Cutaneous Malignant Melanoma in Chile: Differences in Tumor Thickness and Overall Survival Between Patients From Public and Private Health Care Centers
Keywords:
Melanoma, health care disparities, tumor thickness, Breslow, socioeconomic statusAbstract
Introduction: A low socioeconomic status (SES) is associated with lower survival rates in cutaneous malignant melanoma (CMM). In South America, there are few studies that analyze CMM data according to SES.
Objectives: To determine the differences in microstaging and overall survival in CMM between public and private health care centers.
Methods: Retrospective cohort study. Histopathological reports with a diagnosis of CMM from two public hospitals (PuH) and one private health care center (PrH) in Santiago from 2008 to 2018 were included. Patients’ death certificates were obtained to estimate overall survival.
Results: 1014 MMC were found. The mean age was 58.6 ± 16.8 years and 59.9% corresponded to female patients. Of these, 33.9% received treatment at PuH and 66.1% at PrH. Patients from PuH had an increased risk of having an invasive CMM and a >1 mm thickness melanoma compared to PrH (OR 2.77 and 6.06, respectively). Patients with invasive CMM from the PuH were 6.29-fold more likely to die than a patient from the PrH.
Conclusions: We observed a great disparity in tumor thickness between the socioeconomic sectors, reflecting a later detection and lower survival rate in PuH. Our results highlight a gap on which National Public Health should focus.
References
Arnold M, Singh D, Laversanne M, et al. Global Burden of Cutaneous Melanoma in 2020 and Projections to 2040. JAMA Dermatol. 2022;158(5):495-503. DOI: 10.1001/jamadermatol.2022.0160. PMID: 35353115. PMCID: PMC8968696.
Schadendorf D, Fisher DE, Garbe C, et al. Melanoma. Nat Rev Dis Primers. 2015;1(April):1–20. DOI:10.1038/nrdp.2015.3. PMID: 27188223.
Nikolaou V, Stratigos AJ. Emerging trends in the epidemiology of melanoma. Br J Dermatol. 2014;170(1):11-19. DOI:10.1111/bjd.1249. PMID: 23815297.
Ministerio de Salud de Chile. Primer informe de registros poblacionales de cáncer de Chile. Quinquenio 2003-2007. 2012:1–178.
Plan Nacional de Cáncer 2018-2028. Ministerio de Salud de Chile. 2019. p. 1-185. Available from: https://www.minsal.cl/wp-content/uploads/2019/01/2019.01.23_PLAN-NACIONAL-DE-CANCER_web.pdf; January 2023.
Idorn LW, Wulf HC. Socioeconomic status and cutaneous malignant melanoma in Northern Europe. Br J Dermatol. 2014;170(4):787–793. DOI: 10.1111/bjd.12800. PMID: 24359255.
Singh SD, Ajani UA, Johnson CJ, et al. Association of cutaneous melanoma incidence with area-based socioeconomic indicators-United States, 2004-2006. J Am Acad Dermatol. 2011;65(5 SUPPL. 1):S58.e1–S58.e12. DOI: 10.1016/j.jaad.2011.05.035. PMID: 22018068.
Jiang AJ, Rambhatla P V, Eide MJ. A Systematic Review of Socioeconomic and Lifestyle Factors and Melanoma. Br J Dermatol. 2014; 172(4):885-915. DOI: 10.1111/bjd.13500. PMID: 25354495.
Rutherford MJ, Ironmonger L, Ormiston-Smith N, et al. Estimating the potential survival gains by eliminating socioeconomic and sex inequalities in stage at diagnosis of melanoma. Br J Cancer. 2015;112(s1):S116–S123. DOI: 10.1038/bjc.2015.50. PMID: 25734390. PMCID: PMC4385984.
Becerril-Montekio V, Reyes Jde D, Manuel A. Sistema de salud de Chile [The health system of Chile]. Salud Publica Mex. 2011;53 Suppl 2:s132-s143. PMID: 21877079.
Rosenthal A, Reddy S, Cooper R, et al. Disparities in melanoma-specific mortality by race/ethnicity, socioeconomic status, and health care systems. J Am Acad Dermatol. 2023;88(3):560-567. DOI: 10.1016/j.jaad.2022.10.004. PMID: 36228942.
