1
|
Bucchi L, Mancini S, Zamagni F, Crocetti E, Dal Maso L, Ferretti S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Bella F, Carrozzi G, Cascone G, Ferrante M, Michiara M, Musolino A, Tumino R, Usticano A, Allotta A, Pollina Addario S, Lacarrubba F, Stanganelli I, Falcini F. North-south differences in incidence and surveillance of cutaneous malignant melanoma in Italy. TUMORI JOURNAL 2024:3008916241255458. [PMID: 38825831 DOI: 10.1177/03008916241255458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
BACKGROUND In Italy, the incidence of cutaneous malignant melanoma is two-fold higher in the north than in the south. This gradient might be associated with differences in incidence trends and disease surveillance. We compared the time trends in incidence rates, mortality rates, dermatologic office visit rates and skin biopsy rates between the Emilia-Romagna Region (northern Italy) and the Sicily Region (southern Italy). METHODS The cancer registries of Parma, Modena, Ferrara and Romagna (current population, 2,606,465) and Catania-Messina-Enna, Siracusa and Ragusa (2,775,019) provided incidence and mortality records for the years 2008-2017. The records of outpatient services delivered in public health facilities were obtained from the two Regional Administrations. Trends in rates were assessed with the estimated average annual percent change. North-south differences were expressed as age-standardised rate ratios. RESULTS In the context of a generalised increasing incidence trend, which was more moderate in the female population of the Sicily Region, the standardised rate ratios were: 5.31 (males) and 5.20 (females) for in situ cutaneous malignant melanoma; 2.10 and 2.07 for invasive cutaneous malignant melanoma, with an excess incidence concentrated in lesions ⩽1.00 mm thick (3.58 and 3.05); 3.00 and 2.44 for dermatologic office visits; and 5.25 and 5.02 for skin biopsies. Mortality was stable in both Regions. CONCLUSIONS In the Emilia-Romagna Region, as compared with the Sicily Region, a higher incidence of cutaneous malignant melanoma -especially of in situ and early invasive cutaneous malignant melanoma- coexisted with a higher level of clinical surveillance. The question of the direction of the cause-effect relationship between increased incidence and increased diagnostic scrutiny remains open.
Collapse
Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Federica Zamagni
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Stefano Ferretti
- Romagna Cancer Registry, Section of Ferrara, Local Health Authority and University of Ferrara, Ferrara, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Francesca Bella
- Siracusa Cancer Registry, Provincial Health Authority of Siracusa, Italy
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health Department, Local Health Authority, Modena, Italy
| | - Giuseppe Cascone
- Cancer Registry, Provincial Health Authority (ASP), Ragusa, Italy
| | - Margherita Ferrante
- Integrated Cancer Registry of Catania-Messina-Enna, Azienda Ospedaliero-Universitaria Policlinico 'Rodolico-San Marco', Catania, Italy
| | - Maria Michiara
- Parma Cancer Registry, Medical Oncology Unit, Parma University Hospital, Parma, Italy
| | - Antonino Musolino
- Parma Cancer Registry, Medical Oncology Unit, Parma University Hospital, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rosario Tumino
- Siracusa Cancer Registry, Provincial Health Authority of Siracusa, Italy
| | - Antonella Usticano
- Cancer Registry, Provincial Health Authority (ASP), Ragusa, Italy
- Department of Health Activities and Epidemiological Observatory of Sicily Region, Palermo, Italy
| | - Alessandra Allotta
- Department of Health Activities and Epidemiological Observatory of Sicily Region, Palermo, Italy
| | | | | | - Ignazio Stanganelli
- Skin Cancer Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
- Dermatology Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
- Cancer Prevention Unit, Local Health Authority, Forlì, Italy
| |
Collapse
|
2
|
Bucchi L, Mancini S, Crocetti E, Dal Maso L, Baldacchini F, Vattiato R, Giuliani O, Ravaioli A, Zamagni F, Bella F, Bidoli E, Caldarella A, Candela G, Carone S, Carrozzi G, Cavallo R, Ferrante M, Ferretti S, Filiberti RA, Fusco M, Gatti L, Gili A, Iacovacci S, Magoni M, Mangone L, Mazzoleni G, Michiara M, Musolino A, Piffer S, Piras D, Rizzello RV, Rosso S, Rugge M, Scala U, Stracci F, Tagliabue G, Toffolutti F, Tumino R, Biggeri A, Masini C, Ridolfi L, Villani S, Palmieri G, Stanganelli I, Falcini F. The descriptive epidemiology of melanoma in Italy has changed - for the better. Ital J Dermatol Venerol 2023; 158:483-492. [PMID: 38015485 DOI: 10.23736/s2784-8671.23.07653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
A recent research project using data from a total of 40 cancer registries has provided new epidemiologic insights into the results of efforts for melanoma control in Italy between the 1990s and the last decade. In this article, the authors present a summary and a commentary of their findings. Incidence increased significantly throughout the study period in both sexes. However, the rates showed a stabilization or a decrease in men and women aged below 35 years. The risk of disease increased for successive cohorts born until 1973 (women) and 1975 (men) while subsequently tending to decline. The trend towards decreasing tumor thickness and increasing survival has continued, but a novel favorable prognostic factor has emerged since 2013 for patients - particularly for males - with thick melanoma, most likely represented by molecular targeted therapies and immune checkpoint inhibitors. Due to this, the survival gap between males and females has been filled out. In the meanwhile, and despite the incidence increase, dermatologists have not lowered their threshold to perform skin biopsy. Skin biopsy rate has increased because of the increasingly greater volume of dermatologic office visits, but the proportion of skin biopsies out of dermatologic office visits has remained constant. In summary, an important breakthrough in melanoma control in Italy has taken place. Effective interventions have been implemented across the full scope of care, which involve many large local populations - virtually the whole national population. The strategies adopted during the last three decades represent a valuable basis for further steps ahead in melanoma control in Italy.
Collapse
Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy -
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Pordenone, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Federica Zamagni
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Francesca Bella
- Siracusa Cancer Registry, Azienda Sanitaria Provinciale (ASP), Siracusa, Italy
| | - Ettore Bidoli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Pordenone, Italy
| | - Adele Caldarella
- Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Giuseppa Candela
- Trapani Cancer Registry, Department of Prevention, Servizio Sanitario Regionale Sicilia, Azienda Sanitaria Provinciale (ASP), Trapani, Italy
| | - Simona Carone
- Taranto Cancer Registry, Unit of Statistics and Epidemiology, ASL Taranto, Taranto, Italy
| | | | | | - Margherita Ferrante
- Integrated Cancer Registry of Catania-Messina-Enna, Rodolico-San Marco Polyclinic University Hospital, Catania, Italy
| | - Stefano Ferretti
- Romagna Cancer Registry - Section of Ferrara, ASL Ferrara, University of Ferrara, Ferrara, Italy
| | - Rosa A Filiberti
- Liguria Cancer Registry, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
| | | | - Luciana Gatti
- Mantova Cancer Registry, Epidemiology Unit, Agenzia di Tutela della Salute (ATS) della Val Padana, Mantua, Italy
| | - Alessio Gili
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | - Michele Magoni
- Registry of Brescia Province, Epidemiology Unit, Brescia Health Protection Agency, Brescia, Italy
| | - Lucia Mangone
- Epidemiology Unit, AUSL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Maria Michiara
- Parma Cancer Registry, Medical Oncology Unit, Parma University Hospital, Parma, Italy
| | - Antonino Musolino
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit and Cancer Registry, Parma University Hospital, Parma, Italy
| | - Silvano Piffer
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Trento, Italy
| | - Daniela Piras
- Sassari Cancer Registry, Azienda Regionale per la Tutela della Salute (ATS), Sassari, Italy
| | - Roberto V Rizzello
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Trento, Italy
| | - Stefano Rosso
- Piedmont Cancer Registry, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Fabrizio Stracci
- Umbria Cancer Registry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giovanna Tagliabue
- Lombardy Cancer Registry of Varese Province, Cancer Registry Unit, Department of Research, National Cancer Institute IRCCS Foundation, Milan, Italy
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Pordenone, Italy
| | - Rosario Tumino
- Cancer Registry, Department of Histopathology, Provincial Health Authority (ASP), Ragusa, Italy
| | - Annibale Biggeri
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Carla Masini
- Unit of Oncological Pharmacy, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Laura Ridolfi
- Department of Immunotherapy, Cell Therapy and Biobank, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Simona Villani
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Giuseppe Palmieri
- Department of Immuno-oncology and Targeted Oncologic Biotherapies, University of Sassari, Sassari, Italy
- Unit of Tumor Genetics, IRGB-CNR, Sassari, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
- Cancer Prevention Unit, ASL Forlì, Forlì-Cesena, Italy
| |
Collapse
|
3
|
Alsayyah A. Differentiating between early melanomas and melanocytic nevi: A state-of-the-art review. Pathol Res Pract 2023; 249:154734. [PMID: 37573619 DOI: 10.1016/j.prp.2023.154734] [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] [Received: 05/06/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
Clinicians and dermatologists are challenged by accurate diagnosis of melanocytic lesions, due to melanoma's resemblance to benign skin conditions. Several methodologies have been proposed to diagnose melanoma, and to differentiate between a cancerous and a benign skin condition. First, the ABCD rule and Menzies method use skin lesion characteristics to interpret the condition. The 7-point checklist, 3-point checklist, and CASH algorithm are score-based methods. Each of these methods attributes a score point to the features found on the skin lesion. Furthermore, reflectance confocal microscopy (RCM), an integrated clinical and dermoscopic risk scoring system (iDscore), and a deep convoluted neural network (DCNN) also aids in diagnosis. RCM optically sections live tissues to reveal morphological and cellular structures. The skin lesion's clinical parameters determine iDscore's score point system. The DCNN model is based on a detailed learning algorithm. Therefore, we discuss the conventional and new methodologies for the identification of skin diseases. Moreover, our review attempts to provide clinicians with a comprehensible summary of the wide range of techniques that can help differentiate between early melanomas and melanocytic nevi.
Collapse
Affiliation(s)
- Ahmed Alsayyah
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Post Box No. 1982, Dammam 31441, Saudi Arabia.
| |
Collapse
|
4
|
Huang C, Burke H, Scolyer RA, Guitera P. Lentigo maligna and lentigo maligna melanoma in young patients in Australian tertiary centres. Clin Exp Dermatol 2023; 48:799-800. [PMID: 36916530 DOI: 10.1093/ced/llad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/22/2023] [Indexed: 03/15/2023]
Abstract
This was a retrospective study of all patients with a diagnosis of lentigo maligna or lentigo maligna melanoma at 50 years of age or younger at the time of their first diagnosis in two Australian tertiary centres. The low recurrence rate in younger patients in this study warrants further investigation. Early diagnosis in young patients is crucial to allow early treatment and lifestyle changes to reduce actinic damage and subsequent development of further melanomas.
Collapse
Affiliation(s)
- Cheng Huang
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Melanoma Institute Australia
| | | | - Richard A Scolyer
- Melanoma Institute Australia
- Faculty of Medicine and Health
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Pascale Guitera
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Melanoma Institute Australia
- Faculty of Medicine and Health
| |
Collapse
|
5
|
Bucchi L, Mancini S, Zamagni F, Crocetti E, Dal Maso L, Ferretti S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Brustolin A, Candela G, Carone S, Carrozzi G, Cavallo R, Dinaro YM, Ferrante M, Iacovacci S, Mazzoleni G, Musolino A, Rizzello RV, Serraino D, Biggeri A, Stanganelli I, Falcini F. Patient presentation, skin biopsy utilization and cutaneous malignant melanoma incidence and mortality in northern Italy: Trends and correlations. J Eur Acad Dermatol Venereol 2023; 37:293-302. [PMID: 36181283 PMCID: PMC10092783 DOI: 10.1111/jdv.18635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/14/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The global increase in incidence of cutaneous malignant melanoma (CMM) occurring in the past decades has been partly attributed to increased diagnostic scrutiny of early lesions, with a potential phenomenon of overdiagnosis. The reported positive linear relation between skin biopsy rate and incidence of early CMM is compatible with this hypothesis. OBJECTIVES We explored the ecological association between the trends in annual dermatologic office visit rates, skin biopsy rates, incidence rates of in situ and invasive CMM by tumour thickness category, and CMM mortality rates in the Emilia-Romagna Region (northern Italy). METHODS Four cancer registries covering a population of 2,696,000 provided CMM incidence data for the years 2003-2017. Dermatologic office visit rates and skin biopsy rates were calculated using the Regional outpatient care database. All rates were age-standardized. Trends were described with the estimated average annual per cent change (EAAPC). Correlations were tested with the Spearman correlation coefficient. RESULTS Incidence increased significantly. The increase was steeper for in situ CMM (EAAPC: men, 10.2; women, 6.9) followed by CMM <0.8 mm thick (9.1; 5.2), but the rates grew significantly for most subgroups of CMMs ≥0.8 mm thick. Mortality decreased significantly among women (-2.3) and non-significantly among men. For dermatologic office visit rate and skin biopsy rate the EAAPC were, respectively, 1.7 and 1.8 for men and 1.2 and 0.9 for women. Annual dermatologic office visit rate correlated with skin biopsy rate in both sexes. However, the proportion of skin biopsies out of dermatologic office visits was constant across the years (range: men, 0.182-0.216; women, 0.157-0.191). CONCLUSIONS In Italy, the increasing CMM incidence trend is, at least in part, genuine. Overdiagnosis-if any-is due to an increased patient presentation at dermatologic offices and not to a lower dermatologic threshold to perform biopsy.
