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Adamson AS, Naik G, Jones MA, Bell KJ. Ecological study estimating melanoma overdiagnosis in the USA using the lifetime risk method. BMJ Evid Based Med 2024; 29:156-161. [PMID: 38242569 DOI: 10.1136/bmjebm-2023-112460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVES To quantify the proportion of melanoma diagnoses (invasive and in situ) in the USA that might be overdiagnosed. DESIGN In this ecological study, incidence and mortality data were collected from the Surveillance, Epidemiology and End Results 9 registries database. DevCan software was used to calculate the cumulative lifetime risk of being diagnosed with melanoma between 1975 and 2018, with adjustments made for changes in longevity and risk factors over the study period. SETTING USA. PARTICIPANTS White American men and women (1975-2018). MAIN OUTCOME MEASURES The primary outcome was excess lifetime risk of melanoma diagnosis between 1976 and 2018 (adjusted for year 2018 competing mortality and changes in risk factors), which was inferred as likely overdiagnosis. The secondary outcome was an excess lifetime risk of melanoma diagnosis in each year between 1976 and 2018 (adjusted and unadjusted). RESULTS Between 1975 and 2018 the adjusted lifetime risk of being diagnosed with melanoma (invasive and in situ) increased from 3.2% (1 in 31) to 6.4% (1 in 16) among white men, and from 1.6% (1 in 63) to 4.5% (1 in 22) among white women. Over the same period, the adjusted lifetime risk of being diagnosed with melanoma in situ increased from 0.17% (1 in 588) to 2.7% (1 in 37) in white men and 0.08% (1 in 1250) to 2.0% (1 in 50) in white women. An estimated 49.7% of melanomas diagnosed in white men and 64.6% in white women were overdiagnosed in 2018. Among people diagnosed with melanomas in situ, 89.4% of white men and 85.4% of white women were likely overdiagnosed in 2018. CONCLUSIONS Melanoma overdiagnosis among white Americans is significant and increasing over time with an estimated 44 000 overdiagnosed in men and 39 000 in women in 2018. A large proportion of overdiagnosed melanomas are in situ cancers, pointing to a potential focus for intervention.
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Affiliation(s)
- Adewole S Adamson
- Department of Internal Medicine (Division of Dermatology), Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Geetanjali Naik
- The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mark A Jones
- Institute for Evidence-based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Katy Jl Bell
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Mahama AN, Haller CN, Labrada J, Idiong CI, Haynes AB, Jacobs EA, Tsevat J, Pignone MP, Adamson AS. Lived Experiences and Fear of Cancer Recurrence Among Survivors of Localized Cutaneous Melanoma. JAMA Dermatol 2024; 160:495-501. [PMID: 38353983 PMCID: PMC10867773 DOI: 10.1001/jamadermatol.2023.6158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/14/2023] [Indexed: 02/17/2024]
Abstract
Importance Most of the rapid increase in cutaneous melanoma incidence in the US has been localized disease that is treated surgically and is associated with high survival rates. However, little is known about the psychological well-being of survivors in the US. Objective To explore the lived experiences and fear of cancer recurrence among survivors of localized cutaneous melanoma. Design, Setting, and Participants This was a qualitative and survey-based study that used semistructured interviews and the Fear of Cancer Recurrence Inventory short form (FCRI-SF) survey tool with participants recruited from an academic dermatology practice affiliated with the University of Texas, Austin. Interviews were completed via telephone or in person from August 2021 to September 2022. Each of the 9 items in the FCRI-SF was rated on a 5-point Likert scale, scored from 0 to 4, with a maximum possible score of 36 points. Data analyses were performed from February 2022 to June 2023. Main Outcomes and Measures Semistructured interviews were analyzed for themes and subthemes associated with the lived experiences of survivors of cutaneous melanoma. The FCRI-SF scores were tabulated, with scores of 13 or greater identifying potential cases of clinically significant fear of cancer recurrence. Results In all, 51 participants (mean [SD] age, 49.5 [11.7] years; 34 [67%] female and 17 [33%] male) with a history of localized melanoma (stage 0-IIA) completed the interview and survey. Among them, 17 (33%) had survived a diagnosis of stage 0 melanoma, and the remainder, at least 1 invasive melanoma diagnosis (stage I-IIA). Semistructured interviews revealed several themes: (1) emotions surrounding follow-up appointments, (2) intensity of melanoma surveillance, (3) lifestyle changes regarding sun exposure, and (4) thoughts about life and death. Thirty-eight of 51 participants had an FCRI-SF score above the threshold for clinical fear of cancer recurrence. Conclusions and Relevance This qualitative and survey-based study found that despite having an excellent prognosis, some survivors of localized melanoma, even those who had stage 0, have high rates of fear of cancer recurrence and intense survivorship experiences that affect their psychological well-being.
