Results from a large-scale melanoma screening conducted in Pennsylvania indicate that, overall, the practice complies with the medical maxim: “first do no harm.” The numbers show that melanoma screenings did not result in a spike in surgical treatments or expert referrals. The study, “Downstream consequences of melanoma screening in a community practice setting: First results,” was published in the journal Cancer.
Malignant melanoma is responsible for roughly 10,000 deaths per year in the United States, but is curable if caught early. For screening to be implemented on a large scale, evidence that the benefits would outweigh potential harms is necessary. Work over the past decade has yielded evidence of such benefits, including reduced deaths due to melanoma. Few studies, however, are known to have quantified potential harms that may be associated with screening activities.
Some specialists have called for primary care providers to be trained in conducting melanoma screenings at medical visits. Others are concerned that such screenings could lead to overtreatment and patient distress should primary care providers mistake benign lesions for cancers.
Researchers from multiple centers examined what happened when targeted primary care providers at the University of Pittsburgh Medical Center were trained to detect early melanoma using the INFORMED (INternet course FOR Melanoma Early Detection) program.
In the analysis, researchers reviewed the data from tens of thousands of encounters with patients, ages 35 and older, during the first eight months of 2013 (before the training) and again in 2014 (after the training).
Care providers were divided into three groups – one in which about one-quarter had training, a second group in which only 1 in 11 of providers were trained, and a third with no training. This approach allowed the researchers to compare outcomes across groups with different training and over time.
Results revealed that neither dermatologist visits nor skin surgeries increased substantially between 2013 and 2014 in any of the groups. Between the groups, there was also little difference in how often those outcomes occurred.
According to the study’s lead author, Dr. Martin Weinstock, the absence of a major change was not because the training had no result. Between 2013 and 2014, the group of care providers with the most training produced an increase of 79 percent in per-patient melanoma diagnoses. There was no increase in melanoma diagnoses in the other two groups with less or no melanoma screening training. (Dr. Weinstock is a professor of dermatology in the Warren Alpert Medical School of Brown University and chief of dermatology at the Providence Veterans Affairs Medical Center.)
This sharp rise in the number of melanoma diagnoses in the most trained group was not matched by a similar increase in dermatologist visits or surgeries, however, likely because the amount of diagnoses were small (24 out of 11,238 patients in 2013, and 48 out of 12,560 patients in 2014).
“The early evidence from this screening effort indicates that melanoma screening coupled with a modified INFORMED training program neither results in large numbers of skin surgeries nor a dramatic increase in visits to dermatologists, which are two potential adverse downstream consequences that have been of concern as a potential basis of morbidity, distress and costs,” the authors wrote. according to a news release.
The team is now planning to further analyze metrics of whether melanoma screening causes distress for patients.