Collapse
Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Federica Zamagni
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Stefano Ferretti
- Romagna Cancer Registry, section of Ferrara, Local Health Authority and University of Ferrara, Ferrara, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Angelita Brustolin
- UOSD Epidemiologia e Registro Tumori (Dip. di Prevenzione ASL VT) c/o Cittadella della Salute, Viterbo, Italy
| | - Giuseppa Candela
- Trapani Cancer Registry, Dipartimento di Prevenzione della Salute, Servizio Sanitario Regionale Sicilia, Azienda Sanitaria Provinciale (ASP), Trapani, Italy
| | - Simona Carone
- Registro Tumori di Taranto, Unità Operativa Complessa di Statistica ed Epidemiologia, Azienda Sanitaria Locale, Taranto, Italy
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health Department, Local Health Authority, Modena, Italy
| | | | | | - Margherita Ferrante
- Integrated Cancer Registry of Catania-Messina-Enna, Azienda Ospedaliero-Universitaria Policlinico "Rodolico-San Marco", Catania, Italy
| | | | | | - Antonino Musolino
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Medical Oncology Unit and Cancer Registry, University Hospital of Parma, Parma, Italy
| | - Roberto Vito Rizzello
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Annibale Biggeri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy.,Department of Dermatology, University of Parma, Parma, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy.,Local Health Authority, Cancer Prevention Unit, Forlì, Italy
| | | |
Collapse
|
6
|
Dunn BK, Woloshin S, Xie H, Kramer BS. Cancer overdiagnosis: a challenge in the era of screening. JOURNAL OF THE NATIONAL CANCER CENTER 2022; 2:235-242. [PMID: 36568283 PMCID: PMC9784987 DOI: 10.1016/j.jncc.2022.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/04/2022] [Accepted: 08/16/2022] [Indexed: 12/30/2022] Open
Abstract
"Screening" is a search for preclinical, asymptomatic disease, including cancer. Widespread cancer screening has led to large increases in early-stage cancers and pre-cancers. Ubiquitous public messages emphasize the potential benefits to screening for these lesions based on the underlying assumption that treating cancer at early stages before spread to other organs should make it easier to treat and cure, using more tolerable interventions. The intuition is so strong that public campaigns are sometimes launched without conducting definitive trials directly comparing screening to usual care. An effective cancer screening test should not only increase the incidence of early-stage preclinical disease but should also decrease the incidence of advanced and metastatic cancer, as well as a subsequent decrease in cancer-related mortality. Otherwise, screening efforts may be uncovering a reservoir of non-progressive and very slowly progressive lesions that were not destined to cause symptoms or suffering during the person's remaining natural lifespan: a phenomenon known as "overdiagnosis." We provide here a qualitative review of cancer overdiagnosis and discuss specific examples due to extensive population-based screening, including neuroblastoma, prostate cancer, thyroid cancer, lung cancer, melanoma, and breast cancer. The harms of unnecessary diagnosis and cancer therapy call for a balanced presentation to people considering undergoing screening, even with a test of accepted benefit, with a goal of informed decision-making. We also discuss proposed strategies to mitigate the adverse sequelae of overdiagnosis.
Collapse
Affiliation(s)
- Barbara K. Dunn
- US National Cancer Institute, Division of Cancer Prevention, Bethesda, Maryland, USA
- Member, The Lisa Schwartz Foundation for Truth in Medicine, Norwich, Vermont, USA
| | - Steven Woloshin
- The Center for Medicine in the Media, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Director, The Lisa Schwartz Foundation for Truth in Medicine, Norwich, Vermont, USA
| | - Heng Xie
- Beijing Biostar Pharmaceuticals Co., Ltd, Beijing, China
| | - Barnett S. Kramer
- Member, The Lisa Schwartz Foundation for Truth in Medicine, Norwich, Vermont, USA
- Rockville, Maryland, USA
| |
Collapse
|
7
|
Sadrolashrafi K, Cotter DG. Not Your Mother's Melanoma: Causes and Effects of Early Melanoma Diagnosis. Dermatopathology (Basel) 2022; 9:368-378. [PMID: 36547217 PMCID: PMC9777089 DOI: 10.3390/dermatopathology9040043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
The year 2022 will herald approximately 100,000 new cases of cutaneous melanoma (CM), and over 7000 deaths from CM. Over the past 40 years, CM incidence has increased nearly six-fold; however, annual mortality has remained relatively constant. These trends encapsulate the phenomenon of overdiagnosis. Increased recognition of indolent lesions that appear histologically malignant may be leading to a melanoma epidemic. Enhanced melanoma awareness, screening efforts, physician uncertainty, medical-legal pressures, and diagnostic scrutiny using tools like immunohistochemical staining, mole mapping, dermoscopy, confocal microscopy, and molecular diagnostics contribute to increased CM diagnosis. As a result, current melanoma staging and treatment guidelines are being challenged. Existing standards fail to accurately identify histologically benign lesions that are lethal or, conversely, histologically malignant lesions that are innocuous. Healthcare systems and, more importantly, patients suffer from this diagnostic ambiguity that leads to the over-treatment of innocuous melanomas and under-treatment of aggressive melanomas. As dermatology continues to experience a shift towards earlier diagnosis of melanoma, management strategies must adapt. Herein, we review factors that may contribute to the increased incidence of melanoma, emphasize deficiencies in current staging systems, and provide insights into the future of melanoma management via precision medicine.
Collapse
Affiliation(s)
- Kaviyon Sadrolashrafi
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89106, USA
| | - David Graham Cotter
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89106, USA
- Las Vegas Dermatology, Las Vegas, NV 89144, USA
- Correspondence:
| |
Collapse
|
8
|
Comment on “An Epidemiologic Analysis of Melanoma Overdiagnosis in the United States, 1975-2017”. J Invest Dermatol 2022; 142:3120-3122. [DOI: 10.1016/j.jid.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/02/2022] [Accepted: 03/31/2022] [Indexed: 11/23/2022]
|
9
|
Zamagni F, Bucchi L, Mancini S, Crocetti E, Dal Maso L, Ferretti S, Biggeri A, Villani S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Brustolin A, Candela G, Carone S, Carrozzi G, Cavallo R, Dinaro YM, Ferrante M, Iacovacci S, Mazzoleni G, Musolino A, Rizzello RV, Serraino D, Stracci F, Tumino R, Masini C, Ridolfi L, Palmieri G, Stanganelli I, Falcini F. The relative contribution of the decreasing trend in tumour thickness to the 2010s increase in net survival from cutaneous malignant melanoma in Italy: a population-based investigation. Br J Dermatol 2022; 187:52-63. [PMID: 35253204 PMCID: PMC9542017 DOI: 10.1111/bjd.21051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The long-term increase in survival from cutaneous malignant melanoma (CMM) is generally attributed to the decreasing trend in tumour thickness, the single most important prognostic factor. OBJECTIVES To determine the relative contribution of decreased tumour thickness to the favourable trend in survival from CMM in Italy. METHODS Eleven local cancer registries covering a population of 8 056 608 (13.4% of the Italian population in 2010) provided records for people with primary CMM registered between 2003 and 2017. Age-standardized 5-year net survival was calculated. Multivariate analysis of 5-year net survival was undertaken by calculating the relative excess risk (RER) of death. The relative contribution of the decrease in tumour thickness to the RER of death was evaluated using a forward stepwise flexible parametric survival model including the available prognostic factors. RESULTS Over the study period, tumour thickness was inversely associated with 5-year net survival and multivariate RER in both sexes. The median thickness was 0.90 mm in 2003-2007, 0.85 mm in 2008-2012 and 0.75 mm in 2013-2017 among male patients, and 0.78 mm, 0.77 mm and 0.68 mm among female patients, respectively. The 5-year net survival was 86.8%, 89.2% and 93.2% in male patients, and 91.4%, 92.0% and 93.4% in female patients, respectively. In 2013-2017, male patients exhibited the same survival as female patients despite having thicker lesions. For them, the increasing survival trend was more pronounced with increasing thickness, and the inclusion of thickness in the forward stepwise model made the RER in 2013-2017 vs. 2003-2007 increase from 0.64 [95% confidence interval (CI) 0.51-0.80] to 0.70 (95% CI 0.57-0.86). This indicates that the thickness trend accounted for less than 20% of the survival increase. For female patients, the results were not significant but, with multiple imputation of missing thickness values, the RER rose from 0.74 (95% CI 0.58-0.93) to 0.82 (95% CI 0.66-1.02) in 2013-2017. CONCLUSIONS For male patients in particular, decrease in tumour thickness accounted for a small part of the improvement in survival observed in 2013-2017. The introduction of targeted therapies and immune checkpoint inhibitors in 2013 is most likely to account for the remaining improvement.
Collapse
Affiliation(s)
- Federica Zamagni
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Lauro Bucchi
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Silvia Mancini
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Emanuele Crocetti
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Luigino Dal Maso
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Stefano Ferretti
- Romagna Cancer Registry, Section of FerraraLocal Health Authority and University of FerraraFerraraItaly
| | - Annibale Biggeri
- Department of Statistics, Computer Science, Applications G. ParentiUniversity of FlorenceFlorenceItaly
| | - Simona Villani
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical EpidemiologyUniversity of PaviaPaviaItaly
| | - Flavia Baldacchini
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Orietta Giuliani
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Alessandra Ravaioli
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Rosa Vattiato
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Angelita Brustolin
- UOSD Epidemiologia e Registro Tumori (Dip. di Prevenzione ASL VT) c/o Cittadella della SaluteViterboItaly
| | - Giuseppa Candela
- Trapani Cancer Registry, Dipartimento di Prevenzione della SaluteServizio Sanitario Regionale Sicilia, Azienda Sanitaria Provinciale (ASP)TrapaniItaly
| | - Simona Carone
- Registro tumori di TarantoUnità operativa complessa di statistica ed epidemiologiaAzienda sanitaria locale TarantoItaly
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health DepartmentLocal Health AuthorityModenaItaly
| | | | | | - Margherita Ferrante
- Integrated Cancer Registry of Catania‐Messina‐EnnaAzienda Ospedaliero‐Universitaria Policlinico ‘Rodolico‐San Marco’CataniaItaly
| | | | | | - Antonino Musolino
- Department of Medicine and SurgeryUniversity of Parma; Medical Oncology Unit and Cancer Registry, University Hospital of ParmaParmaItaly
| | - Roberto Vito Rizzello
- Trento Province Cancer Registry, Unit of Clinical EpidemiologyAzienda Provinciale per i Servizi Sanitari (APSS) TrentoItaly
| | - Diego Serraino
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Fabrizio Stracci
- Department of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Rosario Tumino
- Former Director Cancer RegistryProvincial Health Authority (ASP)RagusaItaly
| | - Carla Masini
- Unit of Oncological PharmacyIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Laura Ridolfi
- Immunotherapy, Cell Therapy and BiobankIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Giuseppe Palmieri
- Institute of Research on Genetics and Biomedicine (IRGB), National Research Council (CNR)SardegnaSassariItaly
| | - Ignazio Stanganelli
- Skin Cancer UnitIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
- Department of DermatologyUniversity of ParmaParmaItaly
| | - Fabio Falcini
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
- Cancer Prevention UnitLocal Health AuthorityForlìItaly
| | | |
Collapse
|
10
|
Waqar S, George S, Jean-Baptiste W, Yusuf Ali A, Inyang B, Koshy FS, George K, Poudel P, Chalasani R, Goonathilake MR, Mohammed L. Recognizing Histopathological Simulators of Melanoma to Avoid Misdiagnosis. Cureus 2022; 14:e26127. [PMID: 35875272 PMCID: PMC9299949 DOI: 10.7759/cureus.26127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/20/2022] [Indexed: 11/05/2022] Open
Abstract
Melanocytic lesions have a wide morphological spectrum, ranging from benign nevi to malignant melanoma. In contrast to a diagnosis of a benign nevus, a diagnosis of melanoma could mean intensive treatment, lifetime monitoring, and a worse prognosis. Therefore, melanocytic tumors are notoriously challenging and associated with a high risk of litigation in surgical pathology. After describing the basic features of nevi and melanoma, this article describes the detailed clinical and histological features of those lesions that share many similar features with melanoma. The entities included are Spitz nevi and atypical Spitz tumors (AST), Reed nevus, dysplastic nevus, cellular blue nevus (CBN), deep penetrating nevus, combined nevus, recurrent nevus, irritated nevus, congenital pattern nevus, acral nevus, and nevi of special sites. Knowledge of these imitators can help pathologists distinguish between benign and malignant cases and avoid misdiagnosis.
