Skin cancer screening: It all comes down to money

I just had to respond to the tone of this post. More and more screening is NOT automatically beneficial, as a layperson might think. There are many factors to consider when deciding whether a screening examination is worthwhile. These include the prevalance of the disease (how many people will actually have it in the general population), the false positive and false negative rates of the screening test, and the benefit of catching the disease early.

Examples where increased screening is not necessarily a good thing include whole body CT scans in asymptomatic people. Yes, you will catch a few cancers here and ther. But, due to the low prevalence of cancer, you will have many more false positives (finding on scan, but no dangerous pathology). What will this lead to? For every 1 cancer you find, you may biopsy 500 people who are have nothing wrong. Of those 500, several may have prolonged complications, etc. Then you have to consider whether diagnosing the 1 cancer actually improved survival.

Another example is PSA levels in men. Very complicated because it can detect cancers that may never have caused the patient a problem. Instead, it will lead to invasive procedures on men who would never have known they had cancer because prostate cancer can be very slow growing.

The analysis is pretty complicated. So statements such as "How can a screening exam NOT be beneficial" are flat out wrong.

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The situation is appalling and most of the focus is on prevention through sunSmart etc, yet we can't wrap everyone up and stop the sun from shining. We should be informing the public about changes which lead to skin cancers, the rest will then follow suit.

Not just over 50's, melanoma is now a real issue for young people. The number of twenty somethings with melanoma is staggering, the number of twenty somethings and early thirty somethings not making it through 5 years is chilling, and that's because the cancer wasn't found quickly enough. It should make anyone serious about skin cancer sit up and take note that screening is not a nice little add on to the story, it's vital, long overdue and very cheap, the skin id highly visible and there is no need for invasive radioactive screening devices so screening is safe.

Awareness campaigns, like the ABC of melanoma, need to target the public, the medical profession need to be trained also in what to look for and to not turn people away, telling them to come back if it bleeds.

We think we are tackling skin cancer, the truth is very different in terms of saving lives the focus should be on melanoma, skin cancer needs an image make over, the best example to follow is breast cancer. From A-Z everything is geared up for sucess, right those people who have skin cancer and don't know about it are being let down big time.

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"The analysis is pretty complicated. So statements such as "How can a screening exam NOT be beneficial" are flat out wrong."

Firstly skin cancer is different to the other cancers because the effects and the warning signs are on the outside of the body.

On the contrary, the analysis is simple, screening is the only way forward. Inaction on screening is condemning yet another generation of melanoma patients into poor prognosis, time matters, inaction kills. Most of the screening today for skin cancer is done at home by you, your partner, a relative who hasn't seen you for a while or a concerned friend.

In most cases this is how a skin cancer is screened, yet when a concerned patient arrives at the doctor, there is neither a track record, an archive of the same mole over a number of years, which the doctor can look back at and say "yes this has changed", nor the urgency on the part of the doctor and in some cases the doctor may not know what is and what isn't a melanoma.

That's the real problem we have here the most advanced screening device for skin cancer in existence in the whole universe today is, our eyes and we don't use them. There is no need for a CT scan unless you are actively looking for spread of cancer, and you wouldn't do that to a person who hasn't been diagnosed, so it's a non starter.

Aside from digital photography, there are a number of really smart technologies coming through, which beam visible light (so no UV) into the skin and it bounces back off cells and builds up a map of what is happening inside a mole for example. If melanin has entered the lower layer of skin, there is a good chance that mole is cancer and needs whipping out for biopsy. Using this type of screening will reduce the amount of biopsies because it will increase the accuracy of the information presented to the medical professional.

http://www.moleaware.org/siascope

There is no need to debate the benefits of screening, if my doctor has an archive of how my skin has changed over the years, he/she can make a better judgment. If the doctor has something like a siascope, the need to biopy on an if it's in doubt take it out policy, could be reduced and thus the biopsy system is sped up.

Inaction is not an option, this needs to happen.

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