Study Finds Overdiagnosis of Dangerous Form of Skin Cancer
A recent study of melanoma indicates potential overdiagnosis, leading to possible overtreatment and the accompanying burdens of emotional and financial stress.
This finding emerges as cancer cases are expected to reach record highs, challenging current melanoma screening methods and underscoring the need to finely tune the balance between early detection and the risk of over-treatment.
Rising Skin Cancer Rates
Sarah Ferguson, the Duchess of York, recently joined the ranks of those diagnosed with malignant melanoma, a form of skin cancer known for its aggressive nature. Her case adds to a growing tally that has become a pressing concern for health professionals and the public alike.
Melanoma, originating from the pigment-producing melanocytes, is distinct among skin cancers. While rarer than basal cell carcinoma and squamous cell carcinoma, melanoma is known for its potential to metastasize to other organs if not promptly addressed. So, while it’s less common, it’s typically more deadly if not treated early on.
Related Stories
Dr. Adamson, in correspondence with The Epoch Times, confirmed that “cases of cutaneous melanoma have risen significantly in the U.S. over the last 40 years, without a corresponding increase in mortality rates.” This disparity forms the study’s foundation, indicating that although diagnoses have skyrocketed, the anticipated climb in death commonly linked with higher diagnosis rates hasn’t been observed to a similar degree.
Study Findings
The researchers looked closely at melanoma cases from 1975 to 2018. In 2018, they identified that close to 50 percent of melanoma diagnoses in white American men and about 64.6 percent in white American women could be considered overdiagnoses, meaning those cases might not have posed a real threat to the patient’s health.
“These overdiagnosis estimates represent approximately 44,000 melanomas in white men and 39,000 in white women,” the study reads.
The study also sheds light on the type of melanoma most prone to overdiagnosis—melanoma in situ—the earliest stage of the disease, also known as stage zero. The research suggests that about 89 percent of such diagnoses in white men and 85 percent in white women might have been overcautious. In simpler terms, a significant number of patients might have been treated for a skin cancer that, in reality, posed little to no risk to their health.
Researchers also highlighted a significant increase in the lifetime risk of being diagnosed with melanoma since 1975, a number that has since nearly doubled.
Danger of Overdiagnosis
The issue of overdiagnosis transcends statistics, profoundly affecting patients’ lives. Dr. Adamson articulated to The Epoch Times the repercussions that may arise when a diagnosis does more harm than good. He noted, “Patients that are overdiagnosed can only be harmed because there is nothing to fix,” he remarked.
These detriments manifest in various forms, including physical, psychological, and economic strains. Patients may face the physical challenges of overtreatment, the emotional distress accompanying a cancer diagnosis, the financial pressures of treatment costs, repeated medical appointments, and the potential for insurance complications.
Dr. Adamson emphasizes the need for a focused strategy in melanoma screening, pointing out the risks of a broad-brush approach. He warns, “Recommending screening for the general public will only exacerbate the problem of overdiagnosis. There’s very little evidence that screening the general population for melanoma saves lives.”
According to Dr. Adamson, the complexity of melanoma treatment lies in the unknown. “Because we don’t know which melanomas are destined to progress and which aren’t, we treat them all,” he explains, capturing the dilemma faced by many in the medical field.
Dr. Adamson urges a restrained and evidence-based approach to screening practices. This view is particularly critical given the delicate balance between the potential benefits and the clear harms of overdiagnosis. “These should be discussed with patients, especially those that receive a diagnosis of melanoma in situ,” Dr. Adamson advises, highlighting the need for transparent communication between health care providers and patients.
Dr. Adamson’s findings have ignited a debate on the issue of melanoma overdiagnosis. Dr. Aaron S. Farberg, a dermatologist and chief medical officer of Bare Dermatology, acknowledges the problem but questions the study’s practical implications.
“Dr. Adamson has identified a problem for which we can do nothing about. He has taken a sensible approach to show that our clinical actions should be risk-aligned,” Dr. Farberg said in an email to The Epoch Times. He then poses a critical question, reflecting the concern within the dermatological community: “What do we do about his study? Do we stop skin cancer screening?”
Dr. Farberg emphasizes the core mission of dermatologists: to detect skin cancer at its earliest, most treatable stages. He contrasts this with what he perceives as Dr. Adamson’s approach, saying, “Our mission as dermatologists is to identify skin cancer as early as possible as it is most treatable when identified early. His mission seems to be quite the opposite.”
The Skin Cancer Foundation chose not to provide remarks on the study when reached via email. Additionally, efforts to solicit comments from the Melanoma Research Foundation have, thus far, not received a response.
Despite the debate on the study’s utility, the importance of seeking expert advice concerning symptoms is clear. Dr. Adamson advises, “If you have a growing, changing, concerning mole, please see a board-certified dermatologist for evaluation.”
