Increased distance to physician associated with thicker skin cancer at...( The farther patients travel to reach...),Health

The farther patients travel to reach the physician who diagnoses their melanoma, the more likely they are to have thicker skin cancer at diagnosis, according to a report in the August issue of Archives of Dermatology, one of the JAMA/Archives journals.

Survival for patients with melanoma is dependent on stage at diagnosis. As Breslow [depth of tumor cells in the skin] thickness increases, overall survival decreases, according to background information in the article. Consequently, early diagnosis may substantially improve patient outcomes. Because melanoma can only be definitively diagnosed based on biopsy findings, diagnosis requires detection of the suspicious lesion and biopsy. Some primary care providers perform diagnostic biopsies, but many prefer to refer patients to dermatologists or surgeons.

Karyn B. Stitzenberg M.D., M.P.H., of the School of Public Health, University of North Carolina at Chapel Hill, and colleagues examined the effect of travel distanceand other factors such as age, sex, poverty rate, living in rural areas and the number of physicians in the areaon access to diagnosing clinicians for 615 patients with melanoma. Patients Breslow thickness was also measured.

The median (midpoint) distance to a diagnosing physician was 8 miles. The median Breslow thickness was 0.6 millimeters. For each one-mile increase in distance, average Breslow thickness at diagnosis increased by 0.6 percent. Patients who traveled more than 15 miles had tumors 20 percent thicker than those of patients who traveled 15 miles or less. Patients from rural counties traveled an average 2.4 miles farther to their diagnosing clinician than those from metropolitan counties. Those from counties with at least one dermatologist traveled an average 8.3 miles less than those without a dermatologist in their counties.

Breslow thickness was also associated with age and poverty. For each 1 percent increase in poverty rate, Breslow thickness in
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