Skin biopsy rates and incidence of melanoma: population based ecological study

doi:10.1136/bmj.38516.649537.E0

BMJ 2005;331:481 (3 September), doi:10.1136/bmj.38516.649537.E0 (published 4 August 2005)

Paper

Skin biopsy rates and incidence of melanoma: population based ecological study

H Gilbert Welch, professor of medicine¹, Steven Woloshin, associate professor of medicine¹, Lisa M Schwartz, associate professor of medicine¹

¹ VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA

Correspondence to: H Gilbert Welch, Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH 03755-1404, USA H.Gilbert.Welch{at}dartmouth.edu

Objectives To describe changes in skin biopsy rates and to determinetheir relation with changes in the incidence of melanoma.

Design Population based ecological study.

Setting Nine geographical areas of the United States.

Participants Participants of the Surveillance Epidemiology andEnd Results (SEER) programme aged 65 and older.

Main outcome measures For the period 1986 to 2001, annual skinbiopsy rates for each surveillance area from Medicare claimsand incidence rates for melanoma for the same population.

Results Between 1986 and 2001 the average biopsy rate acrossthe nine participating areas increased 2.5-fold among peopleaged 65 and older (2847 to 7222 per 100 000 population). Overthe same period the average incidence of melanoma increased2.4-fold (45 to 108 per 100 000 population). Assuming that theoccurrence of true disease was constant, the extra number ofmelanoma cases that were diagnosed after carrying out 1000 additionalbiopsies was 12.6 (95% confidence interval 11.2 to 14.0). Aftercontrolling for a potential increase in the true occurrenceof disease, 1000 additional biopsies were still associated with6.9 (3.1 to 10.8) extra melanoma cases diagnosed. Stage specificanalyses suggested that 1000 biopsies were associated with 4.4(2.1 to 6.8) extra cases of in situ melanoma diagnosed and 2.3(0.0 to 4.6) extra cases of local melanoma, but not with theincidence of advanced melanoma. Mortality from melanoma changedlittle during the period.

Conclusion The incidence of melanoma is associated with biopsyrates. That the extra cases diagnosed were confined to earlystage cancer while mortality remained stable suggests overdiagnosis—theincreased incidence being largely the result of increased diagnosticscrutiny and not an increase in the incidence of disease.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to Technorati Technorati What's this?

Relevant Articles

Melanoma incidence has risen in Europe: Esther de Vries and Jan-Willem W Coebergh
BMJ 2005 331: 698. [Extract] [Full Text]

More melanomas are caught early in the US
BMJ 2005 331: 0. [Full Text] [PDF]

Incidence of breast cancer in Norway and Sweden during introduction of nationwide screening: prospective cohort study: Per-Henrik Zahl, Bjørn Heine Strand, and Jan Mæhlen
BMJ 2004 328: 921-924. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