Collapse
|
11
|
Boffetta P, Goldfarb DG, Zeig-Owens R, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Yung J, Kahn AR, Qiao B, Schymura MJ, Webber MP, Prezant DJ, Dasaro CR, Todd AC, Hall CB. Temporal Aspects of the Association between Exposure to the World Trade Center Disaster and Risk of Cutaneous Melanoma. JID INNOVATIONS 2022; 2:100063. [PMID: 35146479 PMCID: PMC8801528 DOI: 10.1016/j.xjidi.2021.100063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Rescue/recovery workers who responded to the World Trade Center (WTC) attacks were exposed to known/suspected carcinogens. Studies have identified a trend toward an elevated risk of cutaneous melanoma in this population; however, few found significant increases. Furthermore, temporal aspects of the association have not been investigated. A total of 44,540 non-Hispanic White workers from the WTC Combined Rescue/Recovery Cohort were studied between March 12, 2002 and December 31, 2015. Cancer data were obtained through linkages with 13 state registries. Poisson regression was used to estimate hazard ratios and 95% confidence intervals using the New York State population as the reference; change points in hazard ratios were estimated using profile likelihood. We observed 247 incident cases of melanoma. No increase in incidence was detected during 2002-2004. From 2005 to 2015, the hazard ratio was 1.34 (95% confidence interval = 1.18-1.52). A dose‒response relationship was observed by arrival time at the WTC site. Risk was elevated just over 3 years after the attacks. Whereas WTC-related exposures to UVR or other agents might have contributed to this result, exposures other than those at the WTC site, enhanced medical surveillance, and lack of a control group with a similar proportion of rescue/recovery workers cannot be discounted. Our results support continued study of this population for melanoma.
Collapse
Affiliation(s)
- Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - David G. Goldfarb
- Department of Medicine, Montefiore Medical Center, New York, New York, USA
- Fire Department of the City of New York (FDNY), Brooklyn, New York, USA
- Department of Environmental, Occupational and Geospatial Health Sciences, City University of New York Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, New York, New York, USA
- Fire Department of the City of New York (FDNY), Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
- Center of Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jiehui Li
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Robert M. Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Mark R. Farfel
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - James E. Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Janette Yung
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Amy R. Kahn
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Maria J. Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Mayris P. Webber
- Department of Medicine, Montefiore Medical Center, New York, New York, USA
- Fire Department of the City of New York (FDNY), Brooklyn, New York, USA
| | - David J. Prezant
- Department of Medicine, Montefiore Medical Center, New York, New York, USA
- Fire Department of the City of New York (FDNY), Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew C. Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Charles B. Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
12
|
Sacchetto L, Rosso S, Comber H, Bouchardy C, Broganelli P, Galceran J, Hackl M, Katalinic A, Louwman M, Robsahm TE, Tryggvadottir L, Tumino R, Van Eycken E, Walsh PM, Zadnik V, Zanetti R. Skin melanoma deaths within 1 or 3 years from diagnosis in Europe. Int J Cancer 2021; 148:2898-2905. [PMID: 33497469 DOI: 10.1002/ijc.33479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/20/2020] [Accepted: 01/04/2021] [Indexed: 01/03/2023]
Abstract
The steep increase in incidence of cutaneous malignant melanoma in white populations mainly applies to thin lesions with good survival suggesting overdiagnosis. Based on population-based cancer registries (CRs), we have investigated changes in aggressive melanoma, selecting only cases who died within 1 or 3 years after diagnosis in 11 European countries between 1995 and 2012. Trends in fatal cases were analysed by period of diagnosis, sex, tumour thickness, histologic subtype of the lesion, tumour site and CR with a multivariate generalised linear mixed effects model, where geographical area was considered as a random effect. We collected data on 123 360 invasive melanomas, with 5133 fatal cases at 1 year (4%) and 12 330 (10%) at 3 years. The number of fatal cases showed a 16% decrease at 1 year and 8% at 3 years between the first (1995-2000) and the last (2007-2012) period. The highest proportion of fatal cases was seen for men, older age (≥65 years), thick lesions (>1 mm), nodular melanoma, melanoma on the trunk and for poorly documented cases, lacking information about thickness and histologic subtype. The mixed-effects model showed a remarkable variability among European countries. The majority of registries showed a decreasing trend in fatal cases, but a few registries showed an opposite pattern. Trends in fatal melanoma cases, highlighting real changes in risk not related to overdiagnosis, showed a decrease in most European countries, with a few exceptions. Stronger efforts for early detection could lead to a more efficient treatment of melanoma in general.
Collapse
Affiliation(s)
- Lidia Sacchetto
- Piedmont Cancer Registry, Turin, Italy
- Department of Mathematical Sciences, Politecnico di Torino, Turin, Italy
- Department of Mathematics, Università degli Studi di Torino, Turin, Italy
| | | | | | | | - Paolo Broganelli
- A.O.U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Jaume Galceran
- Servei d'Epidemiologia i Prevenció del Càncer, Hospital Universitari Sant Joan de Reus, ISSPV, Tarragona Cancer Registry, Reus, Spain
| | - Monika Hackl
- Austrian National Cancer Registry, Wien, Austria
| | - Alexander Katalinic
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Marieke Louwman
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Trude E Robsahm
- Department of Research, The Cancer Registry of Norway, Oslo, Norway
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland
- Faculty of Medicine, BMC, Laeknagardur, University of Iceland, Reykjavik, Iceland
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP), Ragusa, Italy
| | | | | | - Vesna Zadnik
- Cancer Registry of Republic of Slovenia, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | |
Collapse
|
13
|
Muzumdar S, Lin G, Kerr P, Grant-Kels JM. Evidence concerning the accusation that melanoma is overdiagnosed. J Am Acad Dermatol 2021; 85:841-846. [PMID: 34116095 DOI: 10.1016/j.jaad.2021.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Melanoma is one of the most commonly diagnosed malignancies in the United States and is responsible for the majority of deaths from skin cancer. OBJECTIVE Since the 1970s, the incidence of melanoma has risen appreciably while melanoma-specific mortality has remained stable. This has raised a debate about potential overdiagnosis of melanoma. Herein, we review temporal trends in melanoma incidence and mortality and explore factors that may contribute to observed trends, including an aging population in the United States, ultraviolet exposure, increased numbers of biopsies by dermatologists and physician extenders, skin cancer screenings, histopathology criteria, and historic underdiagnosis. Additionally, we discuss melanoma overdiagnosis and the extent to which it may contribute to current trends. METHODS The literature was reviewed. RESULTS Several factors may contribute to an increased incidence of melanoma, including an aging population, ultraviolet exposure, increased skin biopsies, skin cancer screenings, histopathologic criteria, historic underdiagnosis, and current overdiagnosis. LIMITATIONS Further studies are required to determine exactly which tumors are being overdiagnosed, and how to improve patient outcomes with adjustment to physician's practice. CONCLUSION The rise in the incidence of melanoma observed since the 1970s is likely multifactorial.
Collapse
Affiliation(s)
- Sonal Muzumdar
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Gloria Lin
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Philip Kerr
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut; University of Florida Dermatology Department, Gainesville, Florida.
| |
Collapse
|
14
|
Mao L, Qi Z, Zhang L, Guo J, Si L. Immunotherapy in Acral and Mucosal Melanoma: Current Status and Future Directions. Front Immunol 2021; 12:680407. [PMID: 34149718 PMCID: PMC8212860 DOI: 10.3389/fimmu.2021.680407] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
Acral and mucosal melanomas are extremely rare in Caucasians; however, they are the predominant melanoma subtypes in Asians and other non-Caucasian populations. Acral and mucosal melanomas share many clinicopathological features, including aggressive phenotypes, similar genetic landscapes, and grim prognoses. In spite of advances in melanoma management, patients with acral and mucosal melanomas show limited benefit from current therapies. The rarity of these subtypes of melanoma is a significant factor contributing to the poor understanding of these pathological subtypes and the lack of effective interventions. Furthermore, the mechanisms contributing to disparities between different types of melanoma remain largely unclear. Herein, we comprehensively review current knowledge on the clinicopathological characteristics and mutational landscapes of acral and mucosal melanomas, as well as providing an overview of current therapies for patients with these aggressive melanoma subtypes, focusing on available immunotherapeutic interventions. We also discuss pathological differences between different melanoma subtypes and summarize current knowledge on melanoma disparities between Asians and Caucasians. Finally, we discuss emerging immunotherapeutic strategies for the treatment of acral and mucosal melanomas, focusing on combination therapies with immune checkpoint inhibitors. Unraveling the unique features of acral and mucosal melanomas is key for their early diagnosis and for the development of effective therapies.
Collapse
Affiliation(s)
- Lili Mao
- Department of Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhonghui Qi
- Department of Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Li Zhang
- Global Medical Affairs, MSD China, Shanghai, China
| | - Jun Guo
- Department of Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Lu Si
- Department of Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| |
Collapse
|
15
|
Gibson M, Scolyer RA, Soyer HP, Ferguson P, McGeechan K, Irwig L, Bell KJL. Estimating the potential impact of interventions to reduce over-calling and under-calling of melanoma. J Eur Acad Dermatol Venereol 2021; 35:1519-1527. [PMID: 33630379 DOI: 10.1111/jdv.17189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/19/2020] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pathologists sometimes disagree over the histopathologic diagnosis of melanoma. 'Over-calling' and 'under-calling' of melanoma may harm individuals and healthcare systems. OBJECTIVES To estimate the extent of 'over-calling' and 'under-calling' of melanoma for a population undergoing one excision per person and to model the impact of potential solutions. METHODS In this epidemiological modelling study, we undertook simulations using published data on the prevalence and diagnostic accuracy of melanocytic histopathology in the U.S. POPULATION We simulated results for 10 000 patients each undergoing excision of one melanocytic lesion, interpreted by one community pathologist. We repeated the simulation using a hypothetical intervention that improves diagnostic agreement between community pathologist and a specialist dermatopathologist. We then evaluated four scenarios for how melanocytic lesions judged to be neither clearly benign (post-test probability of melanoma < 5%), nor clearly malignant (post-test probability of melanoma > 90%) might be handled, before sending for expert dermatopathologist review to decide the final diagnosis. These were (1) no intervention before expert review, (2) formal second community pathologist review, (3) intervention to increase diagnostic agreement and (4) both the intervention and formal second community pathologist review. The main outcomes were the probability of 'over-calling' and 'under-calling' melanoma, and number of lesions requiring expert referral for each scenario. RESULTS For 10 000 individuals undergoing excision of one melanocytic lesion, interpreted by a community pathologist, a hypothetical intervention to improve histopathology agreement reduced the number of benign lesions 'over-called' as melanoma from 308 to 164 and the number of melanomas 'under-called' from 289 to 240. If all uncertain diagnoses were sent for expert review, the number of referrals would decrease from 1500 to 737 cases if formal second community pathologist review was used, and to 701 cases if the hypothetical intervention was additionally used. CONCLUSIONS Interventions to improve histopathology agreement may reduce melanoma 'over-calling' and 'under-calling'.
