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Melanoma Education Protects Patients' Siblings

Educating the siblings of melanoma patients about their own cancer risk encourages them to undergo regular skin self-examinations that can catch the disease early, researchers report.

"For skin self-examination, we found that an intensive education intervention has a moderately strong effect among siblings of melanoma patients -- with intervention increasing the likelihood they will carefully examine their skin by 82 percent," said study author Alan Geller, a research associate and professor in the department of dermatology at the Boston University School of Medicine.

Experts estimate that the brothers and sisters of people with melanoma face two to eight times the usual risk for the disease.

However, the Boston study found that melanoma education does not boost the use of sunscreen or visits to the dermatologist in this high-risk group.

Melanoma arises from pigmented cells called melanocytes which can rapidly spread throughout the body. Prolonged exposure to the ultraviolet rays of the sun or a tanning bed elevate the risk for developing the disease.

According to the American Cancer Society, roughly 62,000 Americans will be diagnosed with melanoma this year, and more than 7,900 will die as a result. The researchers note that almost 630,000 Americans are already living with the cancer.

Such figures underscore the fact that melanoma is a growing problem in the United States. Diagnoses are up by a factor of 15 over the last 50 years, the authors noted. And while other cancer death rates having been dropping in recent decades, melanoma mortality numbers have risen by 28 percent over the last 25 years.

To gauge to what degree screening education might improve early detection among high-risk groups, Geller and his team focused on 494 brothers and sisters of 360 patients diagnosed with melanoma in the Boston vicinity shortly before the two-year study began in 1998.

All the siblings were white and over the age of 18. Almost all had health insurance, and none had a prior melanoma diagnosis.

A little less than half the siblings participated in a one-year screening education program, where they were offered a combination of motivational and counseling support by phone, printed material specifically tailored to each patient, and information on free screening facilities.

The other half of the siblings received no intervention beyond what the researchers viewed as "standard procedure": the informing of the initial melanoma patient that his or her siblings and parents are themselves at higher risk for the disease and should seek screening.

Surveys were conducted at the start of the study and six and 12 months down the line, although not all the patients completed all the polls.

The researchers found that after six months, siblings exposed to the program had better improvements in their knowledge about melanoma. By 12 months, participants in the program had fewer practical or psychological obstacles (such as how to find and pay for a dermatologist, or disliking sunscreens) to keeping watch on their skin, seeing a doctor, or using sun protection.

Most important, the program participants were more likely to conduct a careful self-examination compared to non-participants.

By six months, 67 percent of the participants conducted thorough self-exams, including examining the back, as compared with 52 percent of non-participants.

However, the education effort did not impact on either the routine use of sunscreens or wearing sun-protective clothing.

As well, no difference between the groups was found for seeking a dermatologist-conducted screening, although the frequency of such screenings doubled among all the siblings by 12 months.

The news is still good, however, because self-exams are the most basic form of spotting melanoma.

"I'm pleased with the results," said Geller, "because I think skin self-examination is a really important technique that should be learnt. And the beauty of this whole thing is that melanoma is the only visible tumor. So every family member can play really strong role in this -- helping if the subject can't look at his or her back. So this is basically a family education program."

Marianne Berwick, head of the Cancer Epidemiology and Prevention Program at the University of New Mexico Health Sciences Center, Albuquerque, said the study has the potential to help health professionals promote early detection and lower the melanoma death rate.

"Of course, we don't yet have any direct proof that skin self-examination will prevent mortality," said Berwick, who is also associate director for population science for the Cancer Research and Treatment Center at the university center. "But it's something that we think might help. So, my view is that this finding will be a valuable building-block in helping to direct a cancer-education message that will get people to engage in efforts that could be helpful in the long-run."

A second study, also published in the August issue of Cancer, further explored the potential benefits of melanoma education interventions.

A team of Australian researchers found that men over the age of 50 are more likely to get screened for the disease if they are fully informed about major risk factors and are encouraged by their doctor.

The authors, led by Joanne Aitken of the Viertel Centre for Research in Cancer Control at the Queensland Cancer Fund in Brisbane, focused on the screening habits of 3,355 men over the age of 50 who were exposed to a melanoma education effort targeted at people over the age of 30.

Although the intervention boosted screening generally, clinic data revealed that the strongest rise occurred among men over 50.

Aitken and her colleagues noted that among males 50 and over, self-exams doubled by the end of the program, while physician-led screenings increased four-fold.

Phone surveys revealed that the screening increases among the men were linked to a better recognition of their own risk factors, a more positive outlook on screening, and concern over an existing mole or having undergone a prior removal of a mole.

Increased awareness is important among this group, the researchers said, because men over 50 currently account for almost half of all melanoma deaths in developed countries.

By Alan Mozes, HealthDay News, July 12, 2006

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