% compared to 9% in 2012, 10% in 2004.
What a visit to the beach entails:
70% of the respondents go the beach - 69% are aged 18 or older, compared to 93% aged 15-17.
About 40% of the respondents tend to go to the beach at "less dangerous" hours, up to 10 o'clock in the morning - 15%, and in the afternoon after 4pm - 25%.
Among the young people who go the beach, there has been a significant decrease in the percentage of young respondents who go to the beach at "unsafe" hours - 60% in the 2014 survey, as opposed to 74% in the 2012 survey.
Did they get sunburnt over the past year?
15% of the respondents reported getting sunburnt from uncontrolled sun exposure. More young people reported getting sunburnt - 29%, compared to 14% aged 18 or older.
There has been a decrease in the percentage of respondents who were sunburnt as a result of uncontrolled sun exposure - 15%, compared to 19% in 2012.
There has been a significant decrease in reports on sunburns among young people - 29% reported sunburns, compared to 49% in 2012.
Exposure to Israel Cancer Association Public Information:
Over two-thirds of the respondents, 68%, were exposed to Israel Cancer Association "sun smart" information - 71% aged 15-17 and 68% aged 18 or older.
Significant media channels through which 15-17 year olds were exposed to public information: lectures at schools - 37%, TV public service announcements - 29%, ICA website - 10%.
Respondents aged 18 or older who were exposed to TV public service announcements - 33%, to newspaper ads - 25%, to radio ads - 17%, to the ICA website - 13%, to ICA informational materials - 12%.
Among those who were exposed to ICA information, about 60% of aged 18 or older, and about 70% of young people were exposed to ICA TV public service announcements.
Preventative vaccine for melanoma patients at high risk of recurrence through cells engineered with beta protein that stimulate an immune response
Prof. Michal Lotem - Director of the Center for Melanoma and Cancer Immunotherapy, Sharett Institute of Oncology, Hadassah Medical Center, Jerusalem
Background
Despite the great advancement in the treatment of metastatic melanoma, prevention of the risk of disease recurrence is way behind.
This subject is particularly problematic for patients who have undergone surgery to remove cancerous lymph nodes (metastases). They are seemingly cancer-free but have a 50% and higher risk of recurrence.
Over the past 15 years, melanoma patients have been vaccinated with tumor cells removed from their bodies. We have observed that patients in whom the tumor has simulated a strong response in the skin test - have better chances of survival, as opposed to patients demonstrating no response, whose survival [rates] are not improved.
In view of the aforesaid, we have used a genetic engineering technique and we have penetrated a gene encoding a protein into the melanoma cells, which is important in stimulating bb ligand4-1 cells.
This protein stimulates the infected cells to counteract the tumor. In fact, injection of tumor cells expressing protein creates a local "catalyst" driving a protective immune response.
The first 16 patients have been vaccinated to date this year. The vaccination activated a powerful response in their bodies. They are currently being monitored to examine whether the risk of melanoma recurrence will indeed be reduced.
The interest in vaccinations has increased over the past two years in view of new evidence as to the power of the immune system against various tumors, when activated properly.
This research study was financed by Hadassah Hospital and the Adelson Foundation, and has been supported over the years by the ICA.
Innovative Metastatic Melanoma Treatments
Prof. Jacob Schachter - Director of the Ella Institute, Melanoma Institute, Sheba Medical Center, Tel-Hashomer for the Treatment and Research of Melanoma and Skin Cancer at the Sheba Medical Center
According to Prof. Schachter, there have been two main developments in the treatment of metastatic melanoma patients over the past year:
The clinical trials processes with the Anti PD-1 drug are in the final stages, and the drug has been submitted for FDA approval for melanoma indications. The drug is characterized by slight side-effects and greater efficacy, with a significant portion of patients greatly benefitting therefrom. The drug activates an immune-mediated anti-tumor response.
An enhanced technology for the treatment of melanoma cells and other types of cancers has been developed, based on identification of patient-specific cancer driver mutations.
New Ministry of Health procedure for the inspection and labelling of sunscreen products
Mrs. Rinat Bachar - Cosmetics Licensing Dept. Manager, Pharmacy Division of the Ministry of Health, reported, that the Ministry of Health issued a new procedure aimed at inspecting and labelling sunscreen products. The procedure was formulated by a Joint Ministry of Health - ICA Committee of Experts.
This procedure was written to enable the manufacture, import and marketing of sunscreen products that protect against UV rays, while safeguarding public health and welfare, according to the fluctuating and developing regulations across the globe.
