caa a22 4500 397564805 CHVBK 20180308164825.0 cr unu---uuuuu 161202e19960103xx s 000 0 eng 10.1093/jnci/88.1.17 doi (NATIONALLICENCE)oxford-10.1093/jnci/88.1.17 Screening for Cutaneous Melanoma by Skin Self-Examination [Elektronische Daten] [Marianne Berwick, Colin B. Begg, Judith A. Fine, George C. Roush, Raymond L. Barnhill] Background: Although some evidence indicates that early detection protects against the development of lethal melanoma, no randomized clinical trials have been conducted to measure the efficacy of early detection (or screening) in preventing death from this disease. Since melanoma incidence in the United States is relatively rare, a randomized clinical trial to test the efficacy of screening would be extremely expensive. Purpose: As an alternative to a randomized clinical trial, we conducted a population-based, case-control study to investigate whether early detection through skin self-examination (SSE) is associated with a decreased risk of lethal melanoma (includes the presence of advanced disease with distant metastases in addition to death from melanoma). Methods: SSE (conducting a careful, deliberate, and purposeful examination of the skin) was assessed in all subjects by use of a structured questionnaire and personal interviews. The major exposure variable, SSE, was defined following focus-group interviews with melanoma patients and healthy control subjects. The final study population consisted of 1199 Caucasian residents of the state of Connecticut enrolled from January 15, 1987, through May 15, 1989; 650 individuals were newly diagnosed with cutaneous melanoma, and the remaining 549 individuals were age- and sex-frequency matched control subjects from the general population. During the study interviews, nevi on the arms and backs of subjects were counted. In 5 years of follow-up (through March 1994), 110 lethal cases of melanoma were identified. The study design allowed separate estimation of the impact of SSE on reduced melanoma incidence (primary prevention) and survival among incident cases (secondary prevention). Odds ratios (ORs) were used to measure the associations between SSE and melanoma and between SSE and lethal melanoma. Results: SSE, practiced by only 15% of all subjects, was associated with a reduced risk of melanoma incidence (adjusted OR = 0.66; 95% confidence interval [CI] = 0.44-0.99; comparing case patients with control subjects). The data indicated further that SSE may reduce the risk of advanced disease among melanoma patients (unadjusted risk ratio = 0.58; 95% CI = 0.31-1.11); however, longer follow-up is required to confirm this latter estimate. If both estimates are correct, they suggest, in combination, that SSE may reduce mortality from melanoma by 63% (adjusted OR = 0.37; 95% CI = 0.16-0.84; comparing lethal cases with general population controls). Conclusions and Implications: SSE may provide a useful and inexpensive screening method to reduce the incidence of melanoma. SSE may also reduce the development of advanced disease. The results of this study need to be replicated before strategies to increase the practice of SSE are further developed and promoted. [J Natl Cancer Inst 1996;88:17-23] © Oxford University Press ARTICLES nationallicence Berwick Marianne Cancer Prevention Research Unit for Connecticut at Yale, Yale University New Haven Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center New York, NY aut Begg Colin B. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center New York, NY aut Fine Judith A. Cancer Prevention Research Unit for Connecticut at Yale, Yale University New York, NY aut Roush George C. Cancer Prevention Research Institute New York, NY aut Barnhill Raymond L. Brigham and Women's Hospital, Harvard Medical School Boston, MA aut JNCI: Journal of the National Cancer Institute Oxford University Press 88/1(1996-01-03), 17-23 0027-8874 88:1<17 1996 88 jnci https://doi.org/10.1093/jnci/88.1.17 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1093/jnci/88.1.17 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Berwick Marianne Cancer Prevention Research Unit for Connecticut at Yale, Yale University New Haven Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center New York, NY aut NATIONALLICENCE 700 1- Begg Colin B. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center New York, NY aut NATIONALLICENCE 700 1- Fine Judith A. Cancer Prevention Research Unit for Connecticut at Yale, Yale University New York, NY aut NATIONALLICENCE 700 1- Roush George C. Cancer Prevention Research Institute New York, NY aut NATIONALLICENCE 700 1- Barnhill Raymond L. Brigham and Women's Hospital, Harvard Medical School Boston, MA aut NATIONALLICENCE 773 0- JNCI: Journal of the National Cancer Institute Oxford University Press 88/1(1996-01-03), 17-23 0027-8874 88:1<17 1996 88 jnci Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford