Sun, Apr 23, 2017 | updated 09:24 PM IST

Not enough proof that skin cancer screening benefits outweigh risks

Updated: Jul 28, 2016 12:11 IST      
Not enough proof that skin cancer screening benefits outweigh risks

Washington D.C, Jul 28 (ANI): Frowning upon the regular full-body exams for skin cancer, members of the United States Preventive Services Task Force (USPSTF) said that there is not enough proof that they are more beneficial than damaging.

The federally appointed panel of medical experts gave the visual screening a rating of "I," which suggests that there was "insufficient" evidence for it to weigh the potential benefits against possible harms for Americans of average risk.

However, the panel's statement, published in the Journal of the American Medical Association, got a thumbs down from the American Academy of Dermatology.

In an invited commentary, Drs Martin Weinstock and Hensin Tsao agreed that the evidence doesn't meet the task force's standards, but they also questioned whether those standards are appropriate.

Weinstock of the Brown University said, "If you were to take a poll among practicing dermatologists, you'd find the vast majority believe that early detection reduces risk of death from melanoma. Skin self-examination and clinician skin examination are a means of early detection. That's the predominant tool that we have. It makes eminent sense that primary care doctors should be trained to do examination for melanoma."

But Weinstock acknowledged that in the task force's typical hierarchy of evidence, the "gold standard" is not the opinions of experts, but systematic reviews of data from a series of well-controlled randomized clinical trials.

There isn't, and may never be, such evidence regarding melanoma screening, Weinstock said. Clinical trials to determine whether widespread melanoma screening would prevent deaths have to be very large to be definitive, principally because deaths from the condition are not common. No country has yet been willing to spend the many millions of dollars required to fund a large enough trial.

Instead, the USPSTF reviewed the mixed evidence from controlled observational and epidemiological studies. At least some of those suggest both that early screening could save lives and that presumed harms such as overdiagnosis, unnecessary specialist visits and unnecessary surgeries don't emerge when properly trained clinicians and even laypeople conduct visual screening, Weinstock said.

Given a likelihood of little harm, but a potential life-saving benefit, Weinstock and Tsao of Massachusetts General Hospital argue, the task force could consider a different standard for judging the procedure.

"The evidentiary standard needs to be further refined to be appropriate to the modest magnitude of potential harms of a properly performed skin cancer screening," they wrote.

Skin cancer screening, Weinstock noted, is not an invasive procedure like a colonoscopy. For exams with potential serious medical consequences, the highest standards make clear sense. But for melanoma screening, a clinician simply looks at the skin, often while examining a patient during a routine office visit. Meanwhile, freely available training, such as the online course INFORMED that Weinstock helped to create, includes advice on when to appropriately reassure patients that skin lesions are not cancerous.

In their article, Weinstock and Tsao raised four other questions about the task force's approach to considering visual skin screenings:

- Overdiagnosis: While it is likely to a degree, Weinstock said, that is true of many screenings that are recommended, including for lung or breast cancer. If screening can save lives, it may still be worthwhile.

- Assessing risk: To determine whether someone has no known special risk, such as large numbers of moles or atypical moles, a clinician would have to do essentially the same visual inspection that would be done to screen for melanoma anyway.

- Advances in medications: New treatments for melanoma thankfully may save lives, but that could make it even harder to devise a definitive study that would show whether more widespread screening also saves lives.

- Self-examination: The task force is preparing a separate report on consumers conducting their own screening. Weinstock calls that an "artificial distinction" in that the dialogue between doctors and patients routinely means that self-screening and clinical screening are closely linked.

In the end, the duo acknowledged that more evidence would be helpful. "Going forward, it is imperative to develop the requisite evidence and the appropriate evidentiary standards to advance this area of public health," they wrote.

The commentary appears in JAMA. (ANI)

Washington D.C. [USA], Apr 23 (ANI): A recent study has demonstrated that in the general population, central obesity, insulin resistance, diabetes, lipid abnormalities and high alcohol consumption were the strongest predictors of severe liver disease.

