Melanoma Incidence Among Non-Hispanic Whites in All 50 US States From 2001 Through 2015

Background: The United States has large regional variation in primary prevention campaigns for skin cancer. We collected data from all 50 states to examine changes in melanoma incidence and performed age-period-cohort analyses to describe the simultaneous effects of age, period, and cohort on incidence rates. Methods: Annual melanoma incidence rates for non-Hispanic whites from 2001 to 2015 were extracted from the US Cancer Statistics registry. Secular trends were examined overall and by sex and state. We used joinpoint regression to compute annual percent change and average annual percent change and corresponding 95% confidence intervals (CIs). We also analyzed incidence trends by 5-year age group and birth cohort using incidence rate ratios and age-period-cohort modeling. Results: Melanoma incidence increased from 20.7 per 100 000 (95% CI=20.5 to 20.9) in 2001 to 28.2 per 100 000 (95% CI=28.0 to 28.5) in 2015, increasing by 3.90% (95% CI=2.36% to 5.48%) annually between 2001 and 2005 and 1.68% (95% CI=1.37% to 1.99%) annually from 2005 through 2015. The average annual percent change in melanoma incidence rates were similar for men (2.34%, 95% CI=1.91 to 2.78) and women (2.25%, 95% CI=1.60 to 2.91). Age-specific relative risk by birth cohort increased from circa 1921 to 1981 before decreasing. Compared with adults born circa 1956, those born circa 1991 had lower melanoma risk (incidence rate ratio =0.85; 95% CI=0.77 to 0.94). Geographic variation was observed; some states still have melanoma rates trending upwards in all birth cohorts. Conclusions: The continued increase in melanoma incidence among non-Hispanic whites, particularly in states where rates continue to rise among recent and current birth cohorts, underscores the need for increased public health campaigns aimed at reducing sun exposure.