Hille DM; Cancer Alliance Queensland. Differences in the incidence and mortality of melanoma between socioeconomic groups in the Australian state of Queensland: 2001-2016. J Dermatol. 2020;47(2):193-194. DOI: 10.1111/1346-8138.15191. PMID: 31849111.
Steding-Jessen M, Engberg H, et al. Regional and socioeconomic variation in survival of melanoma patients in Denmark. Dan Med J. 2019;66(11):A5572. PMID: 31686649.
Gibson JAG, Dobbs TD, Griffiths R, et al. The association of smoking and socioeconomic status on cutaneous melanoma: a population-based, data-linkage, case-control study. Br J Dermatol. 2020;182(5):1136-1147. DOI:10.1111/bjd.18526. PMID: 31529485. PMCID: PMC7383980.
Mandalà M, Imberti GL, Piazzalunga D, et al. Association of Socioeconomic Status With Breslow Thickness and Disease-Free and Overall Survival in Stage I-II Primary Cutaneous Melanoma. Mayo Clin Proc. 2011;86(2):113–119. DOI: 10.4065/mcp.2010.0671. PMID: 21282485. PMCID: PMC3031435.
Strömberg U, Peterson S, Holmberg E, et al. Cutaneous malignant melanoma show geographic and socioeconomic disparities in stage at diagnosis and excess mortality. Acta Oncol. 2016;55(8):993–1000. DOI: 10.3109/0284186X.2016.1144934. PMID: 26935355.
Eriksson H, Lyth J, Månsson-Brahme E, et al. Low level of education is associated with later stage at diagnosis and reduced survival in cutaneous malignant melanoma: A nationwide population-based study in Sweden. Eur J Cancer. 2013;49(12):2705–2716. DOI: 10.1016/j.ejca.2013.03.013. PMID: 23583439.
Youl PH, Baade PD, Parekh S, English D, Elwood M, Aitken JF. Association between melanoma thickness, clinical skin examination and socioeconomic status: results of a large population-based study. Int J Cancer. 2011;128(9):2158–2165. DOI: 10.1002/ijc.25540. PMID: 20607832.
Salvaggio C, Han S, Martires K, et al. Impact of Socioeconomic Status and Ethnicity on Melanoma Presentation and Recurrence in Caucasian Patients. Oncology. 2016;90(2):79–87. DOI: 10.1159/000441524. PMID: 26840790.
Pollitt RA, Swetter SM, Johnson TM, Patil P, Geller A. Examining the pathways linking lower socioeconomic status and advanced melanoma. Cancer. 2012;118(16):4004–4013. DOI: 10.1002/cncr.26706. PMID: 22179775.
Mackie RM, Hole DJ. Incidence and thickness of primary tumours and survival of patients with cutaneous malignant melanoma in relation to socioeconomic status. BMJ. 1996;312(7039):1125–1128. DOI: 10.1136/bmj.312.7039.1125. PMID: 8620127. PMCID: PMC2350663.
Quintella GL, Koifman S. Socioeconomic status as a predictor of melanoma survival in a series of 1083 cases from Brazil : just a marker of health services accessibility ? Melanoma Res. 2013;23(3):199–205. DOI: 10.1097/CMR.0b013e32835e76f8. PMID: 23442344.
Birch-johansen F, Hvilsom G, Kjær T, Storm H. Social inequality and incidence of and survival from malignant melanoma in a population-based study in Denmark, 1994-2003. Eur J Cancer. 2008;44(14):2043–2049. DOI: 10.1016/j.ejca.2008.06.016. PMID: 18664405.
Ribero S, Davies JR, Requena C, et al. High nevus counts confer a favorable prognosis in melanoma patients. Int J Cancer. 2015;137(7):1691-1698. DOI: 10.1002/ijc.29525. PMID: 25809795. PMCID: PMC4503475.
Quaglino P, Ribero S, Osella-Abate S, et al. Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for non-sentinel lymph node involvement and overall survival in melanoma patients: a single centre observational cohort study. Surg Oncol. 2011;20(4):259-264. DOI: 10.1016/j.suronc.2010.11.001. PMID: 21145730.
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Copyright (c) 2023 Guisella Martínez, Francisca Kinzel, Nadia Vega, Ivo Sazunic, Javier Fernández, María Magdalena Delgado, Francisco Bobadilla, Andrea Zamudio, Laura Segovia
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