Full Story >>

Breastmilk may help detect your cancer risk

Updated: Apr 23, 2017 11:50 IST

Washington D.C. [USA], Apr 23 (ANI): Breastmilk might offer clues about a woman's cancer risk, according to a recent research.

Full Story >>

Soon, new weapon in war against obesity

Updated: Apr 23, 2017 11:14 IST

Washington D.C. [USA], Apr 23 (ANI): A team of scientists has uncovered a potential approach to combat obesity.

Full Story >>

Turns out, being obese is worse than smoking

Updated: Apr 23, 2017 10:52 IST

Washington D.C. [USA], Apr 23 (ANI): You may want to shed those extra kilos as a recent study has found obesity as a top cause of preventable life-years lost.

Full Story >>

Washington D.C. [USA], Apr 23 (ANI): Testing for molecular markers in the urine of kidney transplant patients could reveal whether the transplant is failing and why, according to a recent research.

Full Story >>

Washington D.C. [USA], Apr 23 (ANI): People with drug-resistant bacteria in their urine or stool samples are at an increased risk of developing Sepsis, a bloodstream infection that is also resistant to certain antibiotics, according to a recent study.

Full Story >>

Move over contact lenses, LASIK is better

Updated: Apr 22, 2017 18:05 IST

Washington D.C. [USA], April 22 (ANI): Good news for those who underwent LASIK (laser-assisted in situ keratomileusis) for correction of their vision, as a recent study has found that the rate of cornea infection is lower.

Full Story >>

New Delhi [India], Apr. 22 (ANI): In today's era of booming medical advancements, the chances of survival from cancer can be increased, if it is detected at an early stage.

Full Story >>

Eman Ahmed has done miraculously well: Doctor

Updated: Apr 21, 2017 21:11 IST

Mumbai (Maharashtra) [India], Apr 21 (ANI): 36-year-old Egyptian Eman Ahmed, who was the heaviest woman in the world at 500-plus kg until a few months ago, has lost 250kg in two months after undergoing surgery here at Saifee Hospital.

Full Story >>

Let's create awareness about liver cancer!

Updated: Apr 21, 2017 17:25 IST

New Delhi [India], Apr 21 (ANI): The increasing liver disease is one of the most common diseases in the world.

Full Story >>

College blues? Turn to mindfulness

Updated: Apr 21, 2017 16:35 IST

Washington D.C. [USA], Apr 21 (ANI): Heading off to college? A recent study has suggested that mindfulness may help freshmen stress less and smile more.

Full Story >>

Washington D.C. [USA], April 21 (ANI): A team of US researchers has revealed that the traditional clinical hearing tests often fail to diagnose patients with a common form of inner ear damage, which otherwise might be detected by some behavioural tests.

Full Story >>

Washington D.C. [USA], April 21 (ANI): Canadian researchers have found that people with multiple sclerosis start showing symptoms of something wrong, five years before the onset of disease.

Full Story >>

Washington D.C. [USA], Apr 20 (ANI): You may want to stimulate your brain in early life as a recent study has found that it may help stay mentally healthy in older age.

Full Story >>

New Delhi [India], Apr 20 (ANI): A 24-year-old multiple sclerosis patient recently got another chance at life after undergoing a bone marrow transplantation.

Full Story >>

A weapon against Alzheimer's in your womb?

Updated: Apr 20, 2017 17:13 IST

Washington D.C. [USA], Apr 20 (ANI): Think your memory is starting to slip? A protein found in umbilical cord blood may help turn back the clock on mental ageing.

Full Story >>

New Delhi [India], Apr 20 (ANI): Even though 91% Indians consider health a priority and intend to make healthy changes, a study suggests that almost one-third of the population does not care to visit physicians on time.

Full Story >>

Washington D.C. [USA], April 20 (ANI): Menopausal or pre- menopausal women, aged 40-65, who experience hot flashes or excessive sweating during sleep, are at increased risk of moderate and severe depression.

Full Story >>

New Delhi [India], Apr 19 (ANI): Tobacco is considered to be one of the most important avoidable lifestyle related cause of cancer in the world.

Full Story >>

New Delhi [India], Apr 19 (ANI): According to WHO, liver disease is the 10th most common cause of death in India.

Full Story >>