Examining the pathways linking lower socioeconomic status and advanced melanoma

Authors

  • Ricardo A. Pollitt MD, PhD,

    1. Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California
    Current affiliation:
    1. Ricardo Pollitt's current address: Department of Dermatology, University of California, San Francisco, San Francisco, California
    Search for more papers by this author
  • Susan M. Swetter MD,

    1. Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California
    2. Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
    Search for more papers by this author
  • Timothy M. Johnson MD,

    1. Departments of Dermatology, Otolaryngology, and Surgery, University of Michigan Medical School, Ann Arbor, Michigan
    Search for more papers by this author
  • Pratima Patil MA,

    1. Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts
    Search for more papers by this author
  • Alan C. Geller RN, MPH

    Corresponding author
    1. Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts
    • Harvard School of Public Health, Kresge Building Room 701A, 677 Huntington Avenue, Boston MA 02215
    Search for more papers by this author
    • Fax: (617)


  • The sponsor had no role in the design or conduct of the study; in the collection, analysis, or interpretation of data; or in the preparation of the text, review, or approval of the article.

Abstract

BACKGROUND.

Low socioeconomic status (SES) is associated with more advanced melanoma at diagnosis and decreased survival. Exploring the pathways linking lower SES and thicker melanoma will help guide public and professional strategies to reduce deaths.

METHODS.

The authors surveyed 566 newly diagnosed patients at Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System, and University of Michigan. SES was assessed by education level (high school/general education degree or less [HS], associate/technical school degree, or ≥college graduate). All data was obtained by self-report among patients within three months of their diagnosis.

RESULTS.

HS-educated individuals were significantly more likely than college graduates to believe that melanoma was not very serious (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.79-4.71) and were less likely to know the asymmetry, borders (irregular), color (variegated), and diameter (>6 mm) (ABCD) melanoma rule or the difference between melanoma and ordinary skin growths (OR, 0.34 [95% CI, 0.23-0.52] and 0.26 [95% CI, 0.16-0.41] respectively). Physicians were less likely to have ever told HS-educated versus college-educated individuals they were at risk for skin cancer (OR, 0.46; 95% CI, 0.31-0.71) or instructed them on how to examine their skin for signs of melanoma (OR, 0.40; 95% CI, 0.25-0.63). HS-educated individuals were less likely to have received a physician skin examination within the year before diagnosis (OR, 0.54; 95% CI, 0.37-0.80).

CONCLUSIONS.

Decreased melanoma risk perception and knowledge among low-SES individuals and decreased physician communication regarding skin examinations of these individuals may be key components of the consistently observed socioeconomic gradient in mortality. The current findings suggest the need to raise melanoma awareness among lower-SES patients and to increase physician awareness of socioeconomic disparities in clinical communication and care. Cancer 2012. © 2011 American Cancer Society.

Ancillary