Collapse
Affiliation(s)
- M Gibson
- School of Public Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Central Sydney Clinical School, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Department of Dermatology, Royal Prince Alfred Hospital Sydney, Camperdown, NSW, Australia
| | - R A Scolyer
- Central Sydney Clinical School, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Melanoma Institute of Australia, The University of Sydney, Camperdown, NSW, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Camperdown, NSW, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - P Ferguson
- Central Sydney Clinical School, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Melanoma Institute of Australia, The University of Sydney, Camperdown, NSW, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Camperdown, NSW, Australia
| | - K McGeechan
- School of Public Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - L Irwig
- School of Public Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - K J L Bell
- School of Public Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
16
|
Čelakovská J, Bukač J, Čáková L, Šimková M, Jandová E. Epidemiology of Melanoma in the Czech Republic in East Bohemia in the Period 2002-2017 and the Effect of the Annual Sunshine Exposure. ACTA MEDICA (HRADEC KRÁLOVÉ) 2021; 63:10-17. [PMID: 32422111 DOI: 10.14712/18059694.2020.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM The evaluation of the trend in the occurrence of melanoma nodulare, melanoma superficiale, lentigo maligna and melanoma in situ in the period of 2002-2017 in East Bohemia region in the Czech Republic. We examine if the annual numbers of hours of sunshine could affect the number of patients with melanoma. METHOD In the peridod of 2002-2017, altogether 2230 patients with new diagnosis of melanoma were examined. We studied 1) If there is some trend in the occurrence of lentigo maligna and melanoma in situ, melanoma superficiale, and melanoma nodulare and if there is a difference in the age of patients with this diagnosis (adjusted calculation of specific kind of melanomas and adjusted calculation of age). 2) If the annual numbers of hours of sunshine affect the trend in the occurrence of melanoma and if the annual numbers of hours of sunshine affect the body site of melanoma. RESULTS AND CONCLUSION Our study confirmed that the number of patients with lentigo maligna and melanoma in situ had increased in East Bohemia region in the period of 2002-2017. The number of melanomas of nodular and superficial type does not increase. The total number of melanomas in this period does not increase either. No difference of the age of patients with melanoma nodulare, superficiale, lentigo maligna and melanoma in situ was confirmed. We confirmed no relation of the annual numbers of hours of sunshine to the number of melanoma and to the body site of melanoma.
Collapse
Affiliation(s)
- Jarmila Čelakovská
- Department of Dermatology and Venereology Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic.
| | - Josef Bukač
- Department of Medical Biophysics, Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - Lenka Čáková
- Department of Dermatology and Venereology Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - Marie Šimková
- Department of Dermatology and Venereology Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - Eva Jandová
- Department of Dermatology and Venereology Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| |
Collapse
|
17
|
Kutzner H, Jutzi TB, Krahl D, Krieghoff‐Henning EI, Heppt MV, Hekler A, Schmitt M, Maron RCR, Fröhling S, Kalle C, Brinker TJ. Überdiagnose von Melanomen – Ursachen, Konsequenzen und Lösungsansätze. J Dtsch Dermatol Ges 2020; 18:1236-1244. [DOI: 10.1111/ddg.14233_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Tanja B. Jutzi
- Nachwuchsgruppe Digitale Biomarker für die Onkologie (DBO), Nationales Centrum für Tumorerkrankungen (NCT) Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
| | - Dieter Krahl
- Privates Labor für Dermatohistopathologie Mönchhofstraße 52 Heidelberg
| | - Eva I. Krieghoff‐Henning
- Nachwuchsgruppe Digitale Biomarker für die Onkologie (DBO), Nationales Centrum für Tumorerkrankungen (NCT) Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
| | | | - Achim Hekler
- Nachwuchsgruppe Digitale Biomarker für die Onkologie (DBO), Nationales Centrum für Tumorerkrankungen (NCT) Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
| | - Max Schmitt
- Nachwuchsgruppe Digitale Biomarker für die Onkologie (DBO), Nationales Centrum für Tumorerkrankungen (NCT) Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
| | - Roman C. R. Maron
- Nachwuchsgruppe Digitale Biomarker für die Onkologie (DBO), Nationales Centrum für Tumorerkrankungen (NCT) Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
| | - Stefan Fröhling
- Nachwuchsgruppe Digitale Biomarker für die Onkologie (DBO), Nationales Centrum für Tumorerkrankungen (NCT) Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
| | - Christof Kalle
- Berlin Institute of Health (BIH) und Charité – Universitätsmedizin Berlin
| | - Titus J. Brinker
- Nachwuchsgruppe Digitale Biomarker für die Onkologie (DBO), Nationales Centrum für Tumorerkrankungen (NCT) Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
| |
Collapse
|
18
|
Gogebakan KC, Berry EG, Geller AC, Sonmez K, Leachman SA, Etzioni R. Strategizing Screening for Melanoma in an Era of Novel Treatments: A Model-Based Approach. Cancer Epidemiol Biomarkers Prev 2020; 29:2599-2607. [PMID: 32958498 DOI: 10.1158/1055-9965.epi-20-0881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/05/2020] [Accepted: 09/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Benefit-harm tradeoffs of melanoma screening depend on disease risk and treatment efficacy. We developed a model to project outcomes of screening for melanoma in populations with different risks under historic and novel systemic treatments. METHODS Computer simulation model of a screening program with specified impact on overall and advanced-stage incidence. Inputs included meta-analyses of treatment trials, cancer registry data, and a melanoma risk prediction study RESULTS: Assuming 50% reduction in advanced stage under screening, the model projected 59 and 38 lives saved per 100,000 men under historic and novel treatments, respectively. With 10% increase in stage I, the model projects 2.9 and 4.7 overdiagnosed cases per life saved and number needed to be screened (NNS) equal to 1695 and 2632 under historical and novel treatments. When screening was performed only for the 20% of individuals with highest predicted risk, 34 and 22 lives per 100,000 were saved under historic and novel treatments. Similar results were obtained for women, but lives saved were lower. CONCLUSIONS Melanoma early detection programs must shift a substantial fraction of cases from advanced to localized stage to be sustainable. Advances in systemic therapies for melanoma might noticeably reduce benefits of screening, but restricting screening to individuals at highest risk will likely reduce intervention efforts and harms while preserving >50% of the benefit of nontargeted screening. IMPACT Our accessible modeling framework will help to guide population melanoma screening programs in an era of novel treatments for advanced disease.
Collapse
Affiliation(s)
- Kemal Caglar Gogebakan
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Elizabeth G Berry
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Alan C Geller
- Division of Public Health Practice, Harvard School of Public Health, Boston, Massachusetts
| | - Kemal Sonmez
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington. .,Department of Statistics, University of Washington, Seattle, Washington
| |
Collapse
|
19
|
Kutzner H, Jutzi TB, Krahl D, Krieghoff-Henning EI, Heppt MV, Hekler A, Schmitt M, Maron RCR, Fröhling S, von Kalle C, Brinker TJ. Overdiagnosis of melanoma - causes, consequences and solutions. J Dtsch Dermatol Ges 2020; 18:1236-1243. [PMID: 32841508 DOI: 10.1111/ddg.14233] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/13/2020] [Indexed: 12/14/2022]
Abstract
Malignant melanoma is the skin tumor that causes most deaths in Germany. At an early stage, melanoma is well treatable, so early detection is essential. However, the skin cancer screening program in Germany has been criticized because although melanomas have been diagnosed more frequently since introduction of the program, the mortality from malignant melanoma has not decreased. This indicates that the observed increase in melanoma diagnoses be due to overdiagnosis, i.e. to the detection of lesions that would never have created serious health problems for the patients. One of the reasons is the challenging distinction between some benign and malignant lesions. In addition, there may be lesions that are biologically equivocal, and other lesions that are classified as malignant according to current criteria, but that grow so slowly that they would never have posed a threat to patient's life. So far, these "indolent" melanomas cannot be identified reliably due to a lack of biomarkers. Moreover, the likelihood that an in-situ melanoma will progress to an invasive tumor still cannot be determined with any certainty. When benign lesions are diagnosed as melanoma, the consequences are unnecessary psychological and physical stress for the affected patients and incurred therapy costs. Vice versa, underdiagnoses in the sense of overlooked melanomas can adversely affect patients' prognoses and may necessitate more intense therapies. Novel diagnostic options could reduce the number of over- and underdiagnoses and contribute to more objective diagnoses in borderline cases. One strategy that has yielded promising results in pilot studies is the use of artificial intelligence-based diagnostic tools. However, these applications still await translation into clinical and pathological routine.
Collapse
Affiliation(s)
| | - Tanja B Jutzi
- Digital Biomarkers for Oncology group (DBO), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dieter Krahl
- Private Laboratory for Dermatohistopathology, Mönchhofstraße 52, Heidelberg, Germany
| | - Eva I Krieghoff-Henning
- Digital Biomarkers for Oncology group (DBO), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Markus V Heppt
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - Achim Hekler
- Digital Biomarkers for Oncology group (DBO), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Max Schmitt
- Digital Biomarkers for Oncology group (DBO), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Roman C R Maron
- Digital Biomarkers for Oncology group (DBO), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Fröhling
- Digital Biomarkers for Oncology group (DBO), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christof von Kalle
- Berlin Institute of Health (BIH) and Charité-University Medical Center Berlin, Berlin, Germany
| | - Titus J Brinker
- Digital Biomarkers for Oncology group (DBO), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
20
|
Bianconi F, Crocetti E, Grisci C, Primieri C, Stracci F. What has changed in the epidemiology of skin melanoma in central Italy during the past 20 years? Melanoma Res 2020; 30:396-401. [PMID: 30480621 DOI: 10.1097/cmr.0000000000000551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim was to evaluate changes in skin melanoma incidence and mortality at a population level in central Italy over the past two decades. Skin melanoma incidence rate from 1994 to 2014, were retrieved from the Umbrian Cancer Registry (about 900 000 inhabitants). Changes from 1994-1999 to 2010-2014 in tumour and patient characteristics - sex, age (0-44, 45-64, ≥ 65 years), site (head and neck, trunk, limbs), morphology (superficial spreading, nodular, other), thickness (≤ 1, 1-2, 2-4, > 4) and stage I-II, III-IV - were evaluated. Trends in age-standardized incidence and mortality rates were evaluated as annual percent change. During the past two decades, melanoma incidence significantly increased in both sexes (+6%/year among men and +4%/year among women) and in all ages (0-44 years: + 4.7 and + 4.3; 45-64 years: + 6.1 and + 4.4; ≥65 years: + 6.6 and + 1.7), morphologies, except nodular, and stages. Mortality was stable among men and women. In the area, incidence increased for thin and thick melanoma, showing a true increase, whereas mortality did not increase. Therefore, although improvements in treatment and downstaging effect of early diagnosis have to be considered, a certain degree of overdiagnosis cannot be ruled out.
Collapse
Affiliation(s)
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS Istituto scientifico romagnolo per lo studio e la cura dei tumori (IRST), Meldola, Forlì-Cesena
| | - Chiara Grisci
- School of Specialization in Hygiene and Preventive Medicine
| | | | - Fabrizio Stracci
- Umbria Cancer Registry, Umbria
- Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy
| |
Collapse
|
21
|
Clarke LE, Mabey B, Flake Ii DD, Meek S, Cassarino DS, Duncan LM, High WA, Napekoski KM, Prieto VG, Tetzlaff MT, Vitale P, Elder DE. Clinical validity of a gene expression signature in diagnostically uncertain neoplasms. Per Med 2020; 17:361-371. [PMID: 32915688 DOI: 10.2217/pme-2020-0048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Aim: Evaluate the accuracy of a 23-gene expression signature in differentiating benign nevi from melanoma by comparing test results with clinical outcomes. Materials & methods: Seven dermatopathologists blinded to gene expression test results and clinical outcomes examined 181 lesions to identify diagnostically uncertain cases. Participants independently recorded diagnoses and responses to questions quantifying diagnostic certainty. Test accuracy was determined through comparison with clinical outcomes (sensitivity and percent negative agreement). Results: Overall, 125 cases fulfilled criteria for diagnostic uncertainty (69.1%; 95% CI: 61.8-75.7%). Test sensitivity and percent negative agreement in these cases were 90.4% (95% CI: 79.0-96.8%) and 95.5% (95% CI: 87.3-99.1%), respectively. Conclusion: The 23-gene expression signature has high diagnostic accuracy in diagnostically uncertain cases when evaluated against clinical outcomes.
