Is targeted early detection for melanoma feasible? Self assessments of risk and attitudes to screening

Objectives-To study the feasibility of developing targeted screening for those at high risk of melanoma by examining how attitudes relate to (a) acceptance of an invitation for a free skin check and (b) self assessed and clinically assessed risk factors for developing cutaneous melanoma. Design-A population based cross sectional survey. Setting-A general practice with a broad mix of socioeconomic groups in one district health authority. Subjects-A total of 1600 subjects aged 25-69 years stratified using the social deprivation score of wards were randomly selected from a population of 8000; 77% (1227) returned the questionnaire and 56% (896) attended for screening. Main outcome measures-questionnaire measures of confidence in own ability to self assess risk factors for melanoma, attitudes to seeking medical help for skin abnormalities, and self assessment of relative risk of developing melanoma. Results-Clinic attenders were less confident in their ability to self assess risk factors (p<0.005), more favourable towards seeking help (p<0.001), and more pessimistic about developing melanoma (p<0.001) than non-attenders. Those from more affluent wards were more willing to seek help (p<0.001). Those clinically assessed as at higher risk were more pessimistic about developing melanoma (p<0.001) but clinical assessments were inconsistently related to help seeking attitudes and self assessment confidence. Conclusions-Barriers to the uptake of screening included greater optimism about not developing melanoma, confidence in self assessment, and reluctance to seek professional help. Such reluctance was greater in more deprived social groups. Targeting screening at high risk groups cannot depend on self identification and self referral.