Screening rates for skin cancer low among middle-aged and older Caucasian adults: CINJ study

Among people over 50, those who did not finish high school or have not recently had common cancer screenings such as a mammogram, prostate-specific antigen (PSA) test or colorectal cancer screening, are also less likely to be screened for skin cancer. This finding appears in a new study by an investigator at The Cancer Institute of New Jersey (CINJ) and colleagues, which shows screening rates for skin cancer are low among middle-aged and older Caucasian adults and that physicians may want to further emphasize skin examinations for this population, especially for men and those with less education. CINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School.

According to the American Cancer Society, skin cancer is the most common of all cancers. Melanoma represents about five percent of all skin cancer cases, but accounts for most skin cancer deaths. In New Jersey alone, 2,530 individuals were diagnosed with melanoma last year and there were 68,720 new cases nationally. In contrast to many other types of cancer, the mortality rate for melanoma has been steadily rising over the past 35 years. The current study focused on skin cancer screening among middle-aged and older Caucasian adults, as the mortality rate for melanoma has been increasing most notably among these individuals.

The study, Prevalence and Correlates of Skin Cancer Screening Among Middle-aged and Older White Adults in the United States, published in the current online edition of the American Journal of Medicine (Vol. 123, No. 5), examined 10,486 Caucasian men and women aged 50 and older drawn from a random sample of 31,428 adults aged 18 and older who took part in the 2005 National Health Interview Survey. Participants indicated whether they had undergone a skin examination by a dermatologist or other doctor in the past year, and also completed questions about their demographic characteristics, health and healthcare access, history of skin cancer, and other cancer screenings received, such as a mammogram, PSA test, and colorectal cancer screening. Somewhat more than half of the participants (54 percent) were female, and nearly all participants (91 percent) said they had been to a physician at least once in the past year. Of those interviewed, relatively few noted that they had a personal or family history of skin cancer.

The study found that 16 percent of men and 13 percent of women reported having a skin examination in the past year. Factors associated with the lowest rates of having a skin examination in the past year included being aged 50 to 64 years (12 percent skin examination rate among men and women), having a lower education level (some high school education or less: nine percent skin examination rate among men and eight percent among women), lacking screening for breast (seven percent skin examination rate among women), prostate (eight percent skin examination rate among men), and colorectal cancers (seven percent skin examination rate among men and nine percent among women), and not having a personal history of skin cancer (13 percent skin examination rate among men and 12 percent among women).

Elliot J. Coups, PhD, behavioral scientist at CINJ and associate professor of medicine at UMDNJ-Robert Wood Johnson Medical School, is the lead author of the study. "With those older than 50 being at a higher risk for developing melanoma, our study results clearly indicate that more intervention is needed in this population," Dr. Coups said. "Of particular interest is the amount of education one has and how that may affect whether a person is screened or not screened for skin cancer. Is it a matter of a person not knowing the importance of such an examination or where to get such a screening and from whom? Is it a matter of one's insurance not covering a dermatologist or there being no coverage at all? We are hopeful this study leads to further discussion among healthcare professionals, particularly among community physicians, about what steps can be taken to ensure their patients are receiving information on skin cancer screening and are being presented with opportunities to receive that examination."

Another author on the study, Alan C. Geller, MPH, RN, Division of Public Health Practice at Harvard School of Public Health, notes that the correlation between lack of skin cancer screening and other cancer screenings could speak to a larger issue. "These results should indicate to physicians that a more pro-active approach is needed in order to assess whether patients have received screening for multiple types of cancer. Physicians can screen their patients for skin cancer as part of a cancer-related checkup during a general health examination," Geller noted. "Free skin cancer screenings are also available as part of a nationwide program provided by the American Academy of Dermatology in partnership with local dermatologists." Over the past 25 years, more than two million people have been screened as part of that program.