Cancer Research Campaign health education programme to promote the early detection of cutaneous malignant melanoma. I. Work-load and referral patterns

Melia, Jane; Cooper, E. J.; Frost, Thomas; Graham‐Brown, R.A.C.; Hunter, John; Marsden, Aspinall; Vivier, Anthony du; White, John; Whitehead, Stephen; Warin, A P; Wroughton, M.; Ellman, R.; Chamberlain, Jocelyn

doi:10.1111/j.1365-2133.1995.tb08674.x

Cited by 38 publications

(32 citation statements)

References 15 publications

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“…This does not seem to merely reflect a lack of awareness that fairer skin and hair, freckling, and moles might indicate greater vulnerability, as estimates of relative risk of developing skin cancer were quite strongly associated with self assessments of these phenotypic risk factors. Accuracy of self assessment of risk factors may be improved by appropriate health education 19 but attitudinal factors are also likely to influence whether or not individuals will come forward to be screened. Those who were less confident in their own ability to judge their skin sensitivity, freckling, and number of moles were more likely to attend, as were those who were less inhibited about seeking medical advice, but such attitudes were not systematically related to clinically assessed risk status.…”

Section: Discussionmentioning

confidence: 99%

Is targeted early detection for melanoma feasible? Self assessments of risk and attitudes to screening

et al. 2000

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Objectives-To study the feasibility of developing targeted screening for those at high risk of melanoma by examining how attitudes relate to (a) acceptance of an invitation for a free skin check and (b) self assessed and clinically assessed risk factors for developing cutaneous melanoma. Design-A population based cross sectional survey. Setting-A general practice with a broad mix of socioeconomic groups in one district health authority. Subjects-A total of 1600 subjects aged 25-69 years stratified using the social deprivation score of wards were randomly selected from a population of 8000; 77% (1227) returned the questionnaire and 56% (896) attended for screening. Main outcome measures-Questionnaire measures of confidence in own ability to self assess risk factors for melanoma, attitudes to seeking medical help for skin abnormalities, and self assessment of relative risk of developing melanoma. Results-Clinic attenders were less confident in their ability to self assess risk factors (p<0.005), more favourable towards seeking help (p<0.001), and more pessimistic about developing melanoma (p<0.001) than non-attenders. Those from more aZuent wards were more willing to seek help (p<0.001). Those clinically assessed as at higher risk were more pessimistic about developing melanoma (p<0.001) but clinical assessments were inconsistently related to help seeking attitudes and self assessment confidence. Conclusions-Barriers to the uptake of screening included greater optimism about not developing melanoma, confidence in self assessment, and reluctance to seek professional help. Such reluctance was greater in more deprived social groups. Targeting screening at high risk groups cannot depend on self identification and self referral. (J Med Screen 2000;7:199-202)

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Section: Discussionmentioning

confidence: 99%

Is targeted early detection for melanoma feasible? Self assessments of risk and attitudes to screening

et al. 2000

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“…28,29 Melia et al reported on the increased workload in pigmented lesion clinics during a health promotion campaign aimed at promoting early detection and advised about the importance of providing and maintaining access to screening services. 12 Within the present population, 2 years after the intervention, more than 60% of participants in intervention communities indicated an intention to have a clinical skin examination within the next 12 months compared with 50% at baseline. Despite this positive shift in intention, it is likely that without access to skin screening services, rates of clinical skin examination will decrease to baseline levels.…”

Section: Discussionmentioning

confidence: 70%

“…11 Additionally, pigmented lesion clinics have been operating in the UK for a number of years. 12 In 1998, recognizing the high risk of melanoma in the Queensland population and the lack of evidence of the effectiveness of screening, the Queensland Cancer Fund began a randomized controlled trial of a community-based screening program for melanoma. 13 Telephone surveys and postal surveys were conducted to monitor the uptake of skin screening within trial communities during a 3-year intervention period.…”

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Increase in skin cancer screening during a community‐based randomized intervention trial

