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Overcoming Obstacles to Skin Cancer Examinations and Prevention Counseling for High-Risk Patients: Results of a National Survey of Primary Care Physicians

Department of Dermatology, Boston University School of Medicine (ACG, DLO), Boston, MA
Department of Epidemiology, Boston University School of Public Health (ACG), Boston, MA
Department of Dermatology, Memorial-Sloan Kettering Cancer Center, New York, NY (SAO, ACH)
The Skin Cancer Foundation, New York, NY (SV, MT, ACH)

Correspondence: Address correspondence to Alan C. Geller, MPH, RN, Boston University School of Medicine, 720 Harrison Avenue, DOB801A, Boston, MA 02118 (e-mail: ageller{at}bu.edu)

Objective: Primary care physicians are in a unique position to perform skin cancer examinations and provide prevention counseling, given that approximately 40% of office visits to physicians in the United States are to a family practitioner or internist. Compared with family or self-detection, physician detection is associated with an increased probability of detecting thinner melanomas. However, little research has attempted to identify the major obstacles to performing a skin cancer examination and recommending prevention practices.

Methods: In the spring of 2002, we surveyed primary care physicians from all 50 states, including family medicine physicians, internists, and general practitioners sampled from the American Medical Association’s Medical Marketing Services’ database. There were 4 primary outcome variables related to early detection and prevention practices for average-risk patients and patients with risk factors: performing a full-body skin examination; recommending regular skin self-examination; and recommending sun protection practices and avoidance of tanning booths for patients younger than age 35.

Results: We received surveys from 380 (60%) of 632 eligible physicians. Nearly 60% of physicians routinely performed full-body examinations with their high-risk patients. In the regression analysis of factors influencing physician examination of high-risk patients, lack of time was the strongest barrier [odds ratio (OR) 0.3 (95% confidence interval (CI) 0.2 to 0.6)]. Physicians using the most information sources [OR 2.5 (95% CI 1.3 to 4.8)] were the most likely to examine their high-risk patients. Physicians whose patients requested a skin examination were more likely to examine their patients compared with physicians whose patients did not request such an examination (P < .01).

Conclusions: Concerted public and professional education efforts must be made to provide resources that help physicians efficiently weave skin cancer examinations and prevention counseling into routine practice while also motivating high-risk patients to request full-body examinations and counseling.

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