A collaborative paper by University of Kentucky College of Public Health (UK CPH) faculty, staff, and alumni sheds new light on best practices for late-stage melanoma screening.
Dr. Virginia L. Valentin, University of Utah/UK CPH alumna is the lead author of “Late-Stage Melanoma: Be Sure to Screen Uninsured, Unmarried Men,” appearing in the Southern Medical Journal. Co-authors are Dr. Wayne Sanderson, UK CPH epidemiology, Ms. Susan Westneat, UKCPH staff epidemiologist, and Dr. Eric Durbin, Kentucky Cancer Registry/UK CPH alumnus
The investigators designed a study with the aim of assessing Kentucky from 1995 to 2013 data for any associations between individual and social factors and late-stage melanoma.
The study combined three datasets: individual-level data from the Kentucky Cancer Registry, census tract–level data from the U.S. Census, and county-level physician licensure data from the Kentucky Department for Public Health. The study population was described by all cases, early stage, and late stage. Logistic regression was used to evaluate the unadjusted associations between each covariate and early-stage and late-stage disease groups. All of the significant variables were assessed for interaction effect, and the significant interaction terms were used in the final model. Multiple logistic regression provided the final model of late-stage disease.
Investigators found that in the study population, a dramatic increase in melanoma incidence was seen from 1995 to 2013, with a threefold increase in the number of cases per year. Of the 10,109 cases reported, 13.6 percent had late-stage disease, with a mean age for all cases at 56.9 years, and the majority being men. In the data, late-stage cases were more commonly uninsured, or insured with Medicaid or Medicare, compared with cases with early-stage lesions.
“Having a spouse or partner is clearly protective from being diagnosed as having late-stage melanoma, whereas being uninsured or having Medicaid increases the odds of late-stage melanoma,” the authors conclude.
“The incidence of melanoma is increasing dramatically,” note the investigators. “With no screening recommendation for the general population from the U.S. Preventive Task Force, clinicians should focus on those at increased risk of late-stage melanoma: unmarried men who are uninsured or receiving Medicaid.”