New research at UPMC suggests that if full body skin cancer screenings became a part of routine annual primary care visits, significantly more skin cancers would be discovered and at earlier stages.
The results of the study, led by Laura Ferris, M.D., Ph.D., associate professor, Department of Dermatology, and John Kirkwood, M.D., professor, Department of Medicine, Division of Medical Oncology, University of Pittsburgh School of Medicine, are published in JAMA Oncology and follow a similar melanoma screening program done in 2004 in Germany.
According to Ferris, there is a need to establish specific guidelines for regular skin cancer screening since currently, no guidelines exist. About half of all skin cancers are found by patients and half by physicians. However, those skin cancers found by patients tend to be more advanced than those detected by physicians.
"Skin cancer can be detected by the naked eye," said Ferris. "With studies such as this, we hope to gather enough data to develop a uniform recommendation for screening guidelines so melanoma, the deadliest form of skin cancer, can be detected earlier."
UPMC provided the optimal setting for this study, Ferris explained, since the health system employs many primary care physicians (PCPs) with a large patient base and system-wide electronic health records (EHR) to track the screenings and melanomas diagnosed.
UPMC-employed PCPs were offered access to a web-based training program on skin cancer identification. Patients were considered eligible for the screening if they were age 35 or older and saw a UPMC PCP during 2014.
The study examined the electronic health records of more than 300,000 patients who visited a UPMC PCP in 2014 and found approximately 53,000 patients who were in the eligible category were screened for skin cancer, and more than 280,000 were not.
Researchers found the incidence of melanoma in the screened population was more than double that of the unscreened population, and the melanomas discovered in the screened patients were thinner than those of the unscreened patients.
"The thickness of a diagnosed melanoma is the most important predictor of the risk of dying from this cancer," said Ferris. "So finding thinner tumors has the potential to reduce melanoma deaths."
UPMC researchers expect more patient and physician participation as they continue to study the screening process.
"We want to look more specifically at who benefited most from the screening, and whether the screening program can be targeted to capture those patients at highest risk of developing and dying from melanoma in order to make a bigger impact," said Ferris.
Future studies also will focus on whether regular screening can affect overall health care costs and melanoma mortality rates.
Additional researchers include Melissa Saul, M.D., Yan Lin, Ph.D., Fei Ding, M.D., Jian-Min Yuan, M.D., Erica Neuren, B.S., Spandana Maddukuri, B.S., and Francis X. Solano, M.D., all of Pitt; Martin A. Weinstock, M.D., Ph.D., of Providence VA Medical Center and Brown University; and Allen Geller, M.H.P., R.N., of Harvard University.
This trial was supported by National Cancer Institute grant 5P50CA121973-08 and the Melanoma Research Alliance.
Article: A Large Skin Cancer Screening Quality Initiative Description and First-Year Outcomes, Laura K. Ferris, MD, PhD et al., JAMA Oncology, doi: 10.1001/jamaoncol.2016.6779, published online 23 February 2017.