Influence of socioeconomic factors and region of residence on cancer stage of malignant melanoma: a Danish nationwide population-based study

Abstract

BackgroundSocioeconomic differences in survival after melanoma may be due to late diagnosis of the disadvantaged patients. The aim of the study was to examine the association between educational level, disposable income, cohabitating status and region of residence with stage at diagnosis of melanoma, including adjustment for comorbidity and tumor type.MethodsFrom The Danish Melanoma Database, we identified 10,158 patients diagnosed with their first invasive melanoma during 2008–2014 and obtained information on stage, localization, histology, thickness and ulceration. Sociodemographic information was retrieved from registers of Statistics Denmark and data on comorbidity from the Danish National Patient Registry. We used logistic regression to analyze the associations between sociodemographic factors and cancer stage.ResultsShorter education, lower income, living without partner, older age and being male were associated with increased odds ratios for advanced stage of melanoma at time of diagnosis even after adjustment for comorbidity and tumor type. Residence in the Zealand, Central and Northern region was also associated with advanced cancer stage.ConclusionSocioeconomically disadvantaged patients and patients with residence in three of five health care regions were more often diagnosed with advanced melanoma. Initiatives to increase early detection should be directed at disadvantaged groups, and efforts to improve early diagnosis of nodular melanomas during increased awareness of the Elevated, Firm and Growing nodule rule and “when in doubt, cut it out” should be implemented. Further studies should investigate regional differences in delay, effects of number of specialized doctors per inhabitant as well as differences in referral patterns from primary to secondary health care across health care regions.

Patient Satisfaction and Expectations Regarding Mobile Teledermoscopy in General Practice for Diagnosis of Non-melanoma Skin Cancer and Malignant Melanoma

“…The implementation of mobile TDS could be beneficial for patients, especially socioeconomically disadvantaged patients. A study by Ibfelt et al (39) found that male sex, older age, shorter education, lower income, living without a partner, and residence in specific rural regions of Denmark increased the risk of advanced-staged melanoma at the time of diagnosis. In addition, one of the regions with a higher number of advanced-staged melanoma had only half as many treatment centres for dermatology/plastic surgery as the Capital Region (39).…”

“…A study by Ibfelt et al (39) found that male sex, older age, shorter education, lower income, living without a partner, and residence in specific rural regions of Denmark increased the risk of advanced-staged melanoma at the time of diagnosis. In addition, one of the regions with a higher number of advanced-staged melanoma had only half as many treatment centres for dermatology/plastic surgery as the Capital Region (39). In a pilot-study by Kips et al (38) patients expressed that TD would encourage them to consult a general practitioner sooner when experiencing dermatological problems.…”

Understanding Differences in Cancer Survival between Populations: A New Approach and Application to Breast Cancer Survival Differentials between Danish Regions

“…Zealand has the highest proportion of residents with low education level among the Danish regions [39], which could also explain its more adverse stage-at-diagnosis distribution. However, Ibfelt et al (2018) [17] found that even after controlling for differences in socioeconomic status (education and income), the odds ratio of being diagnosed at a later stage remained higher in Zealand than in the Capital region for malignant melanoma. This led the authors to suspect differences in the referral process to specialized care between regions.…”

“…For instance, a more adverse stage distribution can be observed in a low-survival population relative to a high-survival population, but this provides no quantification. Regression analyses, such as the Cox proportional hazard model or other forms of generalized linear models, have been used to study the relation between cancer survival or mortality and a set of independent variables (e.g., stage at diagnosis) [11,16,17]. However, regression model assumptions do not always hold (e.g., proportional hazards).…”

<p>MicroRNA-3662 targets ZEB1 and attenuates the invasion of the highly aggressive melanoma cell line A375</p>

“…Researchers to date have focused largely on the alteration of tumor suppressors including PTEN, CDKN2A or TP53 , or tumor promoters such as TERT, Ras , or Raf , in melanocytes or cutaneous melanoma cells 9,10. Few treatment options are available following the metastasis of cutaneous melanoma to a second site and consequently this stage of the disease then becomes life-threatening 11,12. Thus, it is important that we develop an increased understanding of the underlying mechanisms governing the invasive growth of cutaneous melanoma cells and their metastasis, to enable the development of more effective therapeutic strategies.…”