Prevalence of skin examination behaviours among Australians over time

Reyes-Marcelino, Gillian; Tabbakh, Tamara; Espinoza, David; Sinclair, Craig; Kang, Yoon‐Jung; McLoughlin, Kirstie; Fernández‐Peñas, Pablo; Guitera, Pascale; Aitken, Joanne F.; Canfell, Karen; Dobbinson, Suzanne; Cust, Anne E.

doi:10.1016/j.canep.2020.101874

Cited by 17 publications

(15 citation statements)

References 38 publications

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“…6 As such, a sizeable proportion of the Australian population undergoes regular screening for melanoma and skin cancer each year. 7 There is concern that increased diagnostic scrutiny (including frequent skin examinations, more biopsies and shifts in pathological thresholds) is leading to the detection of indolent melanomas that would not otherwise have come to clinical attention during the lifespan of the patient, a phenomenon described as the 'cycle of melanoma overdiagnosis'. 8 Overdiagnosis leads to overtreatment, patient harm and inflated costs.…”

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confidence: 99%

“…While there is no systematic programme for the early detection of melanoma in Australia, whole‐body skin examinations are commonly offered by primary care physicians, 5 and there are many medical practitioners whose sole clinical activity is ‘skin cancer detection and treatment’ 6 . As such, a sizeable proportion of the Australian population undergoes regular screening for melanoma and skin cancer each year 7 …”

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confidence: 99%

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The effect of screening on melanoma incidence and biopsy rates

Whiteman

Olsen

MacGregor

et al. 2022

British Journal of Dermatology

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Background Cutaneous melanomas are common cancers in white‐skinned populations, and early detection is promoted as a means of reducing morbidity and mortality. There is concern that increased skin screening is leading to overdiagnosis of indolent melanomas with low risk of lethality. The extent of melanoma overdiagnosis associated with screening is unknown. Objectives To estimate possible overdiagnosis by comparing subsequent melanoma incidence and biopsy rates among people subjected to skin screening those who were not. Methods We recruited 43 762 residents of Queensland, Australia, aged 40–69 years, with no prior history of melanoma, selected at random from a population register in 2010. At baseline, participants completed a comprehensive melanoma risk factor survey and were asked if their skin had been examined by a doctor in the 3 years prior to baseline. We calculated incidence and relative risk of histologically confirmed melanoma (invasive and in situ) in years 2–7 of follow‐up, obtained through linkage to the cancer registry. In secondary analyses, we measured biopsy rates in years 2–6 of follow‐up. We used propensity score analysis to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Results In total, 28 155 participants underwent skin screening prior to baseline. We observed 967 first‐incident melanomas (381 invasive) during 197 191 person‐years of follow‐up. Those screened had higher rates of melanoma (aHR 1·29, 95% CI 1·02–1·63) and subsequent skin biopses (aHR 1·85, 95% CI 1·69–2·04) than unscreened participants. The higher risk associated with skin screening was evident for in situ melanoma (aHR 1·45, 95% CI 1·09–1·92) but not invasive melanoma (aHR 1·05, 95% CI 0·72–1·54). In secondary analyses, where screening was defined as having a skin biopsy in the first year after baseline, we observed significantly increased risks of melanoma (aHR 1·53, 95% CI 1·23–1·89) and subsequent biopsies (aHR 2·64, 95% CI 2·46–2·84) relative to those who did not have a biopsy. Conclusions People who undergo skin screening subsequently experience higher rates of biopsies and melanoma (especially in situ melanoma), even after adjusting for all known risk factors, consistent with overdiagnosis. What is already known about this topic? Cutaneous melanomas are common cancers in white‐skinned populations for which early detection is promoted as a means of reducing morbidity and mortality. There is concern that increased surveillance is leading to the overdiagnosis of indolent melanomas that are not destined to be lethal. The extent of melanoma overdiagnosis associated with surveillance is not known. What does this study add? People subjected to skin examinations by a doctor or who undergo skin biopsies subsequently have higher numbers of biopsies and higher rates of melanoma than people not subjected to either, even after adjusting for all known risk factors. These findings suggest that heightened surveillance leads to a proportion of melanomas being diagnosed that otherwise may not have c...

