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Demographic Predictors of Melanoma Stage at Diagnosis
Daniel J. Van Durme, MD;
Jeanne M. Ferrante, MD;
Naazneen Pal, MPH;
Deanna Wathington, MD, MPH;
Richard G. Roetzheim, MD, MSPH;
Eduardo C. Gonzalez, MD
Arch Fam Med. 2000;9:606-611.
Objective To examine sociodemographic characteristics as possible predictors of late-stage melanoma diagnosis. We hypothesized that late-stage diagnosis would be associated with the following: older age, male sex, unmarried status, lower educational attainment and income level, rural residence, and cigarette smoking.
Methods We used data from the state tumor registry to study all incident cases of melanoma occurring in Florida during 1994 whose stage at diagnosis was available (N=1884). We used multiple logistic regression to determine the effects of sociodemographic characteristics on the odds of late-stage (regional or distant metastases) diagnosis.
Results There were 243 patients (12.9%) diagnosed as having melanoma that had metastasized to either regional lymph nodes or distant sites. Patients who were unmarried (odds ratio, 1.5; P=.01), male (odds ratio, 2.2; P<.001), or smokers (odds ratio, 2.2; P<.001) or who resided in communities with lower median educational attainment (odds ratio, 1.5; P=.048) had greater odds of having a late-stage diagnosis.
Conclusions To detect these cancers at an earlier stage and improve outcomes, there should be increased educational efforts directed toward physicians who treat these patients. A recognition that there may be additional risk factors for late-stage diagnosis, beyond the established risk factors, such as family history and excess sun exposure, should be included in the initial assessment. Specific public education efforts should also be targeted to these patients to increase their self-surveillance and surveillance of their partners.
From the Department of Family Medicine (Drs Van Durme, Ferrante, Wathington, Roetzheim, and Gonzalez and Ms Pal) and the Division of Cancer Control, H. Lee Moffitt Cancer Center & Research Institute (Drs Ferrante and Roetzheim), University of South Florida, Tampa.
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