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Janda

et al. 2005

Intl Journal of Cancer

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Survival from cutaneous melanoma is mainly dependent on the thickness of the lesion at diagnosis. Skin screening may increase detection of thin lesions and hence improve survival. Within a community-based randomized controlled trial of a population screening program for melanoma in Queensland, Australia, 9 communities were randomly assigned to the 3-year intervention and 9 communities to the control group. Skin screening prevalence was monitored by cross-sectional surveys at baseline, 1, 2 and 3 years into the intervention and 2 years later. At baseline, prevalence of whole-body clinical skin examination was similar in intervention and control communities. In intervention communities, the prevalence of whole-body skin examinations increased to 29.2%, an absolute difference of 18% from baseline, with a peak of 34.8% 2 years after baseline, and began to decline again at the end of the intervention period. The largest increases were seen in men and women 50 years. Uptake of screening did not differ according to melanoma risk factors; however, the decline in screening was less in participants who reported a number of melanoma risk factors. The prevalence of skin self-examination remained stable during the intervention program. No changes were observed in the control communities. These results indicate that the intervention program significantly increased the prevalence of whole-body clinical skin examinations in intervention communities. Once the intervention program ceased, and particularly after skin clinics ceased, levels of skin screening began to decline. The provision of specialized skin screening clinics may be needed to achieve sufficient screening rates should population based screening for skin cancer be considered. ' 2005 Wiley-Liss, Inc.Key words: melanoma; screening; randomized-controlled trial; intervention Cutaneous melanoma is a significant public health problem in Australia and in other fair-skinned populations throughout the world. In Australia, 8,885 cases of melanoma were recorded in 2001, with an age-standardized rate of 55.2/100,000 for males and 38.3/100,000 for females.1 Within Australia, residents of the state of Queensland carry the highest risk of developing melanoma in the world, with a lifetime risk of 1 in 16 for men and 1 in 23 for women.2 Although melanoma does occur under the age of 30, mortality from melanoma rises with age, and men over 50 years are at particularly high risk to die from melanoma.1 Although rates of melanoma are not as high in the UK and other European countries compared to Australia, incidence continues to increase. In the UK, approximately 7,000 cases of melanoma were diagnosed in 2000, including 3,028 men and 3,939 women with an age-standardized rate of 9.7/100,000 in males and 11.2/100,000 in females. Mortality from melanoma is mainly dependent on the thickness of the lesion at diagnosis. Patients whose melanoma is diagnosed while less than 0.76 mm thick have a better than 98% chance of surviving 5 years or more. Survival decreases rapidly for thicker lesions. ...

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“…Unlike some registries in Australia, and the USA, Breslow thickness is not routinely recorded by all cancer registries in the UK. Careful evaluation of future strategies for early detection or screening is needed to assess the effectiveness of different interventions which should aim to reduce mortality without causing excessive increased workload (Doherty and MacKie, 1988;Burton et al, 1993;Melia et al, 1995a). In the UK targeted screening has been explored (Little et al, 1995;Jackson et al, 1998;Melia et al, 2000) but there are concerns about the accuracy and psychological effects of selfassessment for melanoma risk (Sinclair, 1998).…”

Section: Effects Of Early Detection On Melanoma Mortality 805mentioning

confidence: 99%

“…From 1987 to 1989 the Cancer Research Campaign (CRC) ran a health education programme to promote the early detection of cutaneous malignant melanoma in the general population in 6 district health authorities (DHAs) in England and 1 health board (HB) in Scotland (Melia et al, 1995a(Melia et al, , 1995b. This followed a similar intervention in the west of Scotland (MacKie and Hole, 1992) involving the local media, leaflets and posters.…”

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confidence: 99%

The relation between mortality from malignant melanoma and early detection in the Cancer Research Campaign Mole Watcher Study

et al. 2001

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Summary Between 1987 and 1989 the Cancer Research Campaign funded a health education programme for the early detection of cutaneous malignant melanoma in the general population in 6 health districts of England and 1 health board in Scotland (population of 3 million). The intervention was evaluated by studying its effects on annual and cumulative mortality rates for melanoma. Population-based data on mortality from melanoma were collected in the intervention areas, the health regions covering those areas, and 5 other health regions of England from 1981 to 1996. Deaths from melanoma in cases diagnosed after the start of the intervention were used to study cumulative mortality rates. The annual mortality rates for melanoma, 1981 to 1996, showed no significant difference in their trends between the intervention areas, and other areas of England and Wales. After adjustment for pre-intervention rates, there was also no significant reduction in cumulative mortality from melanoma in the intervention areas compared with the non-intervention areas: rate ratio 1.2 (95% Cl 0.9-1.7) in men, 0.9 (95% Cl 0.7-1.3) in females. The lack of a significant reduction in melanoma mortality associated with the intervention raises questions about this approach to early detection and emphasises the need for new strategies.

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Cancer Research Campaign health education programme to promote the early detection of cutaneous malignant melanoma. I. Work-load and referral patterns

Cited by 38 publications

References 15 publications

Is targeted early detection for melanoma feasible? Self assessments of risk and attitudes to screening

Is targeted early detection for melanoma feasible? Self assessments of risk and attitudes to screening

Increase in skin cancer screening during a community‐based randomized intervention trial

The relation between mortality from malignant melanoma and early detection in the Cancer Research Campaign Mole Watcher Study

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