Skin cancer screening among U.S. adults from 1992, 1998, and 2000 National Health Interview Surveys
Introduction
Skin cancer is the most common form of cancer in the United States and accounts for an estimated 1 million new cases per year, including 55,100 cases of melanoma, the most dangerous skin cancer [1]. Rising melanoma incidence and mortality rates in the past 20 years have become a serious public health concern [2], [3], [4]. Since 1985, as part of a national effort to enhance early detection of melanoma and other skin cancers, the American Academy of Dermatology (AAD) has sponsored an annual education and early detection program that couples education with more than 1.3 million free skin cancer screening exams conducted by dermatologists [5], [6] (written communication, Donna Stein, AAD, August 2002).
Recommendations are inconsistent, however, about whether physicians should use total-body skin examinations to screen for skin cancer. The U.S. Preventive Services Task Force and the National Cancer Institute have found insufficient evidence that skin examination by a clinician reduces skin cancer mortality or morbidity [7], [8]. A potential benefit of screening includes finding thinner melanomas (earlier stage) than are found during usual care. Potential harms can include an embarrassing and inconvenient examination, and expensive diagnostic procedures. The American College of Preventive Medicine recommends periodic skin examinations for those at high risk for malignant melanoma but does not specify a time interval for repeat screening [9]. The strongest recommendations are from the American Cancer Society, which recommends skin cancer screening every 3 years for adults until age 40, and annually thereafter [10]. Despite inconsistent recommendations, the public continues to be advised that early-stage skin cancer can be detected by skin self-examination and total body examination by a physician [5], [11], [12], [13].
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Methods
To calculate national estimates over several years for skin cancer examinations, we used the 1992 and 2000 cancer-control modules and the 1998 prevention module of the Centers for Disease Control and Prevention (CDC) National Health Interview Survey (NHIS). The NHIS selects a multistage probability sample of the civilian noninstitutionalized U.S. population aged 18 and older, and annually interviews respondents in person in the household, to obtain current health and demographic information. We
Results
The number of people who reported ever having a skin exam by a physician was 2,274 (20.6%) in 1992, 6,119 (20.9%) in 1998, and 4,210 (14.5%) in 2000. For a recent skin examination, 1,156 (10.3%) persons reported having one in 1992, 3,182 (11.0%), in 1998, and 2,321 (8.0%) in 2000 (Table 1). For all 3 years, ever and recent skin examination prevalence rates were higher among older than among younger persons, with a quarter to a third of those aged ≥65 reporting having ever been examined.
Discussion
Our study is the first to use a national survey to report on the low skin cancer examination prevalence for all 3 years. Santmyire et al. [23] reported on skin cancer screening rates and sun-protective behavior rates from the 1998 NHIS, but no comparisons were made to 1992. We found that 14–21% of the adults reported ever being screened in 1992, 1998, and 2000; and 8–11% of the adults had recently been screened for skin cancer. Using data from the 1997 National Ambulatory Medical Care Survey of
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