UBC Reports | Vol. 49 | No. 8 | Aug.
7, 2003
Delay by doctors makes it worse
By Hilary Thomson
B.C. patients who suspect they have skin cancer don’t
seek medical attention for an average of almost five months
— even when the lesion is invasive — according to a study
done by a UBC graduate student.
Ingrid Tyler, a Master’s of Health Science student,
gave 175 patients in the Lower Mainland a 24-item questionnaire
about their experience in seeking attention for skin lesions
showing the cancerous changes known as malignant melanoma.
The study is the first in Canada to help assess how malignant
melanoma is detected in B.C. and provides a better understanding
of how patient education and other factors affect delays in
diagnosis.
Between October 2002 and April 2003, Tyler, along with co-investigators
Asst. Prof. Jean Shoveller of the Dept. of Health Care and
Epidemiology and Jason Rivers, a professor of dermatology,
examined the delay times between when the patient first noticed
the lesion to when it was removed.
“We suspected that more significant and suspicious lesions
might prompt people to get to their doctor quickly, but that
wasn’t the case,” says Tyler, who is now pursuing
a residency in community medicine.
She found that patients delayed a visit to their doctor no
matter what the size or thickness of the skin lesion. Almost
one-quarter of patients were unaware that skin cancer could
develop from a mole. Patients surveyed had good understanding
of melanoma in general, however, and understood its relationship
to sun exposure. Almost 90 per cent of patients knew the value
of early detection.
Melanomas usually start in pigment-producing cells and may
start in an existing mole. They are the most aggressive and
dangerous of all skin cancers, making early detection critical.
Affecting about one in 100 Canadians, most melanomas are secondary
to sun exposure.
Approximately 800 Canadians died of malignant melanoma in
1999, according to the B.C. Cancer Agency’s Web site.
The cure rate for all treated melanomas is about 80 per cent.
“There was no significant correlation between knowledge
and delays — including knowledge about risks and early detection,”
says Tyler, adding that the findings were an all-too-common
scenario in the field of public health education. “It’s
not enough that people know about risks, we need to find a
way to help them change behaviour.”
Common reasons for delay included thinking the lesion was
not serious or that it would go away on its own.
A disturbing result, she says, was 25 per cent of the respondents
went to their doctor only when the symptoms were advanced
and the lesion was bleeding and crusting.
The study also found physician delays were almost four months
on average, making the total delay in getting treatment for
malignant melanoma nine and a half months among those surveyed.
Doctor delays were most often due to administrative backlog,
misdiagnosis by a general practitioner or multiple visits
to physicians.
Tyler characterizes the delay in treatment of malignant melanoma
as relatively short compared to other similar studies in Europe
and the U.S. that have shown delays up to 14 months.
For more information about skin cancer risks, visit www.bccancer.bc.ca
and click on information for patients.