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Affiliation(s)
- Ayisha N. Mahama
- Division of Dermatology, Dell Medical School, University of Texas, Austin
| | - Courtney N. Haller
- Division of Dermatology, Dell Medical School, University of Texas, Austin
| | - Jocelyn Labrada
- Division of Dermatology, Dell Medical School, University of Texas, Austin
- Department of Internal Medicine, Dell Medical School, University of Texas, Austin
| | | | - Alex B. Haynes
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas, Austin
- Livestrong Cancer Institutes, The University of Texas, Austin
| | - Elizabeth A. Jacobs
- MaineHealth Institute for Research, Scarborough
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Joel Tsevat
- Department of Internal Medicine, Dell Medical School, University of Texas, Austin
- Center for Research to Advance Community Health and Department of Medicine, Long School of Medicine, University of Texas Health Science Center, San Antonio
- Department of Population Health, Dell Medical School, The University of Texas, Austin
| | - Michael P. Pignone
- Department of Internal Medicine, Dell Medical School, University of Texas, Austin
- Livestrong Cancer Institutes, The University of Texas, Austin
| | - Adewole S. Adamson
- Division of Dermatology, Dell Medical School, University of Texas, Austin
- Department of Internal Medicine, Dell Medical School, University of Texas, Austin
- Livestrong Cancer Institutes, The University of Texas, Austin
- Deputy Editor, JAMA Dermatology
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Maghfour J, Li P, Piontkowski A, Ozog D, Mi QS, Veenstra J. Melanoma incidence and mortality: Exploring the impact of regional ultraviolet (UV) radiation and socioeconomic status in the context of Breslow thickness. J Am Acad Dermatol 2024; 90:637-640. [PMID: 37949120 DOI: 10.1016/j.jaad.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/02/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Jalal Maghfour
- Department of Dermatology, Henry Ford Health, Detroit, Michigan
| | - Pin Li
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan
| | | | - David Ozog
- Department of Dermatology, Henry Ford Health, Detroit, Michigan; Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Qing-Sheng Mi
- Department of Dermatology, Henry Ford Health, Detroit, Michigan; Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Jesse Veenstra
- Department of Dermatology, Henry Ford Health, Detroit, Michigan; Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan.
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Abstract
OBJECTIVES We aimed to systematically identify and scrutinise published empirical evidence about overdiagnosis in malignant melanoma and examine how frequent overdiagnosis of melanoma is and whether this is related to different types of interventions or diagnostic technologies. DESIGN AND SETTING Empirical studies that discussed overdiagnosis in malignant melanoma were eligible, including qualitative and quantitative studies in any type of population, age group and geographical location. We excluded studies that did not include empirical data, studies that only mentioned 'overdiagnosis' without addressing it further and studies that used the term overdiagnosis for cases of misdiagnosis or false positives.We developed the search strategy in cooperation with an information specialist. We searched five databases on 21 April 2022: MEDLINE, Embase, CINAHL, PsycINFO and Cochrane Library.This scoping review adheres to The JBI methodology and Prefered Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping reviews (PRISMA-ScR). Two reviewers independently screened titles, abstracts and full texts for inclusion and extracted data from the included studies. The data extracted include study characteristics, population details, research question, the context and the study's main results. RESULTS Our search resulted in 1134 potentially relevant studies. 35 studies were included: 29 register studies, 3 cohort studies, 1 case-control study, 1 survey study and 1 randomised controlled trial. Most register studies examined trends in melanoma incidence and/or mortality and found a significant increase in incidence between 0.39% and 6.6% annually and a little or no increase in mortality. Three cohort studies and one case-control study showed that skin screening was associated with increased detection of melanoma; especially in situ or thin invasive melanoma. Three studies estimated the degree of overdiagnosis which ranged from 29% to 60%. CONCLUSIONS Epidemiological data suggest a high degree of overdiagnosis in malignant melanoma. Studies that examined the association between skin screening and malignant melanoma all found increased detection of melanomas, mostly thin and in situ melanomas, which raises concern about overdiagnosis.
