Jr. Eiser et al., Is targeted early detection for melanoma feasible? Self assessments of risk and attitudes to screening, J MED SCREE, 7(4), 2000, pp. 199-202
Objectives-To study the feasibility of developing targeted screening for th
ose at high risk of melanoma by examining how attitudes relate to (a) accep
tance of an invitation for a free skin check and (b) self assessed and clin
ically assessed risk factors for developing cutaneous melanoma.
Design-A population based cross sectional survey.
Setting-A general practice with a broad mix of socioeconomic groups in one
district health authority.
Subjects-A total of 1600 subjects aged 25-69 years stratified using the soc
ial deprivation score of wards were randomly selected from a population of
8000; 77% (1227) returned the questionnaire and 56% (896) attended for scre
ening.
Main outcome measures-questionnaire measures of confidence in own ability t
o self assess risk factors for melanoma, attitudes to seeking medical help
for skin abnormalities, and self assessment of relative risk of developing
melanoma.
Results-Clinic attenders were less confident in their ability to self asses
s risk factors (p<0.005), more favourable towards seeking help (p<0.001), a
nd more pessimistic about developing melanoma (p<0.001) than non-attenders.
Those from more affluent wards were more willing to seek help (p<0.001). T
hose clinically assessed as at higher risk were more pessimistic about deve
loping melanoma (p<0.001) but clinical assessments were inconsistently rela
ted to help seeking attitudes and self assessment confidence.
Conclusions-Barriers to the uptake of screening included greater optimism a
bout not developing melanoma, confidence in self assessment, and reluctance
to seek professional help. Such reluctance was greater in more deprived so
cial groups. Targeting screening at high risk groups cannot depend on self
identification and self referral.