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Objective: To examine the characteristics of persons attending a skin cancer screening clinic in Western Australia and compare the effectiveness of screening in different socio-demographic subgroups. Methods: Questionnaires were completed by 5,950 self-selected participants who voluntarily attended the Western Australian Lions Cancer Institute's targeted skin cancer screening clinics during the period 1996-2003. A risk assessment technique was used to identify individuals at high risk of developing melanoma. Provisional diagnoses of suspicious lesions were given at the screening by a medical specialist. Suspicious lesions were later matched with histopathologically confirmed malignant melanomas reported to the Western Australia Cancer Registry. Results: Fifty-seven per cent of attendees were female. The mean age of attendees was 53 years. The yield of suspicious malignant melanomas detected was 24.7 per 1,000 participants screened; the yield of confirmed malignant melanomas detected was 3.0 per 1,000 participants screened. Persons over 50 years of age were three times more likely to have a histopathologically confirmed malignant melanoma detected at the screening than those younger than 50 years (p=-0.049). Conclusions: The yield of confirmed melanomas detected by the Lions Cancer Institute is among the highest reported by a skin cancer screening program. This may have been attributable to the risk assessment technique used by the program. Implications: A free community skin cancer screening program that targets high-risk individuals can detect melanomas.

Abstract Background Routine data from cancer registries often lack information on stage of cancer, limiting their use. This study aimed to determine whether or not it is feasible to add cancer staging data to the routine data collections of a population-based Western Australian Cancer Registry (WACR). Methods For each of the five most common cancer types (prostate, colorectal, melanoma, breast and lung cancers), 60 cases were selected for staging. For the 15 next most common cancer types, 20 cases were selected. Four sources for collecting staging data were used in the following order: the WACR, the hospital based cancer registries (HBCRs), hospital medical records, and letters to treating doctors. If the case was unable to be fully staged, due to lack of information on regional lymph node invasion or distant metastases, we made the following assumptions. Cases which had data available for tumour (T) and regional lymph nodes (N), but no assessment of distant metastasis (MX) were assumed to have no distant metastases (M0). Cases which had data for T and M, but no assessment of regional nodal involvement (NX) were assumed to have no regional nodal involvement (N0). Results The main focus of this project was the process of collecting staging data, and not the outcomes. For ovary, cervix and uterus cancers the existence of a HBCR increased the stageable proportion of cases so that staging data for these cancers could be incorporated into the WACR immediately. Breast and colorectal cancer could also be staged with adequate completeness if it were assumed that MX = M0. Similarly, melanoma and prostate cancer could be staged adequately if it were assumed that NX = N0 and MX = M0. Some cases of stomach, lung, pancreas, thyroid, testis and kidney cancers could be staged, but additional clinical input – on pathology request forms, for example – would be required to achieve useable levels of completeness. For the remaining cancer types either staging is widely regarded as not relevant, and no generally-accepted system exists, or an acceptable level of completeness is not achievable. Conclusion Adding stage to routinely collected information in a cancer registry is possible for many cancer types, particularly if the assumptions regarding missing data are found to be acceptable or if the guidelines for MX = M0 asumptions are clarified. These findings should be generalizable to most cancer registries in developed countries, if hospital-based cancer registries or other specialized databases are accessible.

Pre-screening by specially trained nurses for skincancer/melanoma in Australia seems to wrrant further study based on a trial. The study involved having the nurses not miss lesions that would require specialist examination. Results for 256 screenees in a double-blind study with plastic surgeons and nurses compared show observations by nurses to have a high degree of accuracy.

Reports on Australian researchers' education of the public and health care professionals about clinical trials in an effort to increase enrollment in cancer trials. Deterrents to involvement; Ethical issues.