0
Research Letters |

A Comparison of Florida Skin Cancer Screening Rates With Those in the Rest of the United States FREE

Cristina A. Fernandez, MSEd; Laura A. McClure, MSPH; William G. LeBlanc, PhD; Tainya C. Clarke, MPH, MS; Robert S. Kirsner, MD, PhD; Kristopher L. Arheart, EdD; David J. Lee, PhD
[+] Author Affiliations

Author Affiliations: Department of Epidemiology and Public Health (Mss Fernandez, McClure, and Clarke and Drs LeBlanc and Lee), Department of Dermatology and Cutaneous Surgery (Dr Kirsner), and Division of Biostatistics (Dr Arheart), University of Miami Miller School of Medicine, Miami, Florida.


Arch Dermatol. 2012;148(3):393-395. doi:10.1001/archdermatol.2011.2937.
Text Size: A A A
Published online

Florida has the second largest number of melanoma cases in the country, an estimated 4430 cases in 2008.1 Fortunately, the 5-year survival rate for individuals whose melanoma is treated before it spreads to the lymph nodes is 98%.1 Knowing the high UV index in Florida and lack of population-based data on skin cancer screening among the different US states, we designed our study to compare skin cancer screening rates among Floridians with those of residents in the rest of the United States.

The National Health Interview Survey (NHIS) is an annual, cross-sectional household survey of the US civilian noninstitutionalized population. We analyzed data from the 2000 and 2005 NHIS Cancer Control Modules (CCMs), which are the only sources of national population-based data on cancer screening.2 In all CCMs, participants were asked, “Have you EVER had all of your skin from head to toe checked for cancer by a dermatologist or some other kind of doctor? ” (yes/no).2 Then they were asked “When did you have your MOST RECENT skin exam to check for cancer? ”2 Data were grouped according to whether participants reported a skin examination during the last 12 months.

Data were pooled, and analyses took into account sample weights and design effects. Logistic regression analyses were performed with self-reported skin screening as the outcome of interest. Florida data were compared with data from the rest of the US states. All analyses were conducted at the Research Data Center to ensure confidentiality. The study received an exempt approval from the University of Miami institutional review board.

When compared with residents of the rest of the US states, Floridians reported significantly higher skin cancer screening rates, specifically Floridians older than 60 years (Table 1). White Floridians had significantly higher rates than white participants in the rest of the US states. Also, non-Hispanic Floridians had significantly higher screening rates than non-Hispanics in the rest of the US states. Among Floridians, there was a notable increase in screening rates with an increase in education. Regardless of health insurance status, Floridians had higher screening rates, although rates were not significantly different between the uninsured groups. Both unemployed and employed Floridians had significantly higher rates of screening than those groups in the rest of the US states.

Table Graphic Jump LocationTable 1. Percentage Differences in Skin Cancer Screening in the Past Year in Florida vs the Rest of the United Statesa

After adjusting for the sociodemographic and health-related indicators listed in Table 2, we found that Floridians retained significantly higher odds of skin cancer screening in the past year than residents in the rest of the US states (odds ratio, 1.52; 95% CI, 1.52-1.54).

Table Graphic Jump LocationTable 2. Logistic Regression of Skin Cancer Screening in the Past Year in Florida vs Rest of the United States

Compared with residents of the rest of the nation, Floridians reported higher rates of skin cancer screening, which were also evident across a range of sociodemographic groups. Results suggest that regional variations in screening rates exist in the United States. However, it is unclear if early detection reduces mortality or morbidity from skin cancer.3 It is important to note that Medicare does not cover skin cancer screening4; however, some insurers within Florida promote skin cancer detection by providing free yearly screening.5 Also, Florida insurers allow direct patient access to dermatologists without a prior referral (statute 627.6472).6 Florida also has several cancer initiatives that may be positively influencing screening activities, such as the Governor's Task Force on Skin Cancer Prevention and the Moffitt Cancer Center's program, “Mole Patrol. ”1 This center has launched educational opportunities for Florida health care providers, which could have led to a greater awareness for routine screening. In addition, many Florida dermatologists have completed their residency in Florida, and are thus more aware of the dangers of residing at Florida's latitude.7 Finally, living in the “Sunshine State ” may raise awareness of the need for skin cancer screening, especially for those with a family history of cancer.1

Limitations of this study include the self-report and cross-sectional nature of the NHIS. A similarly worded self-reported whole-body skin examination question has been validated previously at a sensitivity of 90.5%,8 but this study was conducted outside of the United States. Also, it is unclear who is conducting the screening, and previous literature has shown that screening accuracy varies by practitioner type.3 Nevertheless, the combination of stakeholder efforts for skin cancer screening is essential, especially given the high prevalence of melanoma in Florida.1

Correspondence: Ms Fernandez, Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, 1120 NW 14th St, Ste 1074 (R669), Miami, FL 33136 (CFernandez5@med.miami.edu).