Collapse
Affiliation(s)
- Loren E Clarke
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - Brent Mabey
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - Darl D Flake Ii
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - Stephanie Meek
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - David S Cassarino
- Kaiser Permanente, Los Angeles Medical Center Bldg., Los Angeles, CA 90027, USA
| | - Lyn M Duncan
- Pathology Associates, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Whitney A High
- Department of Dermatology, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Victor G Prieto
- Departments of Pathology & Translational & Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael T Tetzlaff
- Departments of Pathology & Translational & Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Patricia Vitale
- Departments of Dermatology and Pathology, University of Utah Health, Salt Lake City, UT 84132, USA
| | - David E Elder
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
22
|
Herbert A, Koo MM, Barclay ME, Greenberg DC, Abel GA, Levell NJ, Lyratzopoulos G. Stage-specific incidence trends of melanoma in an English region, 1996-2015: longitudinal analyses of population-based data. Melanoma Res 2020; 30:279-285. [PMID: 30106842 PMCID: PMC6330074 DOI: 10.1097/cmr.0000000000000489] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine temporal trends in overall and stage-specific incidence of melanoma. Using population-based data on patients diagnosed with melanoma in East Anglia, England, 1996-2015, we estimated age-standardized time trends in annual incidence rates for each stage at diagnosis. Negative binomial regression was used to model trends over time adjusted for sex, age group and deprivation, and to subsequently examine variation in stage-specific trends by sex and age group. The age-standardized incidence increased from 14 to 29 cases/100 000 persons (i.e. 4% annually). Increasing incidence was apparent across all stages but was steepest for stage I [adjusted annual increase: 5%, 95% confidence interval (CI): 5-6%, and more gradual for stage II-IV disease (stage II: 3%, 95% CI: 2-4%; stage III/IV: 2%, 95% CI: 1-3%)]. Stage II-IV increase was apparent in men across age groups and in women aged 50 years or older. Increases in incidence were steeper in those aged 70 years or older, and in men. The findings suggest that both a genuine increase in the incidence of consequential illness and a degree of overdiagnosis may be responsible for the observed increasing incidence trends in melanoma in our population during the study period. They also suggest the potentially lower effectiveness of public health awareness campaigns in men and older people.
Collapse
Affiliation(s)
- Annie Herbert
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) research group, Department of Behavioural Sciences and Health, University College London, 1-19 Torrington Place, London, UK
| | - Minjoung M. Koo
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) research group, Department of Behavioural Sciences and Health, University College London, 1-19 Torrington Place, London, UK
| | - Matthew E. Barclay
- Public Health England National Cancer Registration and Analysis Service, Victoria House, Capital Park, Fulbourn, Cambridge, UK
- Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Cambridge, UK
| | - David C. Greenberg
- Public Health England National Cancer Registration and Analysis Service, Victoria House, Capital Park, Fulbourn, Cambridge, UK
- Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Cambridge, UK
| | | | - Nick J. Levell
- Dermatology Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) research group, Department of Behavioural Sciences and Health, University College London, 1-19 Torrington Place, London, UK
- Public Health England National Cancer Registration and Analysis Service, Victoria House, Capital Park, Fulbourn, Cambridge, UK
- Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Cambridge, UK
| |
Collapse
|
23
|
Morgese F, Sampaolesi C, Torniai M, Conti A, Ranallo N, Giacchetti A, Serresi S, Onofri A, Burattini M, Ricotti G, Berardi R. Gender Differences and Outcomes in Melanoma Patients. Oncol Ther 2020; 8:103-114. [PMID: 32700073 PMCID: PMC7359998 DOI: 10.1007/s40487-020-00109-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Melanoma is one of the most common cancers in younger people. The incidence of cutaneous melanoma is increasing in patients of both sexes, with female patients generally living longer than their male counterparts. The aim of this retrospective study was to evaluate and confirm the sex-based difference in survival of melanoma patients and the relationship of this difference with pathological features. METHODS A total of 1023 patients who had been treated at the Department of Medical Oncology, Università Politecnica Marche (Ancona, Italy) and the INRCA-IRCCS Department of Dermatology (Ancona, Italy) between 1987 and 2014 were enrolled in the study. RESULTS In terms of stage of disease at onset, there was a significant difference in disease-free survival (DFS) and overall survival (OS) in favor of female patients in disease stage I (P = 0.001 and P = 0.01, respectively) and II (P = 0.02 and P = 0.009, respectively). Female patients also showed a significant improvement in 12-year DFS and 12-year OS adjusted for pathological features (Breslow thickness, ulceration, "absent" tumor-infiltrating lymphocyte (TIL) melanomas, "non-brisk" TIL pattern). Globally, female patients had an advantage over with male patients in both DFS and OS (P < 0.001). CONCLUSIONS Our results show that women have a survival benefit over with men after adjustment for many variables that can reduce mortality risk in female melanoma patients. In a future investigation we wish to examine possible biological sex differences in tumor-host interactions.
Collapse
Affiliation(s)
- Francesca Morgese
- Clinica Oncologica, Università Politecnica delle Marche-Azienda Ospedaliero-Universitaria Umberto I, Via Conca, Ancona, AN, Italy
| | - Caterina Sampaolesi
- Clinica Oncologica, Università Politecnica delle Marche-Azienda Ospedaliero-Universitaria Umberto I, Via Conca, Ancona, AN, Italy
| | - Mariangela Torniai
- Clinica Oncologica, Università Politecnica delle Marche-Azienda Ospedaliero-Universitaria Umberto I, Via Conca, Ancona, AN, Italy
| | - Alessandro Conti
- Department of Clinical and Specialist Sciences, Urology, Università Politecnica delle Marche-Azienda Ospedaliero-Universitaria Umberto I, Via Conca, Ancona, AN, Italy
| | - Nicoletta Ranallo
- Clinica Oncologica, Università Politecnica delle Marche-Azienda Ospedaliero-Universitaria Umberto I, Via Conca, Ancona, AN, Italy
| | - Alfredo Giacchetti
- L'Unità Operativa di Dermatologia, INRCA/IRCCS, Via Montagnola, Ancona, AN, Italy
| | - Stefano Serresi
- L'Unità Operativa di Dermatologia, INRCA/IRCCS, Via Montagnola, Ancona, AN, Italy
| | - Azzurra Onofri
- Clinica Oncologica, Università Politecnica delle Marche-Azienda Ospedaliero-Universitaria Umberto I, Via Conca, Ancona, AN, Italy
| | - Michela Burattini
- Clinica Oncologica, Università Politecnica delle Marche-Azienda Ospedaliero-Universitaria Umberto I, Via Conca, Ancona, AN, Italy
| | - Giuseppe Ricotti
- L'Unità Operativa di Dermatologia, INRCA/IRCCS, Via Montagnola, Ancona, AN, Italy
| | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche-Azienda Ospedaliero-Universitaria Umberto I, Via Conca, Ancona, AN, Italy.
| |
Collapse
|
24
|
Koo MM, Rubin G, McPhail S, Lyratzopoulos G. Incidentally diagnosed cancer and commonly preceding clinical scenarios: a cross-sectional descriptive analysis of English audit data. BMJ Open 2019; 9:e028362. [PMID: 31530591 PMCID: PMC6756358 DOI: 10.1136/bmjopen-2018-028362] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 06/11/2019] [Accepted: 08/14/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Cancer can be diagnosed in the absence of tumour-related symptoms, but little is known about the frequency and circumstances preceding such diagnoses which occur outside participation in screening programmes. We aimed to examine incidentally diagnosed cancer among a cohort of cancer patients diagnosed in England. DESIGN Cross-sectional study of national primary care audit data on an incident cancer patient population. SETTING We analysed free-text information on the presenting features of cancer patients aged 15 or older included in the English National Audit of Cancer Diagnosis in Primary Care (2009-2010). Patients with screen-detected cancers or prostate cancer were excluded. We examined the odds of incidental cancer diagnosis by patient characteristics and cancer site using logistic regression, and described clinical scenarios leading to incidental diagnosis. RESULTS Among the studied cancer patient population (n=13 810), 520 (4%) patients were diagnosed incidentally. The odds of incidental cancer diagnosis increased with age (p<0.001), with no difference between men and women after adjustment. Incidental diagnosis was most common among patients with leukaemia (23%), renal (13%) and thyroid cancer (12%), and least common among patients with brain (0.9%), oesophageal (0.5%) and cervical cancer (no cases diagnosed incidentally). Variation in odds of incidental diagnosis by cancer site remained after adjusting for age group and sex.There was a range of clinical scenarios preceding incidental diagnoses in primary or secondary care. These included the monitoring or management of pre-existing conditions, routine testing before or after elective surgery, and the investigation of unrelated acute or new conditions. CONCLUSIONS One in 25 patients with cancer in our population-based cohort were diagnosed incidentally, through different mechanisms across primary and secondary care settings. The epidemiological, clinical, psychological and economic implications of this phenomenon merit further investigation.
Collapse
Affiliation(s)
- Minjoung Monica Koo
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College of London, London, UK
| | - Greg Rubin
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Sean McPhail
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College of London, London, UK
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College of London, London, UK
| |
Collapse
|
25
|
Diagnostic Performance of a Support Vector Machine for Dermatofluoroscopic Melanoma Recognition: The Results of the Retrospective Clinical Study on 214 Pigmented Skin Lesions. Diagnostics (Basel) 2019; 9:diagnostics9030103. [PMID: 31450697 PMCID: PMC6787620 DOI: 10.3390/diagnostics9030103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 11/17/2022] Open
Abstract
The need for diagnosing malignant melanoma in its earliest stages results in an increasing number of unnecessary excisions. Objective criteria beyond the visual inspection are needed to distinguish between benign and malignant melanocytic tumors in vivo. Fluorescence spectra collected during the prospective, multicenter observational study (“FLIMMA”) were retrospectively analyzed by the newly developed machine learning algorithm. The formalin-fixed paraffin-embedded (FFPE) tissue samples of 214 pigmented skin lesions (PSLs) from 144 patients were examined by two independent pathologists in addition to the first diagnosis from the FLIMMA study, resulting in three histopathological results per sample. The support vector machine classifier was trained on 17,918 fluorescence spectra from 49 lesions labeled as malignant (1) and benign (0) by three histopathologists. A scoring system that scales linearly with the number of the “malignant spectra” was designed to classify the lesion as malignant melanoma (score > 28) or non-melanoma (score ≤ 28). Finally, the scoring algorithm was validated on 165 lesions to ensure model prediction power and to estimate the diagnostic accuracy of dermatofluoroscopy in melanoma detection. The scoring algorithm revealed a sensitivity of 91.7% and a specificity of 83.0% in diagnosing malignant melanoma. Using additionally the image segmentation for normalization of lesions’ region of interest, a further improvement of sensitivity of 95.8% was achieved, with a corresponding specificity of 80.9%.
Collapse
|
26
|
Melanoma signature in Brazil: epidemiology, incidence, mortality, and trend lessons from a continental mixed population country in the past 15 years. Melanoma Res 2019; 28:629-636. [PMID: 30204684 DOI: 10.1097/cmr.0000000000000511] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The current research aimed to understand melanoma epidemiology in Brazil and to evaluate temporal trends in incidence and mortality. The data came from Brazilian Hospital Cancer Registries, Population Based Cancer Registries, and the National Mortality Information System from 2000 to 2014. Descriptive statistics were used for epidemiological and clinical characteristics. To describe trends in change in incidence and mortality rates, the Average Annual Percentage Change (AAPC) was calculated. Between 2000 and 2013, in men, the median incidence rate rose from 2.52 to 4.84, with an AAPC of +21.5% [95% confidence interval (CI): 15.4-28] and in women from 1.93 to 3.22 per 100 000, with an AAPC of +13.9% (95% CI: 8.1-20). Regarding mortality, between 2000 and 2014, the rates went from 0.85 to 0.9 per 100 000 for men (AAPC=+0.8, 95% CI: 0.4-1.1) and from 0.56 for 0.53 per 100 000 for women (AAPC=-0.1, 95% CI: -0.2 to 0). From the database, a total of 28 624 patients with melanoma were included. Most of the patients were females (51.9%), White (75%) and with stage I or II (53.2%). Sex, ethnicity, education level, geographical area of the cancer center, topography, histology, time between diagnosis and treatment, and early death were significantly associated with distant metastases. Brazil is a large country with a very young population and a low rate of melanoma incidence and prevalence that should increase over the years. Understanding the trends attributed to melanoma is important for behavioral counseling interventions that focus on promoting skin cancer prevention.
