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Analysis: Skin Cancer Test Pays Off

Posted on: Monday, 15 January 2007, 18:02 CST

By OLGA PIERCE

A one-time screening of adults over 50 for skin cancer is a cost-effective way to save lives, a new study says.

The rate of melanoma, a serious form of skin cancer, rose 29 percent from 1975 to 2000, but the screening rate did not increase with it. In 2006 there were more than 60,000 new cases at a total treatment cost of $740 million.

But a routine visual scan for the disease by a doctor could dramatically reduce the disease's mortality rate, because, like most cancers, melanoma is most treatable in earlier stages. The cost: about $7,400 for every year of life saved, according to an article appearing this week in the Archives of Dermatology.

Treatments are considered cost-effective if they cost less than $50,000 per additional year of life.

Melanoma is the only cancer for which incidence and mortality rates are rising unabated, while screening, the potential means for reducing the burden of disease, continues to be underused, say the authors, researchers at the Boston University School of Public Health.

For patients with a sibling suffering from skin cancer, the study found it would be cost-effective to check for melanoma every two years. The cost of screening in that group was $24,000 per additional year of life.

Before this study, routine screening for signs of melanoma was not included on any national list of cancer-prevention recommendations because of a lack of evidence. The new evidence, while based on a mathematical model and not a clinical trial, still makes a compelling case for the screenings, according to the authors, especially because no large-scale clinical trial is forthcoming.

Either screening programs should be expanded or efforts to perform a definitive efficacy trial should be initiated, the authors write. The lack of evidence of screening efficacy from a randomized trial has been cited as an obstacle to population-based melanoma screening, yet the cost of such a trial seems prohibitive.

Revising screening recommendations without clinical data is controversial, but that data is not always available, said Howard Koh, a professor at the Harvard University School of Public Health, in an accompanying editorial.

For melanoma, however, no randomized prospective clinical screening trial exists worldwide, writes Koh. Furthermore, none appears to be forthcoming.

At the very least, therefore, the new study should encourage investment in such a trial, he added. "The cost-effectiveness ratios generated were comparable to those seen for other types of cancer screening, such as for breast cancer and colorectal cancer.

This new quantitative analysis not only reinforces consideration of one-time screening for melanoma but also resurrects hopes for a definitive randomized trial using this strategy.

Even if patients want skin cancer screenings, however, they may have difficulty getting them, according to a recent study of 12 cities. Due to a lack of dermatologists, many patients have to wait months for an appointment after their doctor refers them for further evaluation of possible skin cancer.

If the cost of screenings could be further reduced, the new study authors write, it would make them even more cost-effective -- and accessible.

Source: United Press International

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