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confidence: 99%

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confidence: 99%

The effect of screening on melanoma incidence and biopsy rates

Whiteman

Olsen

MacGregor

et al. 2022

British Journal of Dermatology

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“…Participants were not provided with their traditional risk category as we were specifically interested in evaluating the impact of genomic risk information. Previous studies have shown that sun-sensitive phenotype, family history, and skin cancer risk perception are associated with sun protection and skin check behaviors (although there is variability in findings) [16,17] and that self-perceived risk of developing melanoma is weakly related to actual risk [22].…”

Section: Traditional Risk Scoresmentioning

confidence: 99%

“…We conducted the Melanoma Genomics Managing Your Risk Study, a large, population-based randomized controlled trial to evaluate our hypothesis that giving the public information on personal genomic risk of melanoma based on a polygenic risk score would motivate reduced sun exposure, and increased sun protection and early detection behaviors, with no psychological harms. We also hypothesized that the behavioral effect may differ according to the presence of traditional risk factors, such as sun-sensitive phenotype or family history of melanoma, as these factors may influence sunrelated preventive behaviors and risk perception [16,17].…”

Section: Introductionmentioning

confidence: 99%

Impact of personal genomic risk information on melanoma prevention behaviors and psychological outcomes: a randomized controlled trial

Smit

Allen

Beswick

et al. 2021

Genetics in Medicine

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Purpose We evaluated the impact of personal melanoma genomic risk information on sun-related behaviors and psychological outcomes. Methods In this parallel group, open, randomized controlled trial, 1,025 Australians of European ancestry without melanoma and aged 18–69 years were recruited via the Medicare database (3% consent). Participants were randomized to the intervention (n = 513; saliva sample for genetic testing, personalized melanoma risk booklet based on a 40-variant polygenic risk score, telephone-based genetic counseling, educational booklet) or control (n = 512; educational booklet). Wrist-worn ultraviolet (UV) radiation dosimeters (10-day wear) and questionnaires were administered at baseline, 1 month postintervention, and 12 months postbaseline. Results At 12 months, 948 (92%) participants completed dosimetry and 973 (95%) the questionnaire. For the primary outcome, there was no effect of the genomic risk intervention on objectively measured UV exposure at 12 months, irrespective of traditional risk factors. For secondary outcomes at 12 months, the intervention reduced sunburns (risk ratio: 0.72, 95% confidence interval: 0.54–0.96), and increased skin examinations among women. Melanoma-related worry was reduced. There was no overall impact on general psychological distress. Conclusion Personalized genomic risk information did not influence sun exposure patterns but did improve some skin cancer prevention and early detection behaviors, suggesting it may be useful for precision prevention. There was no evidence of psychological harm.

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“…a check of a mole or spot, and 41% reported no skin check. 14 The relatively high prevalence of skin checks in Australia is probably due to multiple factors including high awareness of skin cancer 6 , the presence of designated primary care skin cancer clinics, and community-wide prevention campaigns.…”

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Early detection of skin cancer in Australia – current approaches and new opportunities

Janda¹,

Olsen²,

Mar³

et al. 2022

Public Health Res Pract

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The large health and financial impacts of skin cancer can be minimised through early detection • Concerns about the current unstructured approach to skin cancer early detection include variable quality of care, sociodemographic inequalities, excision of many benign lesions, overdiagnosis, gaps in workforce training, and health system inefficiencies • Australia is experiencing a changing landscape of skin cancer early detection, driven by increasing health system costs, advances in diagnostic technologies and artificial intelligence, validated riskstratification tools, and consumer-driven digital technologies

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Prevalence of skin examination behaviours among Australians over time

Cited by 17 publications

References 38 publications

The effect of screening on melanoma incidence and biopsy rates

The effect of screening on melanoma incidence and biopsy rates

Impact of personal genomic risk information on melanoma prevention behaviors and psychological outcomes: a randomized controlled trial

Early detection of skin cancer in Australia – current approaches and new opportunities

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