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      Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy

      1 , * , 1 , 2 , 3 , 4 , 5 , 6 , 7 , 6 , 8 , 9 , 10 , 2 , 2 , 2 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 12 , 11 , 21 , 22 , 23 , 24 , 6 , 25 , 9 , 11 , 6 , 19 , 16 , 26 , 13 , 27 , 11 , 28 , 29 , 30 , 31 , 20 , 6 , 23 , 32 , 33 , 34 , 13 , 6 , 35 , 36

      Melanoma Management

      Future Medicine Ltd

      early detection, guidelines, keratinocyte carcinoma, melanoma, melanoma odds ratio, melanoma relative risk, melanoma risk factors, screening, skin cancer, USPSTF

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          Melanoma is usually apparent on the skin and readily detected by trained medical providers using a routine total body skin examination, yet this malignancy is responsible for the majority of skin cancer-related deaths. Currently, there is no national consensus on skin cancer screening in the USA, but dermatologists and primary care providers are routinely confronted with making the decision about when to recommend total body skin examinations and at what interval. The objectives of this paper are: to propose rational, risk-based, data-driven guidelines commensurate with the US Preventive Services Task Force screening guidelines for other disorders; to compare our proposed guidelines to recommendations made by other national and international organizations; and to review the US Preventive Services Task Force's 2016 Draft Recommendation Statement on skin cancer screening.

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          Most cited references 53

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          Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001.

          Obesity and diabetes are increasing in the United States. To estimate the prevalence of obesity and diabetes among US adults in 2001. Random-digit telephone survey of 195 005 adults aged 18 years or older residing in all states participating in the Behavioral Risk Factor Surveillance System in 2001. Body mass index, based on self-reported weight and height and self-reported diabetes. In 2001 the prevalence of obesity (BMI > or =30) was 20.9% vs 19.8% in 2000, an increase of 5.6%. The prevalence of diabetes increased to 7.9% vs 7.3% in 2000, an increase of 8.2%. The prevalence of BMI of 40 or higher in 2001 was 2.3%. Overweight and obesity were significantly associated with diabetes, high blood pressure, high cholesterol, asthma, arthritis, and poor health status. Compared with adults with normal weight, adults with a BMI of 40 or higher had an odds ratio (OR) of 7.37 (95% confidence interval [CI], 6.39-8.50) for diagnosed diabetes, 6.38 (95% CI, 5.67-7.17) for high blood pressure, 1.88 (95% CI,1.67-2.13) for high cholesterol levels, 2.72 (95% CI, 2.38-3.12) for asthma, 4.41 (95% CI, 3.91-4.97) for arthritis, and 4.19 (95% CI, 3.68-4.76) for fair or poor health. Increases in obesity and diabetes among US adults continue in both sexes, all ages, all races, all educational levels, and all smoking levels. Obesity is strongly associated with several major health risk factors.
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            Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure.

            A systematic revision of the literature was conducted in order to undertake a comprehensive meta-analysis of all published observational studies on melanoma. An extensive analysis of the inconsistencies and variability in the estimates was performed to provide some clues about its Epidemiology. Following a systematic literature search, relative risks (RRs) for sun exposure were extracted from 57 studies published before September 2002. Intermittent sun exposure and sunburn history were shown to play considerable roles as risk factors for melanoma, whereas a high occupational sun exposure seemed to be inversely associated to melanoma. The country of study and adjustment of the estimates adjuste for phenotype and photo-type were significantly associated with the variability of the intermittent sun exposure estimates (P = 0.024, 0.003 and 0.030, respectively). For chronic sun exposure, inclusion of controls with dermatological diseases and latitude resulted in significantly different data (P = 0.05 and 0.031, respectively). Latitude was also shown to be important (P = 0.031) for a history of sunburn; studies conducted at higher latitudes presented higher risks for a history of sunburns. Role of country, inclusion of controls with dermatological diseases and other study features seemed to suggest that "well conducted" studies supported the intermittent sun exposure hypothesis: a positive association for intermittent sun exposure and an inverse association with a high continuous pattern of sun exposure.
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              Cancer risks in BRCA2 mutation carriers.