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Affiliation(s)
- Mille Falk Bjørch
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emma Grundtvig Gram
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Primary Health Care Research Unit, Region Zealand, Denmark
| | - John Brandt Brodersen
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Primary Health Care Research Unit, Region Zealand, Denmark
- Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Grady D, Katz MH, Steinbrook R. The Rita Redberg Era at JAMA Internal Medicine. JAMA Intern Med 2023; 183:760-761. [PMID: 37358844 DOI: 10.1001/jamainternmed.2023.2719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Affiliation(s)
- Deborah Grady
- Deputy Editor, JAMA Internal Medicine
- University of California, San Francisco
| | - Mitchell H Katz
- Deputy Editor, JAMA Internal Medicine
- NYC Health + Hospitals, New York, New York
| | - Robert Steinbrook
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Editor at Large and Online Editor, JAMA Internal Medicine
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Smith B, Smith JE, Demanelis K, Ferris LK. Changes in skin cancer screening rates in the United States from 2005 to 2015. J Am Acad Dermatol 2023; 89:142-145. [PMID: 36804574 DOI: 10.1016/j.jaad.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/19/2023] [Accepted: 02/09/2023] [Indexed: 02/20/2023]
Affiliation(s)
- Brandon Smith
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | - Kathryn Demanelis
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Chen Y, Gutierrez V, Morris L, Marti JL. Diagnostic Scrutiny and Patterns of Elevated Cancer Risk: Uncovering Overdiagnosis Through Standardized Incidence Ratios. Cureus 2023; 15:e42439. [PMID: 37637595 PMCID: PMC10447997 DOI: 10.7759/cureus.42439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Certain medical diagnoses and environmental or occupational exposures may be associated with elevated risk of cancer diagnosis, either through causal mechanisms or via increased detection of a subclinical reservoir through increased diagnostic scrutiny (overdiagnosis). The present study aimed to investigate the distribution of elevated cancer risks associated with different diagnoses and exposures. A systematic literature search was conducted to identify studies published in the last 30 years that examined the standardized incidence ratio (SIR) associated with exposures and risk factors. Meta-SIRs for each cancer type were calculated. The distribution of elevated cancer risks was then compared between cancer types previously reported to be susceptible to overdiagnosis and those that have not been associated with overdiagnosis. The review of 108 studies identified four patterns: SIR generally elevated for 1) only overdiagnosis-susceptible cancer types, 2) both overdiagnosed and non-overdiagnosed cancer types, 3) select cancers in accordance with risk factor or exposure, and 4) SIRs that did not exhibit a distinct increase in any cancer type. The distribution of elevated cancer risks may serve as a signature of whether the underlying risk factor or exposure is a carcinogenic process or a mechanism of increased diagnostic scrutiny uncovering clinically occult diseases. The identification of increased cancer risk should be viewed with caution, and analyzing the pattern of elevated cancer risk distribution can potentially reveal conditions that appear to be cancer risk factors but are in fact the result of exposure to medical surveillance or other healthcare activities that lead to the detection of indolent tumors.
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Affiliation(s)
- Yunchan Chen
- Department of Surgery, Weill Cornell Medicine, New York, USA
| | | | - Luc Morris
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jennifer L Marti
- Division of Breast Surgical Oncology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, USA
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Adamson AS, Welch H, Welch HG. Melanoma Incidence by Sex, Indoor Tanning, and Body Site-Reply. JAMA Intern Med 2023; 183:390-391. [PMID: 36780182 DOI: 10.1001/jamainternmed.2022.6734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- Adewole S Adamson
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin
| | - Heather Welch
- Institute of Marine Science, University of California, Santa Cruz
| | - H Gilbert Welch
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
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He M, Huang J. Melanoma Incidence by Sex, Indoor Tanning, and Body Site. JAMA Intern Med 2023; 183:390. [PMID: 36780181 DOI: 10.1001/jamainternmed.2022.6737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- Mengyang He
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Jinchang Huang
- Institute of Acupuncture and Moxibustion Oncology, Beijing University of Chinese Medicine, Third Affiliated Hospital, Beijing, China
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