NCPA - National Center for Policy Analysis


August 16, 2005

Since 1986, the diagnosis rate of melanoma -- a form of skin cancer -- has more than doubled, but experts question whether the growing diagnoses reflect an increase in the cancer itself, or an increase in detection due to screening.

Many dermatologists argue that melanoma is becoming more common, but a new study published in the British Medical Journal indicates that the numbers may simply reflect the fact that more people are getting screened.

According to H. Gilbert Welch and his colleagues:

  • Since 1986, skin biopsies have risen by 250 percent, which is about the same rate as the rise in the incidence of early stage melanoma.
  • However, there was no increase in the melanoma death rate or the incidence of advanced disease.

They say that if the incidence of melanoma was really on the rise, one would expect to see an increase in the cancer at all stages, similar to findings on lung cancer caused by smoking.

Some question the benefit of screening if it has not reduced the death rate or the incidence of advanced disease. The American Cancer Society and the American Academy of Dermatology recommend regular screenings, but note that there are some drawbacks. In 1997, two dermatologists noted that individuals who receive a diagnosis of melanoma, even where there is none, can have difficulty obtaining medical insurance. Additionally, screening costs the medical system billions of dollars.

Early detection, says Welch, "is a double-edge sword and people need to remember that."

Source: Gina Kolata, "Melanoma Is Epidemic. Or Is It?" New York Times, August 9, 2005; and H. Gilbert Welch, Steven Woloshin, and Lisa M Schwartz, "Skin biopsy rates and incidence of melanoma: population based ecological study," British Medical Journal, Aug 2005.

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