              Carriers of germline mutations in the BRCA2 gene are known to be at high risk of breast and ovarian cancers, but the risks of other cancers in mutation carriers are uncertain. We investigated these risks in 173 breast-ovarian cancer families with BRCA2 mutations identified at 20 centers in Europe and North America. Other cancer occurrence was determined in a final cohort of 3728 individuals, among whom 681 persons had breast or ovarian cancer and 3047 persons either were known mutation carriers, were first-degree relatives of known mutation carriers, or were first-degree relatives of breast or ovarian cancer patients. Incidence rates were compared with population-specific incidence rates, and relative risks (RRs) to carriers, together with 95% confidence intervals (CIs), were estimated by use of a maximum likelihood approach. Three hundred thirty-three other cancers occurred in this cohort. Statistically significant increases in risks were observed for prostate cancer (estimated RR = 4.65; 95% CI = 3.48-6.22), pancreatic cancer (RR = 3.51; 95% CI = 1. 87-6.58), gallbladder and bile duct cancer (RR = 4.97; 95% CI = 1. 50-16.52), stomach cancer (RR = 2.59; 95%CI = 1.46-4.61), and malignant melanoma (RR = 2.58; 95% CI = 1.28-5.17). The RR for prostate cancer for men below the age of 65 years was 7.33 (95% CI = 4.66-11.52). Among women who had already developed breast cancer, the cumulative risks of a second, contralateral breast cancer and of ovarian cancer by the age of 70 years were estimated to be 52.3% (95% CI = 41.7%-61.0%) and 15.9% (95% CI = 8.8%-22.5%), respectively. In addition to the large risks of breast and ovarian cancers, BRCA2 mutations may be associated with increased risks of several other cancers.

                Author and article information

                Melanoma Manag
                Melanoma Manag
                Melanoma Management
                Future Medicine Ltd (London, UK )
                March 2017
                01 March 2017
                01 March 2017
                : 4
                : 1
                : 13-37
                [1 ]Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA
                [2 ]University of Utah, Salt Lake City, UT, USA
                [3 ]University of Washington, Seattle, WA, USA
                [4 ]University of Arizona Cancer Center, Tucson, AZ, USA
                [5 ]Moffitt Cancer Center, Tampa, FL, USA
                [6 ]Oregon Health & Science University, Portland, OR, USA
                [7 ]Stanford University Medical Center & VA Palo Alto Health Care System, Palo Alto, CA, USA
                [8 ]Intermountain Healthcare & University of Utah, Salt Lake City, UT, USA
                [9 ]University of Colorado, Aurora, CO, USA
                [10 ]Columbia University, New York, NY, USA
                [11 ]The Ohio State University, Columbus, OH, USA
                [12 ]Harvard Medical School, Boston, MA, USA
                [13 ]University of Pittsburgh, Pittsburgh, PA, USA
                [14 ]Mayo Clinic Arizona, Scottsdale, AZ, USA
                [15 ]University of California, Irvine, Orange, CA, USA
                [16 ]University of Pennsylvania, Philadelphia, PA, USA
                [17 ]The University of Texas MD Anderson Cancer Center, Houston, TX, USA
                [18 ]University of Washington, Seattle, WA, USA
                [19 ]Emory University & Atlanta VA Medical Center, Atlanta, GA, USA
                [20 ]Northwestern University Feinberg School of Medicine, Chicago, IL USA
                [21 ]Inova Medical Group, Fairfax, VA, USA
                [22 ]St Luke's University Hospital & Temple University, Bethlehem, PA, USA
                [23 ]Boston University, Boston, MA, USA
                [24 ]Case Western Reserve University, Cleveland, OH, USA
                [25 ]University of Missouri, Columbia, MO, USA
                [26 ]Vanderbilt University, Nashville, TN, USA
                [27 ]Harvard Medical School & Massachusetts General Hospital, Charlestown, MA, USA
                [28 ]Winship Cancer Institute of Emory University, Atlanta, GA, USA
                [29 ]The Christ Hospital, Cincinnati, OH, USA
                [30 ]City of Hope National Cancer Center, Duarte, CA, USA
                [31 ]Mayo Clinic Rochester, MN, USA
                [32 ]Johns Hopkins University, Baltimore, MD
                [33 ]NYU Langone Medical Center, New York, NY, USA
                [34 ]Department of Dermatology, University of Athens, Andreas Sygros Hospital, Athens, Greece
                [35 ]Bend Memorial Clinic, Bend, OR, USA
                [36 ]University of Texas MD Anderson Cancer Center, Houston, TX, USA
                Author notes
                *Author for correspondence: leachmas@

                Authors contributed equally.

                © 2016 Sancy Leachman


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