A Comparison of Florida Skin Cancer Screening Rates With Those in the Rest of the United States

Florida has the second largest number of melanoma cases in the country, an estimated 4430 cases in 2008.¹ Fortunately, the 5-year survival rate for individuals whose melanoma is treated before it spreads to the lymph nodes is 98%.¹ Knowing the high UV index in Florida and lack of population-based data on skin cancer screening among the different US states, we designed our study to compare skin cancer screening rates among Floridians with those of residents in the rest of the United States.

The National Health Interview Survey (NHIS) is an annual, cross-sectional household survey of the US civilian noninstitutionalized population. We analyzed data from the 2000 and 2005 NHIS Cancer Control Modules (CCMs), which are the only sources of national population-based data on cancer screening.² In all CCMs, participants were asked, “Have you EVER had all of your skin from head to toe checked for cancer by a dermatologist or some other kind of doctor? ” (yes/no).² Then they were asked “When did you have your MOST RECENT skin exam to check for cancer? ”² Data were grouped according to whether participants reported a skin examination during the last 12 months.

Data were pooled, and analyses took into account sample weights and design effects. Logistic regression analyses were performed with self-reported skin screening as the outcome of interest. Florida data were compared with data from the rest of the US states. All analyses were conducted at the Research Data Center to ensure confidentiality. The study received an exempt approval from the University of Miami institutional review board.

When compared with residents of the rest of the US states, Floridians reported significantly higher skin cancer screening rates, specifically Floridians older than 60 years (Table 1). White Floridians had significantly higher rates than white participants in the rest of the US states. Also, non-Hispanic Floridians had significantly higher screening rates than non-Hispanics in the rest of the US states. Among Floridians, there was a notable increase in screening rates with an increase in education. Regardless of health insurance status, Floridians had higher screening rates, although rates were not significantly different between the uninsured groups. Both unemployed and employed Floridians had significantly higher rates of screening than those groups in the rest of the US states.

After adjusting for the sociodemographic and health-related indicators listed in Table 2, we found that Floridians retained significantly higher odds of skin cancer screening in the past year than residents in the rest of the US states (odds ratio, 1.52; 95% CI, 1.52-1.54).

Compared with residents of the rest of the nation, Floridians reported higher rates of skin cancer screening, which were also evident across a range of sociodemographic groups. Results suggest that regional variations in screening rates exist in the United States. However, it is unclear if early detection reduces mortality or morbidity from skin cancer.³ It is important to note that Medicare does not cover skin cancer screening⁴; however, some insurers within Florida promote skin cancer detection by providing free yearly screening.⁵ Also, Florida insurers allow direct patient access to dermatologists without a prior referral (statute 627.6472).⁶ Florida also has several cancer initiatives that may be positively influencing screening activities, such as the Governor's Task Force on Skin Cancer Prevention and the Moffitt Cancer Center's program, “Mole Patrol. ”¹ This center has launched educational opportunities for Florida health care providers, which could have led to a greater awareness for routine screening. In addition, many Florida dermatologists have completed their residency in Florida, and are thus more aware of the dangers of residing at Florida's latitude.⁷ Finally, living in the “Sunshine State ” may raise awareness of the need for skin cancer screening, especially for those with a family history of cancer.¹

Limitations of this study include the self-report and cross-sectional nature of the NHIS. A similarly worded self-reported whole-body skin examination question has been validated previously at a sensitivity of 90.5%,⁸ but this study was conducted outside of the United States. Also, it is unclear who is conducting the screening, and previous literature has shown that screening accuracy varies by practitioner type.³ Nevertheless, the combination of stakeholder efforts for skin cancer screening is essential, especially given the high prevalence of melanoma in Florida.¹

Correspondence: Ms Fernandez, Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, 1120 NW 14th St, Ste 1074 (R669), Miami, FL 33136 (CFernandez5@med.miami.edu).

Accepted for Publication: November 29, 2011.

Author Contributions: Ms Fernandez and Drs Leblanc, Arheart, and Lee had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Fernandez, McClure, and Lee. Acquisition of data: Fernandez, LeBlanc, and Arheart. Analysis and interpretation of data: McClure, LeBlanc, Clarke, Kirsner, and Arheart. Drafting of the manuscript: Fernandez, and McClure. Critical revision of the manuscript for important intellectual content: Fernandez, McClure, LeBlanc, Clarke, Kirsner, Arheart, and Lee. Statistical analysis: LeBlanc and Arheart. Obtained funding: Lee. Administrative, technical, and material support: Fernandez, McClure, Clarke, Arheart, and Lee. Study supervision: Fernandez and Lee.

Funding/Support: The study was fully funded by Bankhead Coley Cancer Research Program grant 1BG06-341963 (Dr Lee).

Role of the Sponsors: The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; or in the preparation, review, or approval of the manuscript.

Additional Contributions: The US Department of Health and Human Services and the National Center for Health Statistics collected and compiled the data in the National Health Interview Survey (NHIS). The collector of the original data bears no responsibility for the analyses or interpretations presented in this publication. The Research Data Center conducted our analyses.