When was the last time you got a full-body exam for skin
cancer? If you can’t remember, you’re not alone.
Many primary care doctors are too busy and many patients are too
embarrassed to get checked.
A report in the January issue of Archives of
Dermatology, one of the JAMA/Archives journals lists time constraints,
other illnesses and patient embarrassment as the top reasons
preventing dermatologists, internists and family practitioners from
conducting full-body skin cancer screenings.
However, dermatologists are significantly more likely than
internists and family practitioners to conduct such
screenings.
According to the American Cancer Society, skin cancer is the
most common of all cancers. It accounts for nearly half of all
cancers in the United States.
The study authors said it’s critical for patients to get screened regularly and for doctors to adopt secondary prevention strategies aimed at early detection in an effort to reduce its associated morbidity and mortality.
"Previous studies have suggested that many individuals, particularly those with established risk factors for melanoma, would benefit from active skin cancer screening and surveillance, and screening by dermatologists in particular may also be cost-effective," the authors wrote.
Susan A. Oliveria, Sc.D., M.P.H., of Memorial Sloan-Kettering Cancer Center, New York, and colleagues surveyed 2,999 physicians randomly selected from the American Medical Association's Medical Marketing Services database in 2005.
Of those, 1,669 (59.2 percent) returned surveys, including 559 family practitioners, 431 internists and 679 dermatologists.
More dermatologists (81.3 percent) than family practitioners (59.6 percent) or internists (56.4 percent) report regularly performing full-body skin examinations on their patients.
Among all the responding physicians, the top three barriers to performing these examinations were time constraints, competing illnesses and patient embarrassment or reluctance.
More family practitioners (54.4 percent) and internists (54.5 percent) reported time constraints as a moderate or major barrier than did dermatologists (30.6 percent),
Dermatologists were more likely to cite patient embarrassment or reluctance as a moderate or major barrier (44.2 percent, vs. 31.3 percent of family practitioners and 32.7 percent of internists).
This may be because patients visit the dermatologist with more stigmatizing skin conditions, because they don't have an established relationship with a specialist or because they do not expect to undress, the authors note.
"Patients may see a dermatologist for an isolated skin condition, such as a wart, and the dermatologist may feel awkward asking this person to undress for a full-body skin examination."
Since internists and primary care doctors routinely ask for patients to undress for physical examinations, undressing for a skin cancer screening is a little less embarrassing.
Recognizing such barriers could help to overcome them in both primary and secondary care settings.
The authors said skin cancer is an ideal cancer for encouraging screening because many risk factors are well known, including family history, the presence of atypical nevi, skin type and history and pattern of sun exposure; because the disease is highly prevalent; and because there are opportunities for early detection.
"Understanding the determinants of patient skin cancer screening could help promote interventions based on physician characteristics that are amenable to change, potentially improve physicians' prevention practices and help promote early detection," the authors concluded.
