CHICAGO – The rate of skin cancer screening by primary care physicians has increased, compared with relatively stable rates for breast, pelvic, and rectal examinations in this setting, according to a study.
"It is very encouraging that more primary care physicians are looking at patients' skin to hopefully detect skin cancer earlier," Dr. Jeremy S. Bordeaux said . "Hopefully the outcome will be that when patients are diagnosed with melanoma, it will be at an earlier stage, and they will be more likely to live."
There are insufficient numbers of dermatologists to perform total body examinations for all patients in the United States. In addition, many patients at risk are more likely to see a primary care doctor, said Dr. Bordeaux, director of Mohs Micrographic and Dermatologic Surgery at University Hospitals and Case Western Reserve University in Cleveland.
Dr. Bordeaux sought to quantify primary-care physician skin cancer screening and counseling. He also wanted to identify factors associated with a higher likelihood for screening and counseling.
He assessed outpatient, nonurgent visits to office-based physicians in the years 1997-2000, and then compared those numbers with 2005 and 2006 using data from the National Ambulatory Medical Care Survey (NAMCS). He looked at prevalence in aggregate for skin cancer and breast cancer screening, pelvic and rectal examinations, and counseling about skin cancer prevention and tobacco cessation.
Primary care physicians screened 19% of white patients for skin cancer in the first time period, compared with 26% in 2005-2006, Dr. Bordeaux said at the meeting, which was held jointly with the American Society of Cosmetic Dermatology and Aesthetic Surgery.
In contrast, "the screening rates for everything else stayed pretty flat," Dr. Bordeaux said. For example, prevalence of screening for breast cancer increased only modestly to 36% (2005-2006) from 31% (1997-2000). For pelvic exams, the increase was 35% vs. 32%, respectively, and for rectal exams, 24% vs. 20%. Data were incomplete to compare percentages for skin cancer counseling between the two time periods.
Interestingly, Dr. Bordeaux said, "With nonwhite patients, there were the same trends, including the increase in skin cancer screening [26% vs. 19%]." In addition, nonwhite patient screening for breast cancer increased at a similarly modest rate between the two time periods: 34% vs. 30%, respectively. For pelvic exams, the increase was 34% vs. 31%, and for rectal exams, 22% vs. 19%. Tobacco cessation counseling rates increased 7% in 2005-2006 vs. 5% in the 1997-2000 time periods.
Certain factors were significantly associated with increased likelihood of skin screening by primary care physicians. "You are more likely to get screened if you are female, are seen by a physician – versus a physician extender and if you have private insurance," Dr. Bordeaux said.
Specifically, males were less likely to be screened (odds ratio, 0.82), compared with females. Patients who saw a doctor (versus a nonphysician) were more likely to be screened (OR, 3.02), as were those with private insurance (OR, 1.54), compared with Medicare or Medicaid patients.
Age made a significant difference in terms of skin cancer prevention counseling. Compared with younger patients, the study revealed that primary care physicians were less likely to counsel those aged 40 and older about sun-protective behaviors (OR, 0.64).
A second, prospective study is now underway, Dr. Bordeaux said. He plans to correlate the depth/severity of melanomas with history of complete skin examination screening by a dermatologist or primary care physician.
The American Society for Dermatologic Surgery provided a Cutting Edge Research Grant to fund the study. Dr. Bordeaux had no relevant financial disclosures.