Self-reported screening for skin cancer in Austria

ARTICLE

Auteur(s) : Gerald Haidinger, Thomas Waldhoer, Nikolaus Duschek, Christian Vutuc

Department of Epidemiology, Centre of Public Health, Medical University of Vienna, Borschkegasse 8a, 1090 Vienna, Austria

accepté le 22 Juin 2009

The Austrian Cancer Society started the first campaign in 1988, informing the public about skin cancer, and has repeated it every year since then [1]. The campaigns entitled “sun without remorse” (“Sonne ohne Reue”) inform about skin cancer and its primary and secondary prevention. The target population is encouraged to see a doctor for a whole body skin examination, to determine the person’s individual risk and to receive information on primary prevention and self-screening. Because primary prevention is a major target of the campaign, younger age groups are especially addressed.

We report for the first time on the prevalence of knowledge about and of self-reported participation and frequency of screening for skin cancer in Austrian men and women aged 15-79 years, sampled in the years 1995 and 2005.

Materials and methods

This analysis was restricted to men and women aged 15-79 years. The study groups comprised of 966 men and 1,081 women in 1995 and of 951 men and 1,021 women in 2005.

In the questionnaire, screening for skin cancer in asymptomatic persons was explicitly asked for, but not for the diagnostic examination in patients with symptoms. Men and women were asked if they had ever heard of early detection of skin cancer and if so, whether they had ever had a whole body examination during their lifetime, and if so, the number of screenings. Respondents who had never heard of early detection of skin cancer (1995: men: n = 392, 40.6%, women: n = 459, 42.5%; 2005 men: n = 438, 46.1%, women: n = 367, 35.9%) were included in our calculations and counted as never-screened.

The following categories were defined for age: 15-39 years, 40-59 years and 60-79 years and for frequency of screenings: once, 2-3 times, 4+ times, number not specified, and never had. Subsequently the respondents were asked whether the screening was performed by a dermatologist or by a general practitioner, by another specialist or at an out-patient clinic.

Besides the screening-specific information, socio-demographic variables concerning sex, age, marital status, residence, education and income were collected. Education was categorized as being “high” when respondents answered to having completed general qualification for university entrance or having completed a university study (which – in Austria – corresponds to 12 years of school or more). Frequencies and confidence limits were calculated in SAS [9]. Statistics comprised of chi-square tests of differences in prevalence between the 1995 and the 2005 survey, and between educational levels, as well as between areas of residence.

Results

The prevalence of screening for skin cancer increased in men from 8.1% in 1995 to 13.3% in 2005 (table 2) and in women from 11.2% to 22.4% (table 3). In all age groups, the prevalence increased in all frequency categories except in men in the age group 60-79 years where in the category “2-3 screenings” the prevalence decreased slightly. Regarding education, differences were found between poorly educated and highly educated persons, showing that higher education leads to an increase of screening usage, although statistically non significant. Statistically significant differences were only found in males in the 1995 survey: 21.1% (95% CI: 20.9-21.3) of the highly educated men made use of screening, compared to 11.3% (95% CI: 11.2-11.4) of the men with lower education levels.

In both surveys, in men and in women, most of the screenings were performed by dermatologists, in 2005 more than 70% of the screenings (table 4). Classification by area of residence did not produce statistically significant differences between groups.
Table 1 Prevalence of knowledge about skin cancer screening in Austria

Discussion

The proportion of screenings by dermatologists increased in men as well as in women from 1995 to 2005. This trend towards seeing a specialist is desirable although in rural areas the general practitioner remains the primary care provider.

In the literature we found only very view studies on this topic: in the 1998 National Health Interview Survey in the age group 18-65 + years, 20% of male and 21.9% of female respondents reported having ever had a skin examination; in the year 2000 survey this prevalence decreased to 14.2% in men and 15.0% in women [10]. The numbers found in our 2005 survey are lower in men but higher in women, although with an increase in both sexes since 1995.

Our prevalence rates are based on self-reports. Nevertheless these data may reflect under-reporting because respondents may be unaware of having received a skin cancer screening along the way during any consultation of a doctor. However, a validation study in Australia reported a sensitivity of 90.5% [11]. This may not easily be comparable to Austria because of the high incidence of melanoma in Australia and thus a much higher awareness in that population. A high awareness is desirable from the view point of public health and can be expected for Austria, too, because of trends in incidence (figure 1).

Meanwhile, effectiveness of screening seems to be proven by a reduction of tumour thickness [12] and by the trends in mortality where a levelling-off in males and even a slight reduction in females can be observed (figure 1).

Acknowledgements

References

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