Screening finds skin cancer, but does it save lives?
Doctors find a high number of malignant tumors when a state-wide skin cancer screening program is introduced, says a new study.
Based on results from a program in Germany, researchers say 116 people need to be screened for skin cancer and five people need to have a biopsy to find one malignant tumor.
They, however, cannot say whether the screenings actually saved lives.
Still, the numbers reported in the new study are “quite good,” said Dr. Alexander Katalinic, one of the study’s coauthors, in an email to Reuters Health.
In the United States, the last time the government-backed U.S. Preventive Services Task Force (USPSTF) looked at the screenings in 2009, the group said there was not enough evidence to recommend full-body exams to check for signs of skin cancer in adults. The USPSTF, however, did not recommend against it either.
Dr. Virginia Moyer, the chair of the USPSTF, said the group reviews its guidelines every few years, and as for now its 2009 recommendation stands.
SOME FALSE POSITIVES
For the study, the researchers examined data from the Skin Cancer Research to Provide Evidence for Effectiveness of Screening in Northern Germany (SCREEN) program, which was conducted in the German state of Schleswig-Holstein between 2003 and 2004. (Germany has had a national skin cancer screening program in place since July 2008.)
More than 360,000 people older than 20 years old and living in the state chose to be screened by doctors who went through a special training to identify suspicious skin lesions or moles.
Skin cancer is the most common form of cancer in the United States. In the United States in 2008, 59,695 people were diagnosed with melanomas of the skin, and 8,623 people died from it.† CDC leads national efforts to reduce skin cancer through education. When in the sun, seek shade, cover up, get a hat, wear sunglasses, and use sunscreen.
More than 45,000 cases of melanoma occurred in 45 states and the District of Columbia each year between 2004 and 2006, according to the report. Melanoma is the deadliest type of skin cancer, causing about 8,000 deaths in the U.S. each year.
Significant Findings
- Deaths caused by melanoma accounted for $3.5 billion in lost productivity each year.
- A person who died of melanoma between 2000 and 2006 died 20 years prematurely, compared to 17 years from other cancers.
- Melanoma rates were higher among white, Hispanic females aged 50 and younger, and Asian/Pacific Islander females aged 40 and younger, compared to their male counterparts. This study also found that Hispanics, American Indians/Alaska Natives, and Asians were diagnosed with melanoma at younger ages than whites and blacks.
- Melanoma incidence was higher among females than males, increased with age, and was higher in non-Hispanic whites than Hispanic whites, blacks, American Indians/Alaska Natives, and Asians/Pacific Islanders.
- In 2005, 34% of adults had been sunburned in the past year, and in 2004, 69% of adolescents were sunburned during the previous summer.
- Doctors are required by law to report melanomas to central cancer registries, but many dermatologists reported being unaware of reporting requirements.
Some people decided to see a dermatologist while others went to a general practitioner who referred them to a dermatologist if they suspected skin cancer.
Overall, about 16,000 people had a biopsy - about one for every 23 people who were screened. Doctors identified about 3,100 malignant tumors from those biopsies.
The cost for each screening is about $27. A biopsy can run over $100, and the removal of a malignant skin lesion can cost about $800.
The researchers cannot say how many screenings led to an unnecessary biopsy or treatment, because of the program’s design. But, Katalinic said “of course there are false positives.”
Overall, there were 3,103 malignant skin tumors, and 585 of those were malignant melanomas, the most deadly type.
More than 50 people between the ages of 20 and 49 years old had to have a biopsy to identify one melanoma. That’s more than double the 20 biopsies needed to find one in people over 65 years old.
MELANOMA
- One person dies of melanoma every hour (every 62 minutes).
- One in 55 people will be diagnosed with melanoma during their lifetime.
- Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old.
- The survival rate for patients whose melanoma is detected early, before the tumor has penetrated the skin, is about 99 percent. The survival rate falls to 15 percent for those with advanced disease.
- The vast majority of mutations found in melanoma are caused by ultraviolet radiation.
- The incidence of many common cancers is falling, but the incidence of melanoma continues to rise at a rate faster than that of any of the seven most common cancers. Between 1992 and 2004, melanoma incidence increased 45 percent, or 3.1 percent annually.
- An estimated 123,590 new cases of melanoma were diagnosed in the US in 2011 — 53,360 noninvasive (in situ) and 70,230 invasive, with nearly 8,790 resulting in death.
- Melanoma accounts for less than five percent of skin cancer cases,20 but it causes more than 75 percent of skin cancer deaths.
- Survival with melanoma increased from 49 percent (1950 - 1954) to 92 percent (1996 - 2003).
- Melanoma is the fifth most common cancer for males and sixth most common for females.
- Women aged 39 and under have a higher probability of developing melanoma than any other cancer except breast cancer.
- About 65 percent of melanoma cases can be attributed to ultraviolet (UV) radiation from the sun.
- One or more blistering sunburns in childhood or adolescence more than double a person’s chances of developing melanoma later in life.
- A person’s risk for melanoma doubles if he or she has had more than five sunburns at any age.
- Survivors of melanoma are about nine times as likely as the general population to develop a new melanoma.
Katalinic said, as an epidemiologist, he thinks the number needed to screen or biopsied should be improved, especially among younger people. There were also 1961 basal cell carcinomas, 392 squamous cell carcinomas and 165 were other types of malignant tumors.