WHO H. Gilbert Welch MD, MPH, Chief Inspector, Center for Surgery and Public Health, Brigham and Women ‘s Hospital; co – author of a new Phonics Board article published in The New England Journal of Medicine.
WHAT is skin melanoma now the third most commonly diagnosed cancer in the US Diagnosis of melanoma is six times as high today as it was 40 years ago. Although the incidence of melanoma has risen sharply, melanoma mortality has been generally stable. In a Sounding Board article, Welch and colleagues provide evidence on why they believe more diagnostic research is a key driver for the rapid rise in melanoma diagnosis.
“Melanoma is now a poster child for overdiagnosis,” Welch said. “While the usual response was to recommend regular skin tests, epilepsy is far more likely to be caused by more skin tests – not its solution.”
Among many examples, Welch and co-authors describe a study in which nine dermatopathologists reviewed skin biopsy samples used for diagnosis 20 years earlier. Many of the previously diagnosed inoperable samples were now seen as melanoma. Welch and co-authors also share data showing that, among the Medicare population, the proportion of biopsied beneficiaries increased each year from 2004 to 2017, almost doubling over that period . Over the same period, the incidence of melanoma doubled in adults 65 and older.
The authors point out that there is a lot of potential harm in overdiagnosis of melanoma, ranging from immediate – scarring, wound infection, out-of-pocket costs – to long-term effects. time such as restricting access to care for people with symptomatic skin diseases. .
“Despite the preferred goals of all parties, further diagnostic study can be a cycle of increased overdiagnosis and intervention in any disease with a reservoir of subclinical forms. Melanoma is an exception,” the authors write. “The economic turmoil caused by Covid-19 calls on clinicians to protect people from the financial pressures of not having to be turned into patients. ”
###
Disclaimer: AAAS and EurekAlert! they are not responsible for the accuracy of press releases posted to EurekAlert! by sending institutions or for using any information through the EurekAlert system.