Dataset Information

A Large Skin Cancer Screening Quality Initiative: Description and First-Year Outcomes.

ABSTRACT:

Importance

The lack of prospective randomized clinical trials demonstrating that full-body skin examination (FBSE) reduces melanoma morbidity or mortality has prompted an "I" rating from the United States Preventive Services Task Force for population-based skin cancer screening. More data on these screening programs are needed.

Objectives

To describe a skin cancer screening quality initiative in a large health care system and to determine if the intervention was associated with screening of a demographically higher-risk population than previous screening programs and if melanoma incidence and thickness differed in screened vs unscreened patients.

Design, setting, and participants

This observational evaluation of a prospectively implemented quality initiative was conducted in a large health care system in western Pennsylvania (University of Pittsburgh Medical Center, UPMC) among adults seen in an office visit by a UPMC-employed primary care physician (PCP) in 2014.

Interventions

Implementation of a campaign promoting annual skin cancer screening by FBSE, including training of PCPs, promotion of the initiative to physicians and patients, and modification of the electronic health record (EHR) to include FBSE as a recommended preventive service for patients 35 years or older.

Main outcomes and measures

Characteristics of screened and unscreened patients and melanomas detected among them.

Results

Of 333 735 adult patients seen in an office visit by PCPs in 2014, 53 196 patients (15.9% of the screen-eligible population) received an FBSE, and 280 539 did not. Screened patients were slightly older (median age, 60 vs 57 years; P < .001) but did not differ significantly by sex (43.2% vs 43.1% men; P = .49) from the unscreened population. Fifty melanomas were diagnosed in screened patients and 104 melanomas were diagnosed in unscreened patients. Screened patients were more likely than unscreened patients to be diagnosed with melanoma (adjusted risk ratio [RR], 2.4; 95% CI, 1.7-3.4; P < .001) and to have a thinner invasive melanoma (median thickness, 0.37 mm vs 0.65 mm; P < .001). The incidence of melanoma lesions 1 mm or thicker was similar in screened vs unscreened patients (adjusted RR, 0.7; 95% CI, 02.-2.2; P = .52).

Conclusions and relevance

Large-scale screening for melanoma within a United States health care system is feasible and can result in increased detection of thinner melanomas. This intervention also resulted in screening of a higher proportion of men and an older patient population than previous screening interventions in which younger individuals and women predominated.

SUBMITTER: Ferris LK

PROVIDER: S-EPMC5552417 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A Large Skin Cancer Screening Quality Initiative: Description and First-Year Outcomes.

Ferris Laura K LK Saul Melissa I MI Lin Yan Y Ding Fei F Weinstock Martin A MA Geller Alan C AC Yuan Jian-Min JM Neuren Erica E Maddukuri Spandana S Solano Francis X FX Kirkwood John M JM

JAMA oncology 20170801 8

<h4>Importance</h4>The lack of prospective randomized clinical trials demonstrating that full-body skin examination (FBSE) reduces melanoma morbidity or mortality has prompted an "I" rating from the United States Preventive Services Task Force for population-based skin cancer screening. More data on these screening programs are needed.<h4>Objectives</h4>To describe a skin cancer screening quality initiative in a large health care system and to determine if the intervention was associated with sc ...[more]

PMID: 28241191

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Dataset Information

A Large Skin Cancer Screening Quality Initiative: Description and First-Year Outcomes.

Importance

Objectives

Design, setting, and participants

Interventions

Main outcomes and measures

Results

Conclusions and relevance

Publications

A Large Skin Cancer Screening Quality Initiative: Description and First-Year Outcomes.

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