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This Week in the British Medical Journal: Sep 6, 2011

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In the British Medical Journal this week, general practitioner Des Spence writes that calls for a policy to require children to wear sun protection at all times is the wrong way to go about preventing melanoma. Since 1980, the incidence of melanoma in the UK has almost tripled, and, in response, the government has called for a policy to enforce the wearing of hats and sunscreen while outside and to encourage the "active avoidance of the sun," Spence writes. However, sunlight is essential for human survival and well-being, Spence says adding that it is not the people who are most exposed to the sun who are seeing a surge in melanoma. "Melanoma most commonly occurs in areas that are less sun exposed. It is 50 percent more common in social class one, despite the fact that manual workers are more likely to work outside and use sun beds. And women have a 20 percent greater incidence of melanoma yet a 20 percent lower death rate compared with men," Spece says. Although the rates of melanoma have gone up, the actual rate of death from melanoma for people under 65 has stayed the same — this cannot be explained by better treatment, he adds, because melanoma is resistant to chemotherapy. The increased rate of melanoma may simply be nothing more than an artifact of over-diagnosis by eager dermatologists who rush to remove skin lesions that will never progress to cancer, Spence says. Avoiding the sun is likely to result more in higher rates of vitamin D deficiency and bone diseases than a lower rate of melanoma in the UK, he adds.

Also in the British Medical Journal this week, researchers in Belgium present a study on the effects of manual lymph drainage on the development of arm lymphedema related to breast cancer. The team studied 160 patients with breast cancer who had undergone unilateral axillary lymph node dissection, and split them into two groups — an intervention group that underwent a treatment program consistent with guidelines about the prevention of lymphedema, including exercise therapy combined with manual lymph drainage and a control group that underwent the same program, but without the manual lymph drainage. At 12 months after surgery, the researchers found that the cumulative incidence rate for arm lymphedema was comparable between the two groups, as was the time to develop lymphedema. "Manual lymph drainage in addition to guidelines and exercise therapy after axillary lymph node dissection for breast cancer is unlikely to have a medium to large effect in reducing the incidence of arm lymphedema in the short term," the authors write.

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