Collapse
|
27
|
Garbe C, Keim U, Eigentler TK, Amaral T, Katalinic A, Holleczek B, Martus P, Leiter U. Time trends in incidence and mortality of cutaneous melanoma in Germany. J Eur Acad Dermatol Venereol 2019; 33:1272-1280. [DOI: 10.1111/jdv.15322] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/27/2018] [Indexed: 01/11/2023]
Affiliation(s)
- C. Garbe
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
| | - U. Keim
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
| | - T. K. Eigentler
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
| | - T. Amaral
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
- Portuguese Air Force Health Care Direction Lisbon Portugal
| | - A. Katalinic
- Institute of Social Medicine and Epidemiology University Hospital Schleswig‐Holstein Luebeck Germany
| | | | - P. Martus
- Institute for Clinical Epidemiology und Applied Biostatistics Eberhard‐Karls University Tuebingen Germany
| | - U. Leiter
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
| |
Collapse
|
28
|
Gardner LJ, Strunck JL, Wu YP, Grossman D. Current controversies in early-stage melanoma: Questions on incidence, screening, and histologic regression. J Am Acad Dermatol 2019; 80:1-12. [PMID: 30553298 DOI: 10.1016/j.jaad.2018.03.053] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 02/03/2023]
Abstract
In the first article in this continuing medical education series we review controversies and uncertainties relating to the epidemiology and initial diagnosis of localized cutaneous melanoma (ie, stage 0, I, or II). Many of these issues are unsettled because of conflicting evidence. Melanoma incidence appears to be increasing, yet its basis has not been fully explained. Despite the advantages of early detection, the US Preventive Services Task Force does not recommend skin screening for the general population. Occasionally, biopsy specimens of melanoma will show histologic regression, but the prognostic importance of this phenomenon is uncertain. Some practitioners recommend obtaining a sentinel lymph node biopsy specimen for thin melanomas showing regression, although this histologic finding is not part of the staging system for thin melanomas. Our goal is to provide the clinician who cares for patients with (or at risk for) melanoma with up-to-date contextual knowledge to appreciate the multiple sides of each controversy so that they will be better informed to discuss these issues with their patients and their families.
Collapse
Affiliation(s)
| | | | - Yelena P Wu
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Douglas Grossman
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah.
| |
Collapse
|
29
|
Sun X, Zhuang B, Zhang M, Jiang H, Jin Y. Intratumorally Injected Photothermal Agent-Loaded Photodynamic Nanocarriers for Ablation of Orthotopic Melanoma and Breast Cancer. ACS Biomater Sci Eng 2019; 5:724-739. [DOI: 10.1021/acsbiomaterials.8b01111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Xiaodong Sun
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, 27 Taiping Road, Beijing 100850, China
- Institute of Pharmacy, Pharmaceutical College of Henan University, Jin Ming Avenue, Kaifeng 475004, China
| | - Bo Zhuang
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, 27 Taiping Road, Beijing 100850, China
| | - Mengmeng Zhang
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, 27 Taiping Road, Beijing 100850, China
- Institute of Pharmacy, Pharmaceutical College of Henan University, Jin Ming Avenue, Kaifeng 475004, China
| | - Heliu Jiang
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, 27 Taiping Road, Beijing 100850, China
| | - Yiguang Jin
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, 27 Taiping Road, Beijing 100850, China
- Institute of Pharmacy, Pharmaceutical College of Henan University, Jin Ming Avenue, Kaifeng 475004, China
| |
Collapse
|
30
|
|
31
|
Abstract
Although spongiotic (eczematous), psoriatic and cutaneous skin infections are among the most common in dermatology consultations, melanocytic lesions - including the different types of nevi and melanomas - are among those that cause a great deal of concern and stress to patients and their clinicians. A diagnosis of benign melanocytic nevus carries a very good prognosis. However, a diagnosis of melanoma might indicate more aggressive treatment, lifelong surveillance and a worse prognosis. Differentiating between these conditions is not always a straightforward process for clinicians and pathologists. Therefore, knowledge of melanoma mimickers is very important for clinicians in general, and dermatologists and pathologists in particular. In this review, we called attention to some of the more frequent benign but unusual melanocytic lesions that are of diagnostic concern for clinicians evaluating these cutaneous proliferations.
Collapse
Affiliation(s)
- Caroline Bsirini
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Bruce R Smoller
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| |
Collapse
|
32
|
Fleming NH, Grade MM, Bendavid E. Impact of primary care provider density on detection and diagnosis of cutaneous melanoma. PLoS One 2018; 13:e0200097. [PMID: 30005065 PMCID: PMC6044519 DOI: 10.1371/journal.pone.0200097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/19/2018] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Early diagnosis of cutaneous melanoma is critical in preventing melanoma-associated deaths, but the role of primary care providers (PCPs) in diagnosing melanoma is underexplored. We aimed to explore the association of PCP density with melanoma incidence and mortality. METHODS All cases of cutaneous melanoma diagnosed in the United States from 2008-2012 and reported in the Surveillance, Epidemiology, and End Results (SEER) database were analyzed in 2016. County-level primary care physician density was obtained from the Area Health Resources File (AHRF). We conducted multivariate linear regression using 1) average annual melanoma incidence or 2) average annual melanoma mortality by county as primary outcomes, adjusting for demographic confounders and dermatologist density. Cox proportional hazard regression was conducted using individual outcome data from SEER with the same covariates. RESULTS Across 611 counties, 167,305 cases of melanoma were analyzed. Per 100,000 people, an additional 10 PCPs per county was associated with 1.62 additional cases of melanoma per year (95% CI 1.06-2.18, p<0.001). This increased incidence occurred disproportionally in early-stage melanoma (Stage 0: 0.69 cases (0.38-1.00), p<0.001; Stage I: 0.63 cases (0.37-0.89), p<0.001; Stage II: 0.11 cases (0.03-0.19), p = 0.005). There was no statistically significant association between PCP density and incidence of stage III or IV melanoma, or with melanoma-specific mortality. Survival analysis demonstrated elimination of 5-year post-diagnosis mortality risk in medically underserved counties after adjusting for stage. CONCLUSIONS Higher densities of PCPs may be linked to increased diagnosis of early-stage melanoma without corresponding decreases in late-stage diagnoses or melanoma-associated mortality.
Collapse
Affiliation(s)
- Nathaniel H. Fleming
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
| | - Madeline M. Grade
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
| | - Eran Bendavid
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, United States of America
| |
Collapse
|
33
|
Carney PA, Frederick PD, Reisch LM, Titus L, Knezevich SR, Weinstock MA, Piepkorn MW, Barnhill RL, Elder DE, Weaver DL, Elmore JG. Complexities of perceived and actual performance in pathology interpretation: A comparison of cutaneous melanocytic skin and breast interpretations. J Cutan Pathol 2018; 45:478-490. [PMID: 29603324 PMCID: PMC6013368 DOI: 10.1111/cup.13147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 02/26/2018] [Accepted: 03/06/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Little is known about how pathologists process differences between actual and perceived interpretations. OBJECTIVE To compare perceived and actual diagnostic agreement before and after educational interventions. METHODS Pathologists interpreted test sets of skin and/or breast specimens that included benign, atypical, in situ and invasive lesions. Interventions involved self-directed learning, one skin and one breast, that showed pathologists how their interpretations compared to a reference diagnoses. Prior to the educational intervention, participants estimated how their interpretations would compare to the reference diagnoses. After the intervention, participants estimated their overall agreement with the reference diagnoses. Perceived and actual agreements were compared. RESULTS For pathologists interpreting skin, mean actual agreement was 52.4% and overall pre- and postinterventional mean perceived agreement was 72.9% vs 54.2%, an overestimated mean difference of 20.5% (95% confidence interval [CI] 17.2% to 24.0%) and 1.8% (95% CI -0.5% to 4.1%), respectively. For pathologists interpreting breast, mean actual agreement was 75.9% and overall pre- and postinterventional mean perceived agreement was 81.4% vs 76.9%, an overestimation of 5.5% (95% CI 3.0% to 8.0%) and 1.0% (95% CI 0.0% to 2.0%), respectively. CONCLUSIONS Pathologists interpreting breast tissue had improved comprehension of their performance after the intervention compared to pathologists interpreting skin lesions.
Collapse
Affiliation(s)
- Patricia A. Carney
- Professor of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Paul D. Frederick
- Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA
| | - Lisa M. Reisch
- Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA
| | - Linda Titus
- Departments of Epidemiology and of Pediatrics, Geisel School of Medicine at Dartmouth, and the Norris Cotton Cancer Center, Lebanon, NH
| | | | - Martin A. Weinstock
- Professor of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Michael W. Piepkorn
- Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Dermatopathology Northwest, Bellevue, WA
| | - Raymond L. Barnhill
- Department of Pathology, Institut Curie, University of Paris Descartes, Paris, France
| | - David E. Elder
- Department of Pathology, University of Pennsylvania, Philadelphia, PA
| | | | - Joann G. Elmore
- Professor of Internal Medicine, University of Washington, Seattle, WA
| |
Collapse
|
34
|
Robsahm TE, Helsing P, Nilssen Y, Vos L, Rizvi SMH, Akslen LA, Veierød MB. High mortality due to cutaneous melanoma in Norway: a study of prognostic factors in a nationwide cancer registry. Clin Epidemiol 2018; 10:537-548. [PMID: 29780262 PMCID: PMC5951132 DOI: 10.2147/clep.s151246] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to examine why Norway has the highest rate of mortality due to cutaneous melanoma (CM) in Europe. The Norwegian Malignant Melanoma Registry (NMMR) enables the study of clinical and histopathological characteristics of patients who die due to CM. Results The NMMR and the Norwegian Cause of Death Registry provided data on the clinical and histopathological factors as well as the date and cause of death, through June 2015 for all first invasive CMs diagnosed in 2008–2012 (n=8087). Cox regression was used to estimate associations between clinical and pathological factors and CM-specific death. Multiple imputation was used to handle missing data. Results The CMs were equally distributed between men (49.9%) and women (50.1%), and the median follow-up was 4.0 years (range: 0.08–7.5 years). Trunk was the most common anatomic site (48%), superficial spreading melanoma was the dominant melanoma subtype (68.2%), median Breslow thickness was 1.0 mm, ulceration was present in 23% of CMs, and 91.8% of cases were in a local clinical stage at diagnosis. Compared to women, men were diagnosed at a higher age, with thicker and more-often-ulcerated tumor, and more often were in advanced clinical stages. During follow-up, 1015 patients died due to CM, representing 52.8% of all deaths. The nodular subtype made up the dominant proportion of fatal CM cases (55.3% in women, 64.6% in men). Sex, age, anatomic site (trunk), T-stage, ulceration, clinical stage, and having a second primary CM were associated with increased risk of CM-specific death. Conclusion Our data suggest that the high rate of mortality due to CM observed in Norway is attributable to the more advanced stage of the disease at diagnosis. Most high-risk cases occurred in male patients ≥70 years of age. Efforts to improve awareness and secondary prevention of CM, including warning signs of all melanoma subtypes, are required urgently and should be targeted toward men in particular.
