Early detection of skin cancer as public health policy: comparison of campaign and routine activity.

ABSTRACT

OBJECTIVE: The objective of this study was to evaluate the early detection of skin cancer, with emphasis on comparison of campaign (short high-intensity periods) and routine (continuous low-intensity) activity. METHODS: The study population consisted of 5903 campaign and 4284 routine attenders visiting a nurse at the Pirkanmaa Cancer Society between January 1, 1991, and December 31, 2000. Skin cancers were identified from the Finnish Cancer Registry. The performance of the program was evaluated in terms of sensitivity, specificity, positive and negative predictive values. RESULTS: A single lesion was more frequently examined during campaigns whereas a partial or total body were examined less frequently (p<0.001). Attenders received referral for removal of a lesion more frequently in routine activity (52% vs. 20% p<0.001), regardless of extent of the examination. The cumulative incidence of skin cancer within 24 months was 3.2% for routine and 1.6% for campaign attenders (p<0.001). Sensitivity was higher (82% vs. 59%, p<0.001), while specificity was lower (49% vs. 79%, p<0.001) for routine activity. CONCLUSIONS: Even though neither approach appears optimal, scheduled appointments with adequate time allocation per subject provided a lower threshold for detection and a higher yield of skin cancers compared to high-intensity campaigns.