This procedure immediately came into effect, while up to 31 August 2014, cosmetics may be submitted for registration pursuant to the current procedure, as well as pursuant to the new procedure, and as of 1 April 2017, distribution of cosmetics that fail to meet the new procedure criteria shall be banned.
Attached please find the registration procedure for sunscreen products (in Hebrew).
New ICA Initiative: Hairdressers Will Endeavor to Increase Awareness of the Importance of the Early Detection of Skin Cancer
New ICA initiative in collaboration with the National Hairdressers Association of Israel.
Hairdressers will be positioned at a unique station enabling them to examine the neck and scalp of their clients, who are not always aware of lesions in these areas.
The ICA has contacted the the Israel National Hairdressers Association with an offer to develop a unique training program in which hairdressers will be equipped with the tools to enable them to discern suspicious lesions on the neck and scalp, and to encourage their clients to make an appointment with a dermatologist to get themselves checked.
Training will be delivered by Prof. Shalom Avshalom, Advisor to the ICA and Director of the Plastic Surgery Unit at Meir Medical Center in Kfar Saba and a senior lecture at Tel Aviv University.
ICA Skin Cancer Awareness Week in Collaboration with the Healthcare Funds
Upon the initiative of the ICA, and in collaboration with all healthcare funds, over 300 examination clinics will open from 26 May to 1 June (inclusive) to provide free skin lesion examinations throughout Israel.
To make an appointment, please contact the healthcare fund to which the patient belongs.
Please click here for a list of the examination clinics on the ICA website.
The list of examination clinics will also appear in the local newspapers.
ICA Telemeida Teleinformation Center: 1-800-599995
The ICA Information Center Presents New Research Studies
Are there gender differences in body site distribution of melanoma lesions?
In a research study that was conducted in several medical centers and research centers in France, the differences between women and men in body site distribution of melanoma tumors were examined in order to try to adapt the prevention and early detection recommendations by gender.
For the purpose of this research study, data was collected from the National Cancer Registry of France, as well as from questionnaires that were completed by physicians who treated patients, regarding the gender of the patient and the body site distribution of the tumor.
During the period 2004-2011, 1,542 cases of cutaneous melanoma among men and women were documented in the Champagne-Ardenne region of France. The research scientists examined the body site distribute of the tumors in the head and neck area, the upper torso, the upper limbs, the lower limbs, the arms and legs, as well as in the lower extremities of the body.
According to the research findings, there was a significant difference between the body site distribution of melanoma tumors in the lower limbs of women, which characterized 32.2% of the cases, compared to 9.3% of the cases among men, as well as in the body site distribution of melanoma tumors in the upper torso (which does not include the upper limbs) among 41.8% of the men compared to their prevalence among 14.9% of the women.
Melanomas of the hand and foot stood out more among women, with 10.3% of the cases, compared to 6.3% of cases among men.
Among women, there were more right-side head and neck melanoma tumors, whereas among men, there were more melanoma tumors left-side tumors in this area. No significant differences were observed between men and women in the prevalence of melanoma tumors in the rest of the body areas.
The research findings show that men and women develop melanoma in different areas of the body. The research scientists believe that the different distribution attests to the differences in gender behavior patterns in terms of exposure to the sun, and therefore, in addition to strengthening and expanding the current recommendations for protection from the harmful effects of the sun, messages specifically targeted at men or women may improve melanoma prevention.
The research scientists suggest encouraging men who are partially to fully bald, to wear a hat and apply sunscreen, to emphasize specifically to men the importance of avoiding sun exposure to their upper torso, both at work and during leisure hours (as is well known, men tend to expose themselves with their upper torso completely exposed to the sun very often, unprotected by clothing), and concomitantly, warn women of the danger inherent in sun exposure to their legs.
This research study was published in the April 2014 issue of the British Journal of Dermatology.
Is there a link between Viagra use and the risk of cutaneous melanoma?
Research scientists from several American universities sought to examine the link between Viagra use - a drug for the treatment of erectile dysfunction - and the risk of developing melanoma among men in the United States.
The research study was conducted further to evidence from recent research studies which showed that the use of PDE5A enzyme inhibiting drugs, such as Viagra, may increase the risk of developing this disease. The various studies have shown that the use of these drugs has increased the manufacture of melanin, which is a pigment that protects the skin from UV rays, which in turn accelerates the development of cutaneous melanoma. Similarly, it has been observed that the use of PDE5A enzyme inhibitors may raise the risk of melanoma cells' spreading beyond the original tumor.
This research study was conducted in the format of a prospective follow up study. About 25,848 men aged 40-75 interviewed in a survey reported the use of Viagra for the treatment of erectile dysfunction - in the past and at present.