Accepted for Publication: November 29, 2011.

Author Contributions: Ms Fernandez and Drs Leblanc, Arheart, and Lee had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Fernandez, McClure, and Lee. Acquisition of data: Fernandez, LeBlanc, and Arheart. Analysis and interpretation of data: McClure, LeBlanc, Clarke, Kirsner, and Arheart. Drafting of the manuscript: Fernandez, and McClure. Critical revision of the manuscript for important intellectual content: Fernandez, McClure, LeBlanc, Clarke, Kirsner, Arheart, and Lee. Statistical analysis: LeBlanc and Arheart. Obtained funding: Lee. Administrative, technical, and material support: Fernandez, McClure, Clarke, Arheart, and Lee. Study supervision: Fernandez and Lee.

Financial Disclosure: None reported.

Funding/Support: The study was fully funded by Bankhead Coley Cancer Research Program grant 1BG06-341963 (Dr Lee).

Role of the Sponsors: The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; or in the preparation, review, or approval of the manuscript.

Additional Contributions: The US Department of Health and Human Services and the National Center for Health Statistics collected and compiled the data in the National Health Interview Survey (NHIS). The collector of the original data bears no responsibility for the analyses or interpretations presented in this publication. The Research Data Center conducted our analyses.

Florida Department of Health.  Florida State Cancer Plan 2010. http://www.doh.state.fl.us/family/cancer/ccc/plan/NewFlorida_Cancer_Plan_2010.pdf. Accessed September 27, 2011
Centers for Disease Control and Prevention.  2005 National Health Interview Survey, Sample Adult Cancer. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2010/cancerxx_layout.pdf. Accessed January 8, 2012
Wolff T, Tai E, Miller T. Screening for skin cancer: an update of the evidence for the U.S. Preventive Services Task Force.  Ann Intern Med. 2009;150(3):194-198
PubMed
Medicare.  Medicare Coverage 2011. http://www.medicare.gov/coverage/. Accessed September 26, 2011
University of Miami.  University of Miami Free Preventive Care Summary. http://www.miami.edu/index.php/benefits_administration/2012_health_care/free_preventive_care/. Accessed October 4, 2011
The Florida Legislature.  Section 627.6472, Florida Statutes 2009. http://www.myfloridahouse.gov/FileStores/Web/Statutes/FS09/CH0627/Section_0627.6472.HTM. Accessed November 15, 2011
Resneck JS Jr, Kostecki J. An analysis of dermatologist migration patterns after residency training.  Arch Dermatol. 2011;147(9):1065-1070
PubMed
Aitken JF, Youl PH, Janda M,  et al.  Validity of self-reported skin screening histories.  Am J Epidemiol. 2004;159(11):1098-1105
PubMed

Figures

Tables

Table Graphic Jump LocationTable 1. Percentage Differences in Skin Cancer Screening in the Past Year in Florida vs the Rest of the United Statesa
Table Graphic Jump LocationTable 2. Logistic Regression of Skin Cancer Screening in the Past Year in Florida vs Rest of the United States

References

Florida Department of Health.  Florida State Cancer Plan 2010. http://www.doh.state.fl.us/family/cancer/ccc/plan/NewFlorida_Cancer_Plan_2010.pdf. Accessed September 27, 2011
Centers for Disease Control and Prevention.  2005 National Health Interview Survey, Sample Adult Cancer. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2010/cancerxx_layout.pdf. Accessed January 8, 2012
Wolff T, Tai E, Miller T. Screening for skin cancer: an update of the evidence for the U.S. Preventive Services Task Force.  Ann Intern Med. 2009;150(3):194-198
PubMed
Medicare.  Medicare Coverage 2011. http://www.medicare.gov/coverage/. Accessed September 26, 2011
University of Miami.  University of Miami Free Preventive Care Summary. http://www.miami.edu/index.php/benefits_administration/2012_health_care/free_preventive_care/. Accessed October 4, 2011
The Florida Legislature.  Section 627.6472, Florida Statutes 2009. http://www.myfloridahouse.gov/FileStores/Web/Statutes/FS09/CH0627/Section_0627.6472.HTM. Accessed November 15, 2011
Resneck JS Jr, Kostecki J. An analysis of dermatologist migration patterns after residency training.  Arch Dermatol. 2011;147(9):1065-1070
PubMed
Aitken JF, Youl PH, Janda M,  et al.  Validity of self-reported skin screening histories.  Am J Epidemiol. 2004;159(11):1098-1105
PubMed

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles