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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Research Articles

Strategizing Screening for Melanoma in an Era of Novel Treatments: A Model-Based Approach

Kemal Caglar Gogebakan, Elizabeth G. Berry, Alan C. Geller, Kemal Sonmez, Sancy A. Leachman and Ruth Etzioni
Kemal Caglar Gogebakan
1Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.
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Elizabeth G. Berry
2Department of Dermatology, Oregon Health & Science University, Portland, Oregon.
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  • ORCID record for Elizabeth G. Berry
Alan C. Geller
3Division of Public Health Practice, Harvard School of Public Health, Boston, Massachusetts.
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Kemal Sonmez
1Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.
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Sancy A. Leachman
2Department of Dermatology, Oregon Health & Science University, Portland, Oregon.
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Ruth Etzioni
4Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
5Department of Statistics, University of Washington, Seattle, Washington.
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  • For correspondence: retzioni@fredhutch.org
DOI: 10.1158/1055-9965.EPI-20-0881 Published December 2020
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Abstract

Background: Benefit–harm tradeoffs of melanoma screening depend on disease risk and treatment efficacy. We developed a model to project outcomes of screening for melanoma in populations with different risks under historic and novel systemic treatments.

Methods: Computer simulation model of a screening program with specified impact on overall and advanced-stage incidence. Inputs included meta-analyses of treatment trials, cancer registry data, and a melanoma risk prediction study

Results: Assuming 50% reduction in advanced stage under screening, the model projected 59 and 38 lives saved per 100,000 men under historic and novel treatments, respectively. With 10% increase in stage I, the model projects 2.9 and 4.7 overdiagnosed cases per life saved and number needed to be screened (NNS) equal to 1695 and 2632 under historical and novel treatments. When screening was performed only for the 20% of individuals with highest predicted risk, 34 and 22 lives per 100,000 were saved under historic and novel treatments. Similar results were obtained for women, but lives saved were lower.

Conclusions: Melanoma early detection programs must shift a substantial fraction of cases from advanced to localized stage to be sustainable. Advances in systemic therapies for melanoma might noticeably reduce benefits of screening, but restricting screening to individuals at highest risk will likely reduce intervention efforts and harms while preserving >50% of the benefit of nontargeted screening.

Impact: Our accessible modeling framework will help to guide population melanoma screening programs in an era of novel treatments for advanced disease.

Footnotes

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Cancer Epidemiol Biomarkers Prev 2020;29:2599–607

  • Received June 9, 2020.
  • Revision received August 5, 2020.
  • Accepted September 17, 2020.
  • Published first September 21, 2020.
  • ©2020 American Association for Cancer Research.
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Cancer Epidemiology Biomarkers & Prevention: 29 (12)
December 2020
Volume 29, Issue 12
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Strategizing Screening for Melanoma in an Era of Novel Treatments: A Model-Based Approach
Kemal Caglar Gogebakan, Elizabeth G. Berry, Alan C. Geller, Kemal Sonmez, Sancy A. Leachman and Ruth Etzioni
Cancer Epidemiol Biomarkers Prev December 1 2020 (29) (12) 2599-2607; DOI: 10.1158/1055-9965.EPI-20-0881

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Strategizing Screening for Melanoma in an Era of Novel Treatments: A Model-Based Approach
Kemal Caglar Gogebakan, Elizabeth G. Berry, Alan C. Geller, Kemal Sonmez, Sancy A. Leachman and Ruth Etzioni
Cancer Epidemiol Biomarkers Prev December 1 2020 (29) (12) 2599-2607; DOI: 10.1158/1055-9965.EPI-20-0881
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