The research scientists indicate that the dose of Viagra was not reported. Likewise, the participants completed data regarding their lifestyle: weight, smoking habits, and the extent to which they engage in physical activity.
In addition, detailed information was collected regarding the number of moles, skin color and hair color when they were 18, sun exposure habits, and family history of melanoma. Similarly, the research scientists collected information about their past and current places of residence, and classified the men into different categories of sun exposure during their lifetime.
Of all the participants in the research study, about 5.3% reported recent Viagra use, and 6.3% reported having taken Viagra sometime in the past. The follow up was conducted for a decade (2000-2010), during which an incidence of 142 cases of cutaneous melanoma was observed. Similarly, incidence of cutaneous non-melanoma cancers was also observed: 580 cases of Squamous Cell Carcinoma (SCC) cancer and 3,030 cases of Basal Cell Carcinoma (BCC).
Based on the research results, it emerges that the men who reported recent Viagra use, were at a nearly twofold risk of developing cutaneous melanoma. A similar increase in risk was also observed in cases where subjects had taken Viagra in the past. The research results remained similar even when variables such as sun exposure were neutralized.
Upon further analysis of the data, participants suffering from difficult chronic diseases were neutralized, and in this case as well, the results were similar, and indicated a 2.24-fold increased risk of contracting cutaneous melanoma among men who had taken Viagra.
However, no increase was observed in the risk of developing cutaneous non-melanoma cancer, and no link emerged between erectile dysfunction and higher risk of melanoma, but rather, between the use of the drug and melanoma morbidity.
The research scientists emphasize that additional research studies are required to reinforce the link between Viagra use and the risk of cutaneous melanoma.
This research study was published online in the April 2014 issue of JAMA Internal Medicine.
Alcohol consumption may be linked to an increased risk of cutaneous melanoma.
In a research survey, research scientists from Italy and Sweden presented data that reinforce the link between daily alcohol consumption and the risk of cutaneous melanoma.
There are reports that alcohol consumption may make the skin more vulnerable to sunburn, which constitutes a principal risk factor for cutaneous melanoma, however various epidemiological research studies which have investigated the link between alcohol and cutaneous melanoma have revealed findings that are not unequivocal.
In the current research study, the research scientists conducted a methodical survey (meta-analysis) of 16 research studies in order to better estimate the link between alcohol and melanoma risk. Relevant studies were selected, encompassing a total of 6,251 melanoma cases. 6 of the studies that were selected were conducted in Europe, 3 in Australia, 6 in North America and 1 in South America.
To weight the data and compare between the various studies, the units of reported alcohol consumption were adjusted: daily light alcohol consumption was defined as one drink, or less than 12.5 g of alcohol, and moderate-high consumption, was defined as more than one drink or more than 12.5 g of alcohol.
According to the research results, the overall relative risk of cutaneous melanoma emerged to be 20% higher among people who had consumed alcohol on a daily basis, compared to those who didn't consume alcohol at all, or who consumed alcohol once every so often. In terms of light alcohol consumption, the relative risk is 10% higher, whereas among moderate-high alcohol consumers, the relative risk is 18% higher, compared to those who do not consume alcohol at all, or who consume alcohol occasionally.
The research scientists indicate that in 10 research studies, the sun exposure [risk] factor was neutralized, and that the overall risk that emerged in these studies stands at 15%, compared to a 27% risk in the findings of 6 research studies in which no adjustments were made.
Upon further analysis of the research findings, differences emerge according to geographical areas in which the studied were conducted, for example: in all the research studies conducted in Australia, it emerged that the overall cutaneous melanoma risk among alcohol consumers who consumed alcohol on a daily basis, was 20% higher than that of those who do not consume alcohol at all, or consume alcohol occasionally. In Europe, the risk is 4% higher, and on the American continent (north and south), the risk of alcohol consumers who consume alcohol on a daily basis, as opposed to those who do not consume alcohol at all, or consume it once in a while - was 41% higher.
To conclude, the research scientists revealed a link between alcohol consumption and the risk of developing melanoma, and even assert that the combination of alcohol consumption and [exposure to] UV rays play a synergetic role in promoting cancerous processes. However, the research scientists indicate that, in view of the fact that the sun exposure factor was not neutralized in all of the reviewed research studies, it is inevitable that the research results were affected by this component.
This research study has, as have many other studies, attested to the harmful health effects of moderate-high alcohol consumption.
This research study was published online, in the January 2014 issue of the British Journal of Dermatology.