Skin screenings may lead to increased biopsy rates, melanoma overdiagnosis
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Individuals who undergo skin screenings experience higher rates of biopsies and melanoma, according to a study.
There is a growing concern that increased diagnostic scrutiny, including frequent skin examinations and biopsies, is leading to the detection of indolent melanomas that otherwise would have never become lethal, according to David C. Whiteman, MD, PhD, a senior scientist in the cancer control group at QIMR Berghofer Medical Research Institute in Herston, Queensland, Australia, and colleagues wrote.
“The harms of overdiagnosis include psychological harm and overtreatment, leading to unnecessary physical pain and suffering, and higher costs,” Whiteman told Healio. “The paper highlights the challenges of implementing systematic early detection programs for melanoma.”
In this prospective cohort study, researchers observed subsequent melanoma incidence and biopsy rates among people who underwent skin screening examinations compared with those who did not.
The study included 38,682 Queensland, Australia, residents of white European ancestry aged 40 to 69 years with no prior history of melanoma. All participants completed a melanoma risk factor survey at baseline and were asked if they had undergone a skin screening in the past 3 years. The cohort calculated incidence and relative risk in years 2 to 7 of follow-up and measured biopsy rates in years 2 to 6 of follow-up.
Results showed that 28,155 participants that underwent skin screening prior to baseline had higher rates of melanoma (adjusted HR = 1.29; 95% CI, 1.02-1.63) and subsequent skin biopsies (aHR = 1.85; 95% CI, 1.69-2.04) compared with unscreened participants. Secondary analyses showed that those who did vs. did not have skin biopsy screenings in the first year after baseline were significantly at risk of melanoma (aHR = 1.53; 95% CI, 1.23-1.89) and subsequent biopsies (aHR = 2.64; 95% CI, 2.46-2.84).
Even after accounting for all risk factors, the researchers found that overdiagnosis is positively correlated to higher rates of biopsies and melanoma, especially in situ melanoma (aHR = 1.45; 95% CI, 1.09-1.92).
“The greater the scrutiny applied to patients, the more melanomas that are detected,” Whiteman said, “but not all of these are necessarily biologically malignant. In other words, heightened surveillance leads to a proportion of melanomas being diagnosed that otherwise may not have come to clinical attention.”