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Link Between Skin Cancer Diagnosis and Health-Care Screening Practices

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Key Points

  • In the Nurses’ Health Study, positive associations were seen between physical examination and basal cell carcinoma, squamous cell carcinoma, and melanoma. 
  • Similar results were found among the Health Professionals Follow-up Study, with physical examination positively associated with basal cell carcinoma, squamous cell carcinoma, and with an attenuated hazard ratio for melanoma.

According to findings published by Drucker et al in JAMA Dermatology, patients undergoing health-care screening practices for skin cancer have a higher likelihood of being diagnosed—particularly for squamous cell and basal cell carcinomas—than those who do not. Researchers emphasized that screening practices themselves do not cause increased cancer risk, rather patients who are actively engaged with the health-care system are more likely to be diagnosed with skin cancers than those who would otherwise go undetected.

“We encourage investigators studying skin cancer risk factors to account, whenever possible, for detection bias,” authors concluded. “Various strategies can be used, including conditioning on detection-related variables by restriction, stratification, or adjustment.”

Patients were drawn from the Nurses’ Health study (n = 77,736) and the Health Professionals Follow-up Study (n = 39,756). Patients were asked whether they had undergone health-care screening practices, including physical examination by a physician; sigmoidoscopy or colonoscopy; eye examination; serum cholesterol test; mammography; breast and pelvic examinations; as well as prostate-specific antigen test and rectal examination.

Of the two studies, 14,319, 1,517, and 506 incidents of basal cell carcinoma, squamous cell carcinoma, and melanoma were detected, respectively, in the Nurses’ Health Study cohort, and 8,741, 1,191, and 469 incidents in the Health Professionals Follow-up cohort, respectively. In the Nurses’ Health Study, positive associations were seen between physical examination and basal cell carcinoma (hazard ratio = 1.46), squamous cell carcinoma (hazard ratio = 2.32), and melanoma (hazard ratio = 1.66). Similar results were found among the Health Professionals Follow-up Study, with physical examination positively associated with basal cell carcinoma (hazard ratio = 1.43), squamous cell carcinoma (hazard ratio = 1.85), and with an attenuated hazard ratio for melanoma (1.04).

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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