Collapse
Affiliation(s)
| | - Per Helsing
- Department of Dermatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Linda Vos
- Cancer Registry of Norway, Oslo, Norway
| | - Syed Mohammad H Rizvi
- Department of Dermatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars A Akslen
- Centre for Cancer Biomarkers, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| |
Collapse
|
35
|
Weyers W. Screening for malignant melanoma-a critical assessment in historical perspective. Dermatol Pract Concept 2018; 8:89-103. [PMID: 29785325 PMCID: PMC5955075 DOI: 10.5826/dpc.0802a06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/19/2017] [Indexed: 12/13/2022] Open
Abstract
Screening for melanoma has been advocated for many years because early detection and excision have been regarded as the most important measure to lower mortality from that neoplasm. In the past decade, concern has been raised by epidemiologists that screening might result in excision chiefly of "inconsequential cancer," i.e., melanomas that would never have progressed into life-threatening tumors, a phenomenon referred to by the misleading term "overdiagnosis." Without any firm evidence, that speculation has been embraced worldwide, and incipient melanomas have been trivialized. At the same time, efforts at early detection of melanoma have continued and have resulted in biopsy of pigmented lesions at a progressively earlier stage, such as lesions with a diameter of only 2, 3, or 4 mm. Those tiny lesions often lack sufficient criteria for clinical and histopathologic diagnosis, the result being true overdiagnoses, i.e., misdiagnoses of melanocytic nevi as melanoma. This is especially true if available criteria for histopathologic diagnosis are diminuished even further by incomplete excision of lesions. The reliability of histopathologic diagnosis is far higher in excisional biopsies of lesions that were given some more time to develop changes that make them recognizable. Biopsy of pigmented lesions with a diameter of 6 mm has been found to result in a far higher yield of melanomas. In addition to better clinical judgment, slight postponement of biopsies bears the promise of substantial improvement of the reliability of histopathologic diagnosis, and of alleviating true overdiagnoses.
Collapse
|
36
|
The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015. Br J Cancer 2018; 118:1130-1141. [PMID: 29567982 PMCID: PMC5931106 DOI: 10.1038/s41416-018-0029-6] [Citation(s) in RCA: 292] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Changing population-level exposure to modifiable risk factors is a key driver of changing cancer incidence. Understanding these changes is therefore vital when prioritising risk-reduction policies, in order to have the biggest impact on reducing cancer incidence. UK figures on the number of risk factor-attributable cancers are updated here to reflect changing behaviour as assessed in representative national surveys, and new epidemiological evidence. Figures are also presented by UK constituent country because prevalence of risk factor exposure varies between them. METHODS Population attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally representative population surveys. Cancer incidence data for 2015 were sourced from national data releases and, where needed, personal communications. PAF calculations were stratified by age, sex and risk factor exposure level and then combined to create summary PAFs by cancer type, sex and country. RESULTS Nearly four in ten (37.7%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (38.6%) than in UK females (36.8%). Comparing UK countries, the attributable proportion was highest in Scotland (41.5% for persons) and lowest in England (37.3% for persons). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight/obesity, accounting for 15.1% and 6.3%, respectively, of all cases in the UK in 2015. For 10 cancer types, including two of the five most common cancer types in the UK (lung cancer and melanoma skin cancer), more than 70% of UK cancer cases were attributable to known risk factors. CONCLUSION Tobacco and overweight/obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Overweight/obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to mitigate the level of harm associated with exposure or reduce exposure levels-both approaches may effectively impact cancer incidence. Differences in PAFs between countries and sexes are primarily due to varying prevalence of exposure to risk factors and varying proportions of specific cancer types. This variation in turn is affected by socio-demographic differences which drive differences in exposure to theoretically avoidable 'lifestyle' factors. PAFs at UK country level have not been available previously and they should be used by policymakers in devolved nations. PAFs are estimates based on the best available data, limitations in those data would generally bias toward underestimation of PAFs. Regular collection of risk factor exposure prevalence data which corresponds with epidemiological evidence is vital for analyses like this and should remain a priority for the UK Government and devolved Administrations.
Collapse
|
37
|
Aitken JF, Youlden DR, Baade PD, Soyer HP, Green AC, Smithers BM. Generational shift in melanoma incidence and mortality in Queensland, Australia, 1995-2014. Int J Cancer 2017; 142:1528-1535. [PMID: 29105744 DOI: 10.1002/ijc.31141] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/18/2017] [Accepted: 10/24/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Joanne F. Aitken
- Cancer Council Queensland; Brisbane QLD Australia
- Institute for Resilient Regions, University of Southern Queensland; Brisbane QLD Australia
- School of Public Health and Social Work; Queensland University of Technology; Brisbane QLD Australia
| | - Danny R. Youlden
- Cancer Council Queensland; Brisbane QLD Australia
- Menzies Health Institute, Griffith University; Gold Coast QLD Australia
| | - Peter D. Baade
- Cancer Council Queensland; Brisbane QLD Australia
- School of Mathematical Sciences; Queensland University of Technology; Brisbane QLD Australia
| | - H. Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute; Brisbane QLD Australia
- Department of Dermatology; Princess Alexandra Hospital; Brisbane QLD Australia
| | - Adèle C. Green
- QIMR Berghofer Medical Research Institute; Brisbane QLD Australia
- CRUK Manchester Institute and Division of Musculoskeletal & Dermatological Sciences; University of Manchester; Manchester United Kingdom
- Australian Skin and Skin Cancer Research Centre; Brisbane QLD Australia
| | - B. Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital; Brisbane QLD Australia
- Discipline of Surgery, Faculty of Medicine; The University of Queensland; Brisbane QLD Australia
| |
Collapse
|
38
|
Vallès Fernández R, González Martín-Moro J, Prat Gil N, Bonet Simó JM, Mingo-Botín D. Too much Ophthalmology? Ophthalmology in the era of over-diagnosis and over-treatment. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2017; 92:403-405. [PMID: 28502639 DOI: 10.1016/j.oftal.2017.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/02/2017] [Accepted: 02/04/2017] [Indexed: 06/07/2023]
Affiliation(s)
- R Vallès Fernández
- Dirección de Atención Primaria Metropolitana Nord, Institut Català de la Salut, Barcelona, España.
| | - J González Martín-Moro
- Servicio de Oftalmología, Hospital Universitario del Henares, Madrid, España; Grado de Medicina, Universidad Francisco de Vitoria, Madrid, España
| | - N Prat Gil
- Dirección de Atención Primaria Metropolitana Nord, Institut Català de la Salut, Barcelona, España
| | - J M Bonet Simó
- Dirección de Atención Primaria Metropolitana Nord, Institut Català de la Salut, Barcelona, España
| | - D Mingo-Botín
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España
| |
Collapse
|
39
|
Watts CG. The challenge of skin surveillance: observe or biopsy? Br J Dermatol 2017; 176:851-852. [PMID: 28418121 DOI: 10.1111/bjd.15450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C G Watts
- Sydney School of Public Health, The University of Sydney, Lifehouse, Level 6, 119-143 Missenden Road, Camperdown, 2050, Australia
| |
Collapse
|
40
|
Apalla Z, Lallas A, Sotiriou E, Lazaridou E, Ioannides D. Epidemiological trends in skin cancer. Dermatol Pract Concept 2017; 7:1-6. [PMID: 28515985 PMCID: PMC5424654 DOI: 10.5826/dpc.0702a01] [Citation(s) in RCA: 327] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/19/2017] [Indexed: 12/03/2022] Open
Abstract
Skin cancer, including melanoma and non-melanoma skin cancer (NMSC), represents the most common type of malignancy in the white population. The incidence rate of melanoma is increasing worldwide, while the associated mortality remains stable, or is slightly decreasing. On the other hand, the incidence for NMSC varies widely, with the highest rates reported in Australia. In the current review, we highlight recent global trends in epidemiology of skin cancer. We discuss controversial issues raised in current epidemiological data, we analyze the most important risk factors associated with the development of melanoma and NMSC and the impact of skin cancer on health care services. Furthermore, we underline the pressing need for improved registration policies, especially for NMSC, and lastly, we refer to the ongoing primary and secondary prevention strategies and their outcomes so far.
Collapse
Affiliation(s)
- Zoe Apalla
- First Department of Dermatology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Elena Sotiriou
- First Department of Dermatology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Elizabeth Lazaridou
- First Department of Dermatology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Demetrios Ioannides
- First Department of Dermatology, Medical School, Aristotle University of Thessaloniki, Greece
| |
Collapse
|
41
|
Sontheimer RD. MDA5 autoantibody-another indicator of clinical diversity in dermatomyositis. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:160. [PMID: 28480196 DOI: 10.21037/atm.2017.03.94] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Allenbach and colleagues have recently reported for the first time the results of an intriguing study of the histopathologic, immunopathologic and gene expression differences in muscle biopsy tissue from adult dermatomyositis (DM) patients who do and do not have circulating MDA5 autoantibodies (anti-MDA5). Anti-MDA5 were originally identified in a clinically-defined subset of DM patients whose disease was expressed predominately in the skin for unusually long periods of time without accompanying muscle weakness [i.e., "clinically-amyopathic DM" (CADM)] and were at risk for acute, rapidly-progressive form of interstitial lung disease (ILD). As an academic dermatologist in the United States of America (USA) having a career-long interest in the CADM subset, I would like to share my perspective on the results of the work by Allenbach and colleagues and offer some suggestions for additional study in this area. But to do so most effectively, I first would like to review the clinical concept of CADM and its association with anti-MDA5 antibody production and a potentially-fatal form of (ILD).
Collapse
|
42
|
Chiarugi A, Nardini P, Borgognoni L, Brandani P, Gerlini G, Rubegni P, Lamberti A, Salvini C, Lo Scocco G, Cecchi R, Sirna R, Lorenzi S, Gattai R, Battistini S, Crocetti E. Thick melanoma in Tuscany. GIORN ITAL DERMAT V 2017; 154:638-645. [PMID: 28290624 DOI: 10.23736/s0392-0488.17.05584-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The epidemiologic trends of cutaneous melanoma are similar in several countries with a Western-type lifestyle, where there is a progressively increasing incidence and a low but not decreasing mortality - even increasing in selected cases, especially in the older age groups. Also in Tuscany there is a steady rise in the incidence with prevalence of in situ and invasive thin melanomas, with also an increase of thick melanomas. It is necessary to reduce the frequency of thick melanomas to reduce specific mortality. The objective of the current survey has been to compare, in the Tuscany population, by a case-case study, thin and thick melanoma cases, trying to find out those personal and tumor characteristics which may help to customize preventive interventions. METHODS The study included nine centers involved in the melanoma diagnosis. A consecutive series of incident invasive melanomas diagnosed in a period of about 18 months (July 2010 to December 2011) was collected and matched according in a ratio of one thick melanoma (cutoff thickness: 1 mm) every two thin melanomas. The investigators filled in a questionnaire on patients' self-reported sun exposure, way of melanoma detection, awareness and performance of self-skin examination, as well as propensity to prevention in general. RESULTS The results of this survey confirm that older age and the lower education level are associated with a later detection. The habit of performing skin self-examination is crucial in the early diagnosis of thick melanoma. The results of this survey seem to suggest that population aged over 50 years, with few total and few atypical nevi, and limited sun exposure and burning are at higher risk of late diagnosis. It can be assumed that part of the population is not effectively reached by prevention campaigns because they do not recognize themselves as being at risk for skin cancers. CONCLUSIONS In order to achieve a higher rate of early diagnosis of skin melanoma, a new strategy must be implemented. It could be useful to rethink educational campaigns - which seem to unintentionally leave out subjects more at risk for melanoma - and to renew the active involvement of the general practitioners.
