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J Am Acad Dermatol. 2000 Aug;43(2 Pt 1):234-7.

Skin examinations and skin cancer prevention counseling by US physicians: a long way to go.

Author information

  • 1Westwood-Squibb Center for Dermatology Research and the Departments of Dermatology and Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

Abstract

BACKGROUND:

Nonmelanoma skin cancer and actinic keratoses may be partially preventable by physician counseling.

OBJECTIVE:

The purpose of this study was to assess the frequency of counseling for skin cancer prevention.

METHODS:

Data on skin cancer counseling and skin examinations were obtained from representative visits to outpatient physicians in the United States from the 1997 National Ambulatory Medical Care Survey. A limitation of the skin examination data is that the extent of the skin examination was not reported.

RESULTS:

Skin examinations occurred in 60 million (8.6%) of 703 million office visits, and skin cancer prevention counseling or education occurred in 12 million visits (1.5%). For patients younger than 20 years, such prevention counseling occurred in only 1.0% of 169 million visits. For those patients with a current or previous history of nonmelanoma or melanoma skin cancer or actinic keratosis (high-risk patients) identified by the treating physician, 2.8 million (35%) of 7.9 million patients received such counseling. In high-risk patients, dermatologists provided such counseling at 41% of visits, compared with 24% for general and family practice, 9.3% for otolaryngology, 13% for general surgery, and 7.7% for internal medicine. In such high-risk patients, skin examinations were performed at 78% of dermatology visits, 69% of otolarynogolgy visits, 36% of general surgery visits, and 27% of family physician visits. Capitation did not lead to greater primary preventive practices; skin cancer prevention counseling occurred in 4% of high-risk capitated patients compared with 38% of noncapitated patients.

CONCLUSION:

Physicians provide skin cancer prevention counseling or education at fewer than half of visits for high-risk patients. High-risk patients are likely to receive skin cancer prevention messages depending on the specialty of physician that they visit in roughly the following scheme: dermatologists>family physicians>all other specialties. Economic restraints within managed care systems may affect their "health maintenance" function.

PMID:
10906644
[PubMed - indexed for MEDLINE]
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