Time delays and related factors in the diagnosis of cutaneous melanoma.

Delay in melanoma diagnosis was investigated in a population-based sample of 130 patients. The median time elapsing from the first notice of the lesion to excision was 110.5 days. There was no linear correlation between total delay time and Breslow-thickness of the diagnosed melanomas (P=0.19). Patient delay, defined as the time from first notice of a (change in a) lesion to the first observation by a physician, exceeded 2 months in half of all patients. Only 41% of the patients consulted a doctor because they were worried about the lesion. Colour change and itch were associated with a longer patient delay. There was no correlation with age, gender, socio-economic factors, localisation of the lesion and the person who first noticed the lesion. In one quarter of all patients, the time from first observation by a physician to excision of the lesion exceeded 2.5 months. This physician delay seemed to be attributed to misdiagnosis and to a delay occurring during referral.

Screening for breast cancer in Ghent, Belgium: first results of a programme involving the existing health services.

In 1992, a population-based breast cancer screening programme was initiated in the municipality of Ghent: all women aged 40-69 years were personally invited to attend a local radiology unit for a mammogram, after being examined by a general practitioner or gynaecologist of their choice. The results of history taking, clinical breast examination, first and second reading, further investigation and primary treatment were registered. In total, 24.3% of the eligible population was screened in the period 1992-1994. The recall and biopsy rates were 2.9% and 1.4%, respectively. The cancer detection rate was 8.1 per 1000 women screened. Of all cancers detected, 88.0% (66/75) were invasive. Of these, 35.9% (23/64) measured 10 mm or less in diameter. The benign to malignant biopsy ratio was 0.7. Apart from the low participation, these results suggest that the programme is effective, compared with reference standards and the results of other studies.

Trends in mortality from cutaneous malignant melanoma in Belgium.

BACKGROUND AND METHODS: Changes over time of mortality rates from cutaneous malignant melanoma (CMM) in Belgium were analysed, based on people (n = 3695) aged 25-84 years, who died of CMM from 1954 to 1992. All data were collected from the Belgian National Institute of Statistics. For the log-linear analysis and calculation of the average annual change, only the data from 1973 to 1992 were considered. RESULTS: The age-adjusted mortality rates (per 10(5)) for the age group 25-84 years old increased from 0.5 in 1954 to 3.0 in 1992 in men, and from 0.8 in 1954 to 2.2 in 1992 in women. The average annual percentage change in men (-0.003%) was stable over the period 1973-1982, and increased to 4.4% over the period 1983-1992. In women, the average annual increase was 4.6% over the period 1973-1982, and continued to increase to 6.8% over the period 1983-1992. Log-linear analysis showed that the change in rates for both men and women was mainly due to an age-'drift' effect, contrary to the results of the average annual percentage change in men. CONCLUSION: The risk of dying from CMM increased in men and women continuously over the whole period, irrespective of birth cohort. In both men and women, there was approximately a 20% increase in CMM mortality per 5-year period.

Age-specific accuracy of initial versus subsequent mammography screening: results from the Ghent breast cancer-screening programme.

The aim of this study was to determine whether age-related differences in the accuracy of mammography breast cancer screening decrease with repeated examination. Data from the first 8 years (May 1992 to April 1999) of the Ghent breast cancer-screening programme were used for analysis. In total, 28 944 mammography examinations were included. The referral rate, cancer detection rate, positive predictive value, sensitivity and specificity were chosen as performance indicators. Values were calculated for women aged 40-49, 50-59 and 60-69 years, at initial versus subsequent examinations, respectively. For first examinations, overall, performance was much lower for the women in their forties than for the older age groups. On subsequent screening, the effect of age disappeared, as expected, or was even reversed for the positive predictive value and sensitivity of the examination. In the light of the ongoing debate over the eligible age for mammography screening, these results support a universal recommendation beginning at the age of 40 years.

Under-registration of melanoma in Belgium: an analysis.

The overall underestimation of incident cancer cases in the Belgian National Cancer Registry is estimated at about 20-25%, with a probable larger under-registration among males. Melanoma incidence is suspected to be underestimated even further because of the hospital-based reporting system of the National Cancer Registry. To investigate the suspected underestimation of melanoma in Belgium, the official data were compared with international data on melanoma incidence and the results of a melanoma registration programme launched in the province of East Flanders. The Eindhoven Cancer Registry, which covers a registration area near the Belgian border, was used as a reference to calculate the expected number of melanomas in East Flanders for 1995. The results indicate an ongoing under-registration of melanoma cases by the National Cancer Registry. Based on the Eindhoven Cancer Registry data, the under-registration in East Flanders is estimated at 43% for males and 36% for females. The East Flanders registration programme apparently obtains a better registration in females. This is mainly due to a higher registration in the younger age groups. In these groups a higher proportion of in situ melanomas and a thinner median Breslow thickness of the invasive melanomas is observed.

The melanoma burden in Belgium; premature morbidity and mortality make melanoma a considerable health problem.

The aim of this study was to investigate the impact of melanoma on public health in Belgium. Melanoma incidence and mortality rates were analysed relative to those of other cancers. These cancers were then evaluated for premature morbidity and mortality by studying age-specific incidence rates, years of potential life lost before 65, and years of potential life lost per death. Melanoma accounts for 1.23% of all incident cancer cases and 0.7% of all cancer deaths in Belgium. It is the seventeenth most common cancer in men and the sixteenth most common cancer in women. Compared with other, more frequent cancers, melanoma seems to affect patients at a younger age; in the 20-39 age group melanoma is the third most common cancer in both sexes. It is the second most important cancer in terms of years of potential life lost per death, preceded only by tumours of the central nervous system. These findings show that melanoma incidence and mortality rates are exceeded by many other cancers. Nevertheless, melanoma poses an important health problem because of its predilection for young and middle-aged people. We suspect that these observations are not specific for Belgium and will also apply to other European countries.

Diagnostic ability of general practitioners and dermatologists in discriminating pigmented skin lesions.

BACKGROUND: Early recognition of melanoma is the key in preventing metastatic disease. OBJECTIVE: The aim of this study was to evaluate diagnostic ability of general practitioners (GPs) and dermatologists concerning pigmented skin lesions in general and melanoma in particular. We also investigated whether the diagnostic ability of GPs changed after a lecture on melanoma. METHODS: A test set of 13 pigmented skin lesions on 35-mm color slides was presented to 160 GPs and 60 dermatologists during educational courses. RESULTS: GPs correctly evaluated biologic behavior of the pigmented skin lesions in 72% of the evaluations. In 71% of these evaluations they correctly identified the lesions. The proportion of lesions correctly identified was positively correlated with the frequency of pigmented skin lesions in everyday practice. Dermatologists made a correct identification of the lesions in 88% of all evaluations, and they correctly evaluated biologic behavior in 94% of these. Recognition of melanoma was proportional to melanoma exposure in everyday practice. Thick melanomas were better recognized than thin melanomas in both physician groups. After a lecture on melanoma, sensitivity of GPs to recognize malignant disease increased from 72% to 84%, without a significant decrease in specificity. The proportion of lesions correctly identified also rose significantly (66% vs 52%).