Abstract
Background Melanoma incidence is rising rapidly worldwide among white populations. Defining higher-risk populations using risk prediction models may help targeted screening and early detection approaches.
Objectives To assess the feasibility of identifying people at higher risk of melanoma using the Williams self-assessed clinical risk estimation model in U.K. primary care.
Methods We recruited participants from the waiting rooms of 22 general practices covering a total population of > 240 000 in three U.K. regions: Eastern England, North East Scotland and North Wales. Participants completed an electronic questionnaire using tablet computers. The main outcome was the mean melanoma risk score using the Williams melanoma risk model.
Results Of 9004 people approached, 7742 (86%) completed the electronic questionnaire. The mean melanoma risk score for the 7566 eligible participants was 17·15 ± 8·51, with small regional differences [lower in England compared with Scotland (P = 0·001) and Wales (P < 0·001), mainly due to greater freckling and childhood sunburn among Scottish and Welsh participants]. After weighting to the age and sex distribution, different potential cut-offs would allow between 4% and 20% of the population to be identified as higher risk, and those groups would contain 30% and 60%, respectively of those likely to develop melanoma.
Conclusions Collecting data on the melanoma risk profile of the general population in U.K. primary care is both feasible and acceptable for patients in a general practice setting, and provides opportunities for new methods of real-time risk assessment and risk stratified cancer interventions.
Objectives To assess the feasibility of identifying people at higher risk of melanoma using the Williams self-assessed clinical risk estimation model in U.K. primary care.
Methods We recruited participants from the waiting rooms of 22 general practices covering a total population of > 240 000 in three U.K. regions: Eastern England, North East Scotland and North Wales. Participants completed an electronic questionnaire using tablet computers. The main outcome was the mean melanoma risk score using the Williams melanoma risk model.
Results Of 9004 people approached, 7742 (86%) completed the electronic questionnaire. The mean melanoma risk score for the 7566 eligible participants was 17·15 ± 8·51, with small regional differences [lower in England compared with Scotland (P = 0·001) and Wales (P < 0·001), mainly due to greater freckling and childhood sunburn among Scottish and Welsh participants]. After weighting to the age and sex distribution, different potential cut-offs would allow between 4% and 20% of the population to be identified as higher risk, and those groups would contain 30% and 60%, respectively of those likely to develop melanoma.
Conclusions Collecting data on the melanoma risk profile of the general population in U.K. primary care is both feasible and acceptable for patients in a general practice setting, and provides opportunities for new methods of real-time risk assessment and risk stratified cancer interventions.
| Original language | English |
|---|---|
| Pages (from-to) | 939-948 |
| Number of pages | 10 |
| Journal | British Journal of Dermatology |
| Volume | 176 |
| Issue number | 4 |
| Early online date | 23 Dec 2016 |
| DOIs | |
| Publication status | Published - Apr 2017 |
Bibliographical note
Funding sourcesThis study was supported in part by F.M.W.'s Clinician Scientist award (RG 68235) from the National Institute for Health Research (NIHR). The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health. J.A.U.-S. is funded by the NIHR as a Clinical Lecturer. J.D.E. is funded by an NHMRC Practitioner Fellowship. R.D.N. receives funding from Public Health Wales and Betsi Cadwaladr University Health Board.
Acknowledgments
We are indebted to all the patients and companions who took part in our study. We would also like to thank the MelaTools programme Steering Committee members for their scientific support and comments throughout the study: Per Hall, Nigel Burrows, Pippa Corrie, Katharine Acland and Simon Rodwell. We thank all the general practice staff who helped us with recruitment, and also all researchers who were involved in patient recruitment: Eleanor Harrison, Fenglin Guo, Wendy Herring, Dianne Hammond, Cristina Page, Lynne Baker, Aktar Deelawar, Helen McIver, Carole Bartlett, Carol Keel and Sarah Smith. We would also like to thank CRN Eastern for their support and guidance throughout research and development and governance applications, and for providing us with practice data, especially Vivienne Shaw, Andy Wagner and Alexander Phillips. Thank you to James Brimicombe and Rupert Payne for helping with the Index of Multiple Deprivation aggregated scores and Richard Stephens for his contribution to data collection in Scotland and Wales. We give special thanks to Alexis Joannides and ORION for technical support with developing the cloud-based database and building the electronic questionnaires.
Access to Document
- Accepted Manuscript
This is the peer reviewed version of the following article: Usher-Smith, J.A., Kassianos, A.P., Emery, J.D., Abel, G.A., Teoh, Z., Hall, S., Neal, R.D., Murchie, P. and Walter, F.M. (2017), Identifying people at higher risk of melanoma across the U.K.: a primary-care-based electronic survey. Br J Dermatol, 176: 939–948, which has been published in final form at DOI: 10.1111/bjd.15181. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
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Peter Murchie, BSc (Med Sci), MBChB, MSc, MRCGP, CertMgmt (Open), PhD
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Personal Chair (Clinical)
- Institute of Applied Health Sciences
Person: Clinical Academic