Collapse
Affiliation(s)
- Alessandra Chiarugi
- Unit of Secondary Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy -
| | - Paolo Nardini
- Unit of Secondary Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Lorenzo Borgognoni
- Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center, S.M. Annunziata Hospital, AUSL Toscana Centro, Florence, Italy
| | - Paola Brandani
- Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center, S.M. Annunziata Hospital, AUSL Toscana Centro, Florence, Italy
| | - Gianni Gerlini
- Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center, S.M. Annunziata Hospital, AUSL Toscana Centro, Florence, Italy
| | - Pietro Rubegni
- Section of Dermatology, Department of Medical, Surgical Sciences and Neurosciences, AUSL Toscana Sud-Est, Siena, Italy
| | - Arianna Lamberti
- Section of Dermatology, Department of Medical, Surgical Sciences and Neurosciences, AUSL Toscana Sud-Est, Siena, Italy
| | - Camilla Salvini
- Department of Dermatology, AUSL Toscana Centro, Prato Hospital, Prato, Italy
| | - Giovanni Lo Scocco
- Department of Dermatology, AUSL Toscana Centro, Prato Hospital, Prato, Italy
| | - Roberto Cecchi
- Unit of Dermatology, S. Jacopo Hospital, AUSL Toscana Centro, Pistoia, Italy
| | - Riccardo Sirna
- Unit of Dermatology, Misericordia Hospital Grosseto, AUSL Toscana Sud-Est, Grosseto, Italy
| | - Stefano Lorenzi
- Unit of Dermatology, S. Luca Hospital, AUSL Toscana Nord-Ovest, Lucca, Italy
| | - Riccardo Gattai
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Silvio Battistini
- Unit of Dermatology, AUSL Toscana Nord-Ovest, Massa, Massa Carrara, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, Romagna Cancer Institute (IRST) IRCCS, Meldola, Forlì-Cesena, Italy
| |
Collapse
|
43
|
Hübner J, Waldmann A, Geller AC, Weinstock MA, Eisemann N, Noftz M, Bertram S, Nolte S, Volkmer B, Greinert R, Breitbart E, Katalinic A. Interval cancers after skin cancer screening: incidence, tumour characteristics and risk factors for cutaneous melanoma. Br J Cancer 2017; 116:253-259. [PMID: 27898656 PMCID: PMC5243984 DOI: 10.1038/bjc.2016.390] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The rate of interval cancers is an established indicator for the performance of a cancer-screening programme. METHODS We examined the incidence, tumour characteristics and risk factors of melanoma interval cancers that occurred in participants of the SCREEN project, which was carried out 2003/2004 in Schleswig-Holstein, Germany. Data from 350 306 SCREEN participants, who had been screened negative for melanoma, were linked to data of the state cancer registry. Melanoma interval cancers were defined as melanomas diagnosed within 4-24 months after SCREEN examination. Results were compared with melanomas of the pre-SCREEN era (1999-2002), extracted from the cancer registry. RESULTS The overall relative incidence of melanoma interval cancers in terms of observed/expected ratio was 0.93 (95% CI: 0.82-1.05; in situ: 1.61 (1.32-1.95), invasive: 0.71 (0.60-0.84)). Compared with melanomas of the pre-SCREEN era, the interval melanomas were thinner and had a slightly greater proportion of lentigo maligna melanomas whereas nodular melanomas were less frequent. INTERPRETATION The results indicate a moderate performance of the SCREEN intervention with an excess of in situ melanomas. In part, the findings might be due to specifics of the SCREEN project, in particular a short-term follow-up of patients at high risk for melanoma.
Collapse
Affiliation(s)
- J Hübner
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23562, Germany
| | - A Waldmann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23562, Germany
| | - A C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - M A Weinstock
- Center for Dermatoepidemiology, VA Medical Center—111D, 830 Chalkstone Avenue, Providence, RI 02908, USA
- Department of Dermatology, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA
- Departments of Dermatology and Epidemiology, Brown University, 593 Eddy Street, Providence, RI 02903, USA
| | - N Eisemann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23562, Germany
| | - M Noftz
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23562, Germany
| | - S Bertram
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23562, Germany
| | - S Nolte
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité—Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
- Population Health Strategic Research Centre, Deakin University, 221 Burwood Highway, Melbourne, VIC 3125, Australia
| | - B Volkmer
- Division of Molecular Cell Biology, Dermatology Center, Elbe Clinics Stade-Buxtehude, Am Krankenhaus 1, Buxtehude 21614, Germany
| | - R Greinert
- Division of Molecular Cell Biology, Dermatology Center, Elbe Clinics Stade-Buxtehude, Am Krankenhaus 1, Buxtehude 21614, Germany
| | - E Breitbart
- Association of Dermatological Prevention e.V., Cremon 11, Hamburg 20457, Germany
| | - A Katalinic
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23562, Germany
- Cancer Registry of Schleswig-Holstein, Ratzeburger Allee 160, Lübeck 23562, Germany
| |
Collapse
|
44
|
Abstract
Much time, effort and investment goes into the diagnosis of symptomatic cancer, with the expectation that this approach brings clinical benefits. This investment of resources has been particularly noticeable in the UK, which has, for several years, appeared near the bottom of international league tables for cancer survival in economically developed countries. In this Review, we examine expedited diagnosis of cancer from four perspectives. The first relates to the potential for clinical benefits of expedited diagnosis of symptomatic cancer. Limited evidence from clinical trials is available, but the considerable observational evidence suggests benefits can be obtained from this approach. The second perspective considers how expedited diagnosis can be achieved. We concentrate on data from the UK, where extensive awareness campaigns have been conducted, and initiatives in the primary-care setting, including clinical decision support, have all occurred during a period of considerable national policy change. The third section considers the most appropriate patients for cancer investigations, and the possible community settings for identification of such patients; UK national guidance for selection of patients for investigation is discussed. Finally, the health economics of expedited diagnosis are reviewed, although few studies provide definitive evidence on this topic.
Collapse
Affiliation(s)
- Willie Hamilton
- University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK
| | - Fiona M Walter
- Department of Public Health &Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Greg Rubin
- School of Medicine, Pharmacy and Health, Wolfson Building, Queen's Campus, University of Durham, Stockton-on-Tees TS17 6BH, UK
| | - Richard D Neal
- North Wales Centre for Primary Care Research, Bangor University, Gwenfro Unit 5, Wrexham Technology Park, Wrexham LL13 7YP, UK
| |
Collapse
|
45
|
Rat C, Quereux G, Grimault C, Fernandez J, Poiraud M, Gaultier A, Chaslerie A, Pivette J, Khammari A, Dreno B, Nguyen JM. Inclusion of populations at risk of advanced melanoma in an opportunistic targeted screening project involving general practitioners. Scand J Prim Health Care 2016; 34:286-94. [PMID: 27467203 PMCID: PMC5036019 DOI: 10.1080/02813432.2016.1207149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The study objective was to measure the rates of inclusion of populations at risk of advanced melanoma in a pilot targeted screening project involving general practitioners. DESIGN This cross-sectional database study compared the inclusion rates of patients who signed inclusion in a targeted screening project with those of patients who did not, during a period in which both groups of patients consulted investigators. SETTING Data were extracted from the national healthcare insurance records in western France from 11 April to 30 October 2011. PATIENTS Patients, older than 18, considered for the data extraction had consulted one of the 78 participating GPs during the study period, and were affiliated with the national healthcare insurance. MAIN OUTCOME MEASURES Inclusion in the screening was the main outcome measure. Patients at risk of advanced melanoma were characterized by male gender, age over 50, low income, rural residence, farmer, and presence of chronic disease. RESULTS A total of 57,279 patients consulted GPs during the inclusion period and 2711 (4.73%) were included in the targeted screening. Populations at risk of advanced melanoma were less included: men (OR = 0.67; 95%CI [0.61-0.73]; p < 0.001), older than 50 (OR = 0.67; 95%CI [0.60-0.74]; p < 0.001), low income (OR = 0.65; 95%CI [0.55-0.77]; p < 0.001), farmer (OR = 0.23; 95%CI [0.17-0.30]; p < 0.001) and presence of a chronic disease (OR = 0.87; 95%CI [0.77-0.98]; p < 0.028). CONCLUSION This study demonstrated inequalities in the inclusion of patients in a melanoma screening. Patients at risk of advanced cancer were screened less often. Further studies should focus on GPs ability to identify and screen these patients. KEY POINTS Advanced melanoma is more frequently diagnosed in men, older patients and socioeconomically disadvantaged populations, which leads to survival inequalities. • Despite the involvement of general practitioners, the implementation of targeted melanoma screening did not avoid inclusion inequalities. • Men, older patients, patients suffering from chronic diseases, and low-income patients were less likely to benefit from screening. • The display of a conventional or an alarmist poster in the waiting room did not statistically reduce these inclusion inequalities.
Collapse
Affiliation(s)
- Cédric Rat
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
- French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299), Team 2, Nantes, France
- CONTACT Cédric Rat Department of General Practice, Faculty of Medicine of Nantes, 1 rue Gaston Veil, 44035 Nantes, France
| | - Gaelle Quereux
- French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299), Team 2, Nantes, France
- Oncodermatology Department, Nantes University Hospital, Nantes, France
| | - Charlotte Grimault
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Jérémy Fernandez
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Mickael Poiraud
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Aurélie Gaultier
- Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
| | - Anicet Chaslerie
- Medical Department of the French Health Insurance System, Nantes, France
| | - Jacques Pivette
- Medical Department of the French Health Insurance System, Nantes, France
| | - Amir Khammari
- French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299), Team 2, Nantes, France
- Oncodermatology Department, Nantes University Hospital, Nantes, France
| | - Brigitte Dreno
- French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299), Team 2, Nantes, France
- Oncodermatology Department, Nantes University Hospital, Nantes, France
| | - Jean-Michel Nguyen
- French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299), Team 2, Nantes, France
- Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
| |
Collapse
|
46
|
Rogers WA, Mintzker Y. Getting clearer on overdiagnosis. J Eval Clin Pract 2016; 22:580-7. [PMID: 27149914 DOI: 10.1111/jep.12556] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/20/2016] [Accepted: 04/01/2016] [Indexed: 12/01/2022]
Abstract
Overdiagnosis refers to diagnosis that does not benefit patients because the diagnosed condition is not a harmful disease in those individuals. Overdiagnosis has been identified as a problem in cancer screening, diseases such as chronic kidney disease and diabetes, and a range of mental illnesses including depression and attention deficit hyperactivity disorder. In this paper, we describe overdiagnosis, investigate reasons why it occurs, and propose two different types. Misclassification overdiagnosis arises because the diagnostic threshold for the disease in question has been set at a level where many people without harmful disease are nonetheless diagnosed. We illustrate misclassification overdiagnosis using the example of chronic kidney disease. Misclassification occurs in diseases diagnosed using biomarkers or based on patient reported phenomena. Maldetection overdiagnosis arises because, at the time the diagnosis is made and despite the presence of a 'gold standard' diagnostic test, it is not possible to discriminate between harmful and non-harmful cases of the index disease. We illustrate maldetection overdiagnosis using the example of thyroid cancer. While there is some overlap between misclassification and maldetection overdiagnosis, this conceptual analysis helps to clarify the phenomenon of overdiagnosis and is a necessary first step in developing strategies to address the problem.
Collapse
Affiliation(s)
- Wendy A Rogers
- Department of Philosophy and Department of Clinical Medicine, Macquarie University, Australia
| | - Yishai Mintzker
- Faculty of Medicine in the Galilee, Bar Ilan University, Israel
| |
Collapse
|
47
|
|
48
|
González-Martín-Moro J, Zarallo-Gallardo J. Over-diagnosis and over-treatment in Ophthalmology: A review of the literature. ACTA ACUST UNITED AC 2016; 91:526-534. [PMID: 27125187 DOI: 10.1016/j.oftal.2016.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine if the pernicious effects of over-diagnosis and over-treatment have been studied in the most common ocular diseases. MATERIAL AND METHODS Bibliographic search conducted in PubMed. RESULTS The search algorithm used retrieved 29 articles related with the topic. Most of them address the issue tangentially. Only 4 of them address the problem directly. One of them focuses on the problem of over-diagnosis and over-treatment in idiopathic intracranial hypertension. The remaining 3 focus on the problem of over-diagnosis and over-treatment in glaucoma. CONCLUSION The ophthalmology community has thought very little about the detrimental effects of over-diagnosis and over-treatment.
Collapse
Affiliation(s)
- J González-Martín-Moro
- Sección de Glaucoma y Neuro-oftalmología, Servicio de Oftalmología, Hospital Universitario del Henares, Coslada, Madrid, España; Grado de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España.
| | - J Zarallo-Gallardo
- Grado de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España; Sección de Retina, Servicio de Oftalmología, Hospital Universitario del Henares, Coslada, Madrid, Espana
| |
Collapse
|
49
|
Monshi B, Vujic M, Kivaranovic D, Sesti A, Oberaigner W, Vujic I, Ortiz-Urda S, Posch C, Feichtinger H, Hackl M, Rappersberger K. The burden of malignant melanoma – Lessons to be learned from Austria. Eur J Cancer 2016; 56:45-53. [DOI: 10.1016/j.ejca.2015.11.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/29/2015] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
|
50
|
Bleyer A. Screening Mammography: Update and Review of Publications Since Our Report in the New England Journal of Medicine on the Magnitude of the Problem in the United States. Acad Radiol 2016; 23:119-23. [PMID: 26548853 DOI: 10.1016/j.acra.2015.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 12/29/2022]
|