Bharath, A., Turner, R. (2009). Impact of climate change on skin cancer. JRSM 102: 215-218 [Full text]
Bataille, V., Glass, D. (2009). Melanoma: risk factors and controversies. Clin Risk 15: 3-7 [Full text]
Jemal, A., Thun, M. J., Ries, L. A. G., Howe, H. L., Weir, H. K., Center, M. M., Ward, E., Wu, X.-C., Eheman, C., Anderson, R., Ajani, U. A., Kohler, B., Edwards, B. K. (2008). Annual Report to the Nation on the Status of Cancer, 1975-2005, Featuring Trends in Lung Cancer, Tobacco Use, and Tobacco Control. JNCI J Natl Cancer Inst 100: 1672-1694 [Abstract] [Full text]
Abbasi, N. R., Yancovitz, M., Gutkowicz-Krusin, D., Panageas, K. S., Mihm, M. C., Googe, P., King, R., Prieto, V., Osman, I., Friedman, R. J., Rigel, D. S., Kopf, A. W., Polsky, D. (2008). Utility of Lesion Diameter in the Clinical Diagnosis of Cutaneous Melanoma. Arch Dermatol 144: 469-474 [Abstract] [Full text]
Welch, H. G., Woloshin, S., Schwartz, L. M. (2008). The Sea of Uncertainty Surrounding Ductal Carcinoma In Situ--The Price of Screening Mammography. JNCI J Natl Cancer Inst 100: 228-229 [Full text]
Welch, H. G., Woloshin, S., Schwartz, L. M., Gordis, L., Gotzsche, P. C., Harris, R., Kramer, B. S., Ransohoff, D. F. (2007). Overstating the Evidence for Lung Cancer Screening: The International Early Lung Cancer Action Program (I-ELCAP) Study. Arch Intern Med 167: 2289-2295 [Abstract] [Full text]
Carli, P. (2007). Identification of Incipient Tumors by Means of Sequential Dermoscopy Imaging: A New Way to Inflate the "Epidemic" of Melanoma?. Arch Dermatol 143: 805-805 [Full text]
de Vries, E, Houterman, S, Janssen-Heijnen, M., Nijsten, T, van de Schans, S., Eggermont, A., Coebergh, J. (2007). Up-to-date survival estimates and historical trends of cutaneous malignant melanoma in the south-east of The Netherlands. Ann Oncol 18: 1110-1116 [Abstract] [Full text]
Markovic, S. N., Erickson, L. A., Rao, R. D., McWilliams, R. R., Kottschade, L. A., Creagan, E. T., Weenig, R. H., Hand, J. L., Pittelkow, M. R., Pockaj, B. A., Bardia, A., Vachon, C. M., Schild, S. E., Laman, S. D., Maples, W. J., Pulido, J. S., Cameron, J. D., Melanoma Study Group of the Mayo Clinic Cancer Cen, (2007). Malignant Melanoma in the 21st Century, Part 1: Epidemiology, Risk Factors, Screening, Prevention, and Diagnosis. Mayo Clin Proc. 82: 364-380 [Abstract] [Full text]
Berwick, M. (2006). Evaluating early detection in the diagnosis of melanoma.. Arch Dermatol 142: 1485-1486 [Full text]
Bardia, A., Pittelkow, M. R., Rao, R. D. (2006). Risk of Multiple Primary Melanomas. JAMA 295: 1516-1516 [Full text]
Cummins, D. L., Cummins, J. M., Pantle, H., Silverman, M. A., Leonard, A. L., Chanmugam, A. (2006). Cutaneous Malignant Melanoma. Mayo Clin Proc. 81: 500-507 [Abstract] [Full text]
Wilson, C. T. (2006). Basal Cell and Squamous Cell Carcinoma in Persons Younger Than 40 Years. JAMA 295: 278-278 [Full text]
(2005). Why the Increase in Melanoma?. JWatch General 2005: 5-5 [Full text]
de Vries, E., Coebergh, J.-W. W (2005). Melanoma incidence has risen in Europe. BMJ 331: 698-698 [Full text]

Rapid Responses:

Read all Rapid Responses

Making Molehills of Melanomas: Deborah J. Merritt
bmj.com, 10 Aug 2005 [Full text]
Re: Making Molehills of Melanomas: Ellen C G Grant
bmj.com, 11 Aug 2005 [Full text]
Melanoma Among Women, 25-29: Deborah J Merritt
bmj.com, 11 Aug 2005 [Full text]
Re: Melanoma Among Women, 25-29: Ellen C G Grant
bmj.com, 12 Aug 2005 [Full text]
Re to Welch et al: Real increases of melanoma observed in Europe: Esther de Vries, et al.
bmj.com, 30 Aug 2005 [Full text]
Evidence needed for optimal melanoma follow-up methods: Elizabeth K Delaney, et al.
bmj.com, 4 Sep 2005 [Full text]
Skin Cancer Screening Can Help Save Lives: Clay J. Cockerell, MD
bmj.com, 9 Sep 2005 [Full text]