Screening finds skin cancer, but does it save lives?
DID THE SCREENING HELP?
The United States’ National Cancer Institute says about two million people in the U.S. are treated for basal cell or squamous cell cancers every year. As for melanomas, the American Cancer Society says more than 76,000 people will be diagnosed with one in 2012 and about 9,000 will die from it.
“The main question is do we find the right skin cancers to prevent deaths and morbidity (or costs),” said Katalinic.
Another study Katalinic coauthored reported that there was a significant drop in deaths from skin cancer following the program.
Deaths from skin cancer fell by about 50 percent - to one melanoma death or fewer per every 100,000 people each year. The number of deaths from skin cancer in neighboring regions that didn’t do screening remained the same over time.
Skin cancer and ETHNICITY
- Asian American and African American melanoma patients have a greater tendency than Caucasians to present with advanced disease at time of diagnosis.
- Skin cancer comprises one to two percent of all cancers in African Americans and Asian Indians.
- While melanoma is uncommon in African Americans, Latinos, and Asians, it is frequently fatal for these populations.
- As few as 48 percent of melanomas in African Americans are diagnosed at an early stage, compared to 74 percent in Hispanics and 84 percent in Caucasians.
- The overall melanoma survival rate for African Americans is only 77 percent, versus 91 percent for Caucasians.
- Melanomas in African Americans, Asians, Filipinos, Indonesians, and native Hawaiians most often occur on non-exposed skin with less pigment, with up to 60-75 percent of tumors arising on the palms, soles, mucous membranes and nail regions.
- Basal cell carcinoma (BCC) is the most common cancer in Caucasians, Hispanics, Chinese, Japanese, and other Asian populations.
- Squamous cell carcinoma (SCC) is the most common skin cancer among African Americans and Asian Indians.
- Squamous cell carcinomas in African Americans tend to be more aggressive and are associated with a 20-40 percent risk of metastasis (spreading).
- Skin cancer represents approximately 2-4 percent of all cancers in Asians.
- Among non-Caucasians, melanoma is a higher risk for children than adults: 6.5 percent of pediatric melanomas occur in non-Caucasians.
Even that drop, however, could be due to an increased awareness of skin cancer and not the screening itself. The study also didn’t look at whether there was a decrease in overall deaths.
“This is terrific information and certainly will be useful,” said Moyer of the new study. But, she added, it does not answer the question of whether the screening led to better health outcomes. Also, she said the study could have benefited from a comparison group, who did not get screened.
Moyer said the approach of the SCREEN program may also be a way for the U.S. to solve the problem of there not being enough dermatologists to screen everyone for skin cancer.
Basically, specially trained doctors who are not dermatologists act as gatekeepers and refer patients who have suspicious lesions or moles to dermatologist.
“In terms of feasibility, if it were the case that screening were shown to result in better health outcomes, this would be one possible way to manage that,” said Moyer.
SOURCE: Archives of Dermatology, online May 21, 2012
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Frequency of Excisions and Yields of Malignant Skin Tumors in a Population-Based Screening Intervention of 360 288 Whole-Body Examinations
Results Overall, 15 983 excisions were performed (1 of 23 screenees). A total of 3103 malignant skin tumors were diagnosed in 2911 persons: 585 MMs, 1961 BCCs, 392 SCCs, and 165 other malignant skin tumors. Overall, 116 persons (3103 of 360 288) had to be screened to find 1 malignant tumor, with 1 of 620 for MM, 1 of 184 for BCC, and 1 of 920 for SCC. Twenty excisions were performed to find 1 melanoma in men 65 years and older, but more than 50 excisions were required to find 1 melanoma in men aged between 20 and 49 years.
Conclusions The results of SCREEN suggest a high yield of malignant skin tumors in a large-scale population-based screening project. We found that a high number of excisions was performed in the youngest screenees with an associated low yield, suggesting a need in screener training to emphasize a more conservative attitude toward excisions in young screenees.
To our knowledge, SCREEN is the largest skin cancer screening project implemented worldwide. Although this sample size is substantially larger than those of other studies, we achieved comparable yields, especially for melanoma findings, suggesting that large-scale screening interventions detect a high rate of malignant skin lesions. Herein, we report a high number of excisions for few confirmed skin cancers in young screenees. Future screening activities may, therefore, benefit from improved training of the physicians regarding selection of lesions requiring excision. Specifically, we suggest (1) adapting the training curriculum toward a more conservative attitude toward excisions in young screenees and (2) implementing a formal and tailored feedback system in which quality indicators, such as Yield-S and Yield-E, stratified by age and sex are reported to the nondermatologist physicians and dermatologists. We conclude that these results not only inform current policy makers and the wider research community but can also be used as a comparison for the upcoming evaluation of the national Skin Cancer Early Detection Program that was implemented in Germany in July 2008.
Correspondence: Annika Waldmann, PhD, Institute of Clinical Epidemiology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160 (Haus 50), 23562 Luebeck, Germany (.(JavaScript must be enabled to view this email address)).
Financial Disclosure: None reported.