Abstract B28: Married couples' reasons for failing to screen for skin cancer
Authors: Heckman Carolyn , Darlow Susan , Munshi Teja , Manne Sharon 
Published: June 2012

Abstract
Skin cancer is the most common cancer in the US, and incidence continues to increase. Studies have shown that screening is helpful in detecting skin cancer at an earlier more treatable stage and can be done by oneself, with the assistance of a close other, or by a health professional. Many people fail to screen for skin cancer.
The purpose of this study was to examine screening rates in married couples, as well as the reasons for failing to screen. Participants were recruited and assessed by KnowledgePanel from Knowledge Networks (http://www.knowledgenetworks.com/). This is a probability-based panel of potential participants for online surveys, designed to be representative of the US population. Married individuals over 50 years of age with another person living in the home were invited to participate. Participants completed an online survey in which both husbands and wives were asked to indicate whether they received a skin exam from a clinician, or performed a skin exam themselves or with the assistance of a partner. If they answered in the negative, they were asked to endorse reasons for failing to screen from a provided list and could write in other reasons. This questionnaire was completed as part of larger study examining other cancer screening behaviors.
The questionnaire was completed by 3,048 husbands and 2,942 wives (a 77% response rate). Within husbands, 39% reported receiving a clinical skin exam, while 35% of wives reported doing so. Regarding a self- or partner-assisted skin exam, 47% of husbands reported doing so, as opposed to 49% of wives. Forty-eight percent of couples matched in terms of both failing to receive a clinical skin exam, 28% did not match (i.e., one spouse had an exam, while the other did not), and 25% matched in terms of both having had a clinical skin exam. For self- or partner-assisted skin exam, 40% of married couples matched in terms of neither having an exam, 21% did not match (i.e., one spouse performed an exam, while the other did not), and 39% matched in terms of both partners performing a self- or partner-assisted skin exam.
The most commonly endorsed reason among both husbands and wives for failing to obtain a skin exam by a clinician and also not screening oneself is that a doctor did not recommend one, followed by not having any noticeable symptoms of skin cancer, and not perceiving oneself as at risk for skin cancer. Kappa coefficients were calculated to assess husbands' and wives' agreement on the reasons endorsed. Husbands and wives reached moderate agreement for the following reasons for not obtaining a clinical skin exam: healthcare provider hadn't recommended, exam would be inconvenient, did not have noticeable symptoms of skin cancer, would rather have a partner do the exam, and not perceiving oneself as at risk for skin cancer. Similar reasons for not conducting a self- or partner-assisted exam were endorsed and had similar levels of agreement (other than preferring a partner exam), though husbands and wives also had moderate agreement for not conducting an exam due to being too busy.
Results show that more than half of individuals over age 50 do not receive clinical or partner skin exams. Most couples matched in terms of both either having or not having had a skin exam and also endorsed similar reasons for not being screened. Based on these similarities and spousal influence on one another, intervening with couples as a unit may be beneficial in increasing skin cancer screening rates. Findings also highlight the role health professionals may play in encouraging screening for skin cancer, as the most highly cited reason for not getting screened is lack of recommendation from a healthcare provider. Finally, results suggest opportunities for education