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 The conclusion, issued today by the U.S. Preventive Services Task
Force (USPSTF), adds to an ongoing debate in the medical community
about how to strike the right balance between catching dangerous
tumors as early as possible and avoiding unnecessary tests and
treatments that may result from catching too many harmless
abnormalities.
“At this time, the task force concluded that there is not enough
evidence to know whether a full-body skin exam by a clinician
reduces deaths from melanoma,” said Dr. Michael Pignone, a task
force member and researcher at the Dell Medical School at the
University of Texas at Austin.
“We do know that there are potential harms, including over-diagnosis
and unnecessary treatments that can lead to undesirable cosmetic
results,” Pignone added by email.
The vast majority of skin cancers don’t result in death. But
melanoma – a rare form that accounts for less than 2 percent of
cases – has a much higher death rate.
This year, an estimated 76,400 people will develop melanoma in the
U.S. and 10,100 will die from the disease, the task force notes in
recommendations published in JAMA.
Screening may make sense for adults with a history of skin cancer or
symptoms that point to the potential for melanoma, such as an
abnormal mole that is changing in size, shape or color. But other
people might be harmed by screening if it results in unnecessary
biopsies, scarring or damage that can affect feeling or range of
motion, the task force concludes.
The USPSTF, a government-backed independent organization that
reviews medical evidence, last updated its skin cancer screening
guidelines in 2009.
Then, as now, the task force found too little evidence to weigh in
for or against routine screening of all adults. These guidelines are
widely used to determine whether insurance will pay for screenings
and treatments and are widely followed by primary care physicians.
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“It is important for the public to understand that the USPSTF is not
recommending against skin cancer screenings,” said Dr. Abel Torres,
president of the American Academy of Dermatology.
“Additionally, the public should know that this recommendation does
not apply to individuals with suspicious skin lesions and those with
an increased skin cancer risk, and it does not address the practice
of skin self-exams,” Torres, who wasn’t involved in the task force,
said by email.
In a shift from the 2009 guidelines, the task force has eliminated
recommendations that patients do self-exams. This guidance might
make sense to include in recommendations related to counseling
patients about skin cancer, which screening guidelines aren’t meant
to address, the task force noted.
SOURCE: http://bit.ly/1c9i5E4 JAMA, online July 26, 2017.
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