Study shows equity impact on melanoma

Australia has the unenviable reputation of the highest melanoma rates in the world.
 
Further, Queensland has the highest rates of any other state or territory in the country, with rates 40% higher than the national average – essentially making it the world’s skin cancer capital.
 
Add a person’s lower socioeconomic status to the mix and the outlook becomes even bleaker, according to a new study from researchers at the melanoma epicentre.
 
Researchers from the University of Queensland found that people living in areas of lower socioeconomic advantage are more often diagnosed with advanced stage melanoma than those in more affluent areas.
 
Chair of RACGP Specific Interests Cancer and Palliative Care, Associate Professor Joel Rhee, described the study’s finding as ‘not a good situation’.
 
‘It highlights issues with equity when it comes to early diagnosis and management of melanoma,’ he told newsGP.
 
‘There is a need for increased awareness and targeted interventions to ensure that people from lower socioeconomic backgrounds receive the same level of care as others.’
 
Study lead, PhD candidate Danielle Gavanescu, from the University of Queensland’s Frazer Institute, said there was a critical need to identify and prioritise patients at increased risk.
 
She said GPs ‘play a crucial role in melanoma detection’, as a patient’s usual first point of contact.
 
‘Especially for patients in rural or disadvantaged areas, their GP might be their only pathway to an early diagnosis,’ Ms Gavanescu said.
 
She said government incentives ‘could help’ GPs to decrease the disparity between population groups, such as rebates for skin checks, or incentives for them to upskill.
 
‘In Australia, most melanoma is diagnosed by GPs,’ she said.
 
The University of Queensland study involved 700 Queenslanders with stages T1b to Tb4 melanoma, recruited from 2010 to 2014.
 
The 358 living in lower socioeconomic status were found to have a higher likelihood of being diagnosed with ≥T3b-stage disease, compared with the 342 patients in more affluent areas.
 
The study backs up previous research from the University of Sydney, which found the Australian most likely to see a GP with skin cancer issues is male, living in Queensland in regional or remote areas, with lower area-based socioeconomic status.
 
Associate Professor Rhee agrees the Queensland study ‘is consistent with what we know from previous studies’, which is that malignant melanoma disproportionately affects people from lower socioeconomic backgrounds.
 
‘This study shows that people living in lower socioeconomic areas are more likely to be diagnosed with a more advanced form of melanoma,’ he said.
 
Ms Gavanescu said GPs upskilling in cancer detection would be ‘a really powerful tool’ to improve equity, ‘particularly for patients in areas where seeing a specialist is not really an option’.
 
She said GPs are also well placed to conduct opportunistic screening and to educate patients on their melanoma risks, as many patients are often unaware they are at risk.
 
‘Something that we often see in the literature is that delayed diagnosis in certain population groups happens when people don't perceive themselves as being at high risk,’ she said.
 
‘It’s important that we make sure that patients who are high risk are aware that they’re high risk, and know how often they should be getting their skin checked.’
 
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cancer screening melanoma regional and remote skin cancer socioeconomic divide University of Queensland