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

Abstract

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. ...

Visual evaluation of the larynx and hypopharynx during esophagogastroduodenoscopy: a safety and feasibility study

“…Screening people at risk for cancer has been proven effectively for multiple cancers, for example colorectal [8], breast and cervical [9], lung [10], oral [11], and skin cancer [12]. Laryngeal cancer is the only U.S. cancer to have worse survival rates over time; however, there is currently no screening test for it and hypopharyngeal cancer is one of the most deadly with approximately 88 % of patients presenting with stage III or IV disease [13].…”

What motivates men age ≥ 50 years to participate in a screening program for melanoma?

“…Also, their screening behavior during the 2 years after the intervention declined more slowly compared with screening participants overall. 27 The community-based intervention program of melanoma screening employed within this randomized trial was not specifically targeted at men age !50 years. However, particular care was taken to ensure it was also suitable to a male audience.…”

“…The aims, procedures, and outcomes of the skin-screening clinics have been described in detail elsewhere. 27 Members of intervention communities were alerted to the clinics through advertisements and articles in local newspapers, street banners, flyers, and information brochures in physician practices and other places of interest, and personal letters of invitation signed by a sports celebrity for men and a media celebrity for women. The letters contained information regarding the time and place of the clinics and a toll-free telephone number for appointments.…”

“…Uptake was highest among the population age !50 years. 27 The current study investigated predictors of skinscreening participation of men age !50 years within the 3-year community-based screening program for melanoma. We also describe the clinical and histopathologic outcomes of screening examinations in men age !50 years who attended 1 of the dedicated skin-screening clinics provided during the intervention period.…”

Clinical outcomes from skin screening clinics within a community-based melanoma screening program

“…Detailed results are described elsewhere. 17 The aim of the present study was to describe participation in the open-access skin screening clinics that were conducted within the intervention communities, the clinical and histopathological outcomes of the whole-body skin examinations performed at the clinics, the compliance with follow-up of suspect lesions detected during the screening examination and to estimate the specificity for melanoma of whole-body skin examination by primary care physicians within a population screening program for melanoma.…”