The morbidity rates in Israel are among the highest in the world after Australia and New Zealand and are similar to the morbidity rates in the white population in the USA and Norway
Dr. Micha Barhana, Irena Lifshitz
Malignant melanoma of the skin is the most significant malignant disease affecting the skin when the main cause of morbidity is exposure to the sun.
The morbidity rates in Israel are among the highest in the world after Australia and New Zealand and are similar to the morbidity rates in the white population in the USA and Norway.
About 940 new patients are diagnosed every year in recent years (2003-2004), which is a slightly lower number of patients than what we reported in previous years.
The significant change we have seen in recent years is a decrease in the rates of new cases (the rate of new patients) diagnosed in Israel in recent years. Already two years ago we reported that the age-adjusted incidence rates of the disease in women in Israel are in a stable state, meaning that the increase in morbidity rates that characterized Israel in recent decades has stopped. Now that we have data about the occurrence rates in the years 2002-2004 as well, we can say that the melanoma rates in both men and women have begun to decrease, as shown in the following diagram:
We note that the number of cases (and the rates of the disease) in the Arab population are tiny, so it is not possible to check the trends in this population group.
Another interesting fact that emerges from the analysis of morbidity trends in the last 15 years is the ratio of morbidity between men and women. In recent decades, the malignant melanoma of the skin was more associated with women, so that women had the disease more frequently than men. As can be seen in the diagram, until 1995 the disease rates in women were about 20% higher than in men. With the stabilization of morbidity rates in women, in the early nineties and the continued increase in morbidity in men, there was a change in the ratio of morbidity rates so that the morbidity rates in men are about 20% higher than those in women.
A change in the rates of occurrences (new cases) of a disease in the direction of a decrease in morbidity is mainly due to success in primary prevention, which is actually removing or reducing exposure to the causes of morbidity. Changes may also result from reasons unrelated to this, such as in the case of changes in reporting and changes in the short term can result from the cessation of proactive activity for early detection. In Israel, there is no proactive activity on the subject of malignant melanoma and there is no recommendation to carry out such an activity, the incidence rates of targeted melanoma in Israel in recent years constitute about 30% of the total number of melanomas diagnosed in Israel and there is a trend towards an increase in the early diagnosis of the disease. The rate of melanomas diagnosed in the early stages was 2/100,000 in the early nineties and in 2002-2004 it was 4/100,000. This trend contradicts the assumption of a general decrease in disease rates due to the cessation or reduction of early detection (which was actually supposed to lead to an increase in the overall rate of the disease).
As for changes in reporting, it is known that there is an obligation to report all malignant diseases to the National Cancer Registry in Israel. Regular monitoring of the completeness of the reporting is carried out when the last study carried out in Israel about a decade ago indicated a reporting rate of about 95% and since then measures have been taken to improve the reporting. Tests conducted by the national registry team do not support that there have been changes in reporting patterns in Israel, but rather in the direction of more complete reporting.
The reason for the decrease in the incidence of the disease is, in our opinion, related to primary prevention, that is, reducing exposure to the sun. Since the beginning of the 13s, large-scale public awareness campaigns have been conducted in Israel, headed by the "Skin Cancer Awareness Week and its Early Detection" which was initiated by the Cancer Society about XNUMX years ago and is held in cooperation with the Ministry of Health, the health insurance funds, the Israel Dermatology Association and the Israel Plastic Surgery Association. At the same time, an activity has begun to anchor guidelines in regulations such as those dealing with the obligation to shade in public pools and obligations to wear shirts, hats and use sunscreens in activities carried out in schools or as part of them. These actions, together with the raising of public awareness of the harms of sun exposure accompanied by advertising campaigns in the various media for over a decade, are the causes of the decrease in the incidence of the disease. The fact that there is an increase in the rate of early detection only strengthens our assumption. The fact that the public, including the medical public, has an awareness of the disease means that the disease is diagnosed in earlier stages when skin lesions that change their size, color, or whose edges become uneven or that there is a discharge from them bring the public to a professional medical examination and to diagnose the disease in its early stages.
We asked to check whether the decrease in the incidence of the disease applies equally to all population groups in Israel or whether there is a population group in which the change is especially noticeable. This test also has the potential to shed light on the main reason for the change in morbidity trends since it is known that exposure to the sun, including sunburn, at a young age significantly affects the chance of contracting the disease than similar exposure in older people. In addition, the assumption is that those advertising campaigns and increasing awareness may affect mainly the younger generation and relatively less on the older population.
Due to the relatively small number of cases in the younger ages, we divided the patient population into three groups, aged 0-44, 45-64 and the group of older patients who were diagnosed with the disease when they were over 65. The test results indicate a constant increase in the incidence rates in the 65+ age group in men with no sign of A decrease in incidence, while in women, after a moderate increase in incidence between the years 1990 and 2002, there is a downward trend in morbidity.
In the middle age group, 45-64, there is a downward trend in morbidity in men starting from 2002, while between the years 1990-1999 there was stability in morbidity and in the early 2001s an increase in occurrences. Among women in this age group, there is overall stability in morbidity with a tendency to decrease in morbidity rates since XNUMX.
The charts also show data on the incidence of malignant melanoma in the younger population, aged 0-44, but due to the scale of values that refers to all populations, it is difficult to discern trends in this population.
When we examine the incidence of the disease in this group only, we can see the very significant decrease in the morbidity rates in women, when the rates in the early nineties stood at 8 new cases per 100,000 women and in 2004 the rate of new patients with melanoma of the skin aged 0-44 stood at 4.5 new cases per 100,000 Jewish women in Israel.
In men, the morbidity rates in this age group were stable from the beginning of the nineties until the year 2000 and stood at 5 new cases per 100,000 Jewish men in Israel. From this year, and in a gradual and constant manner, the incidence rates of melanoma are also decreasing in men, when at the end of the examined period, the year 2004, four cases of melanoma of the skin were diagnosed in Israel for every 100,000 men aged up to 44.
In conclusion, it can be said that for the first time we have evidence that the public awareness efforts and the direction of the public to take preventive measures, whether by preventing exposure to the sun during the hotter hours of the day or by using shades of various types, including light clothing that shields the skin from direct radiation or by using filters Radiation in a wise way bears fruit.
Two positive trends emerge from the data, one is a decrease in both men and women in the rates of new cases and the other is an increase in the rate of patients diagnosed in a targeted stage of the disease, when the chances of cure are high.
On the sidelines, we note that the number of new cases diagnosed each year in young people aged 0 to 18 is small (10-5 patients per year) and therefore it is difficult to draw clear conclusions regarding changes in incidence in this age group. In any case, there is no sign of an increase in incidents at these ages, even though there are opinions that such a trend exists.
* This article contains medical information. His publication on this website does not constitute a recommendation for this or that treatment, or this or that drug.
