Robert H. Carlson, MBA


August 10, 2016

In This Article

The most important meeting on cancer, the American Society of Clinical Oncology (ASCO) Annual Meeting, also includes studies that may affect primary care physicians (PCPs) in how they talk to and treat patients who have cancer, those at high risk, and cancer survivors. These abstracts below, from the 2016 meeting in Chicago, deal with screening and risk reduction, reducing the risk for recurrence, managing side effects, and end-of-life concerns.

To provide takeaways on how these abstracts might influence the PCP's practice, Medscape asked two experts to discuss the research: Don S. Dizon, MD, an associate professor at Harvard Medical School and clinical co-director of gynecologic oncology at Massachusetts General Hospital Cancer Center, who provided an oncologist's perspective; and Cary P. Gross, MD, professor of medicine in the Institute for Social and Policy Studies at Yale School of Medicine, where he focuses on cancer prevention and treatment, who offered a PCP's point of view.


Online Training for PCPs Increases Rate of Skin Cancer Screening, Detection

Abstract 1508 reported on a program that offered online training in skin cancer screening to PCPs, who were also asked to provide an annual skin examination to patients aged 35 years or older who presented for routine care.

Patients seen by a PCP who completed the online training were more likely to be screened (24.7% of eligible patients vs 12.6% with a provider who did not complete training). And for the 15.5% of screen-eligible patients who were screened for skin cancer, the combination of physician education and population-based screening for melanoma increased detection of thinner melanomas, a predictor of lower mortality. It also resulted in higher rates of screening of men, who are at highest risk for death from melanoma but have much lower screening rates than women.

Dr Dizon: Melanoma is the most fatal skin cancer, and the rate of melanoma continues to rise. Fortunately, skin cancer screening can affect earlier detection of the disease, when it is most curable. To improve access to screening, Laura Ferris, MD, PhD, and the team at the University of Pittsburgh Cancer Institute evaluated the impact of an online screening program for PCPs, designed to make it easier for patients to undergo annual screening during routine office visits.

Their preliminary results showed that PCPs who completed the online program were almost twice as likely to screen patients, and using tumor registry data, they found that screening was associated with more frequent detection of melanoma, thinner lesions, and earlier disease (in situ).

These data support the critical role of PCPs in skin cancer screening and the importance of online training to ensure that it is done accurately. The preliminary data also highlight the unmet need for screening, which hopefully will be addressed through wider access to such programs. Note that even in this program, only 16% of all eligible patients for skin cancer screening were indeed screened.

Dr Gross: This study shows that physicians can be educated to screen more patients, and that the increase in screening led to more patients being diagnosed with melanoma at an earlier stage. There are two additional important take-home points here. First, even in the intervention group, only 1 in 4 patients was screened for skin cancer. Second, and probably related, there is still a lack of consensus regarding the health benefits of routine screening for skin cancer.

In the absence of a randomized study, it is reasonable to recommend screening for patients at increased risk for skin cancer through either demographics (ie, screening white men older than 50 years for melanoma) or family/exposure history. But as is the case with many screening tests, we need more information about whom to screen for skin cancer and how to do it.


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