NEW YORK, Jul 25 (Reuters Health) - Previous research has shown that
Medicaid patients are almost five times as likely as those with commercial
insurance and about twice as likely as uninsured individuals to have a late
diagnosis of the deadly skin cancer, melanoma. Now new research shows that
certain sociodemographic factors such as sex or marital status may also be
linked to a late diagnosis of the condition.
"The prognosis of malignant melanoma is heavily dependent on the stage at
which it is detected," write researchers led by Dr. Daniel J. Van Durme from the
department of family medicine at the University of South Florida. "Therefore,
understanding the determinants of late-stage melanoma diagnosis is an important
cancer-control objective."
In this follow-up to their previous study which reported the effect of
insurance payer on cancer stage at diagnosis, Van Durme and his colleagues
hypothesized that age, sex, marital status, education, income, residence--rural
vs. urban--and smoking status would all be associated with a risk of late-stage
diagnosis of melanoma.
A review of almost 1,900 melanoma cases occurring in Florida during
1994-1995 revealed that "late-stage diagnosis was more common among patients who
were male, unmarried, and smokers and resided in communities with low median
income and education levels," the authors write in the July issue of Archives of
Family Medicine.
The authors note that their research is consistent with previous studies
that also identified men as being "less likely than women to identify their own
melanoma." This is perhaps because men are also reportedly less likely to
undergo either self-screening or physician screening.
However, individuals who engage in self-screening may not easily detect less
visible lesions, Van Durme's research suggests. Marital status, therefore, may
prevent late-stage diagnosis since spouses have been identified as "the third
most common person" to detect many melanomas. "This finding suggests that
physician surveillance of melanoma is especially important for unmarried
patients," the authors comment.
Furthermore, cancer patients who live in areas where the median educational
level was high school or less as well as those with a lower socioeconomic
status--a median household income of $15,000 - 25,000--were more likely to have
a later diagnosis, according to the research. "Patients with a lower
socioeconomic status are less likely to undergo either self-screening or
physician screening," Van Durme's team explains. In addition, these individuals
may have a decreased awareness of and knowledge about the skin cancer, the
authors state.
Yet, despite these other factors, the authors found smoking to be the
greatest predictor of a late-stage diagnosis of melanoma. They hypothesize that
smoking may be associated with "less active skin surveillance," consequently,
melanomas would not be detected until a late stage.
The authors acknowledge several limitations of their study such as the fact
that their data was limited to melanoma cases in Florida, "which may not be
representative of other diseases or other parts of the country." Yet, Van Durme
and his colleagues stress the need for physician awareness of these risk factors
and they urge a "more conscientious" screening of high-risk patients.
In addition, public education efforts recommending increased
"self-surveillance and checking the partner's skin" should be targeted to
patients with a higher risk of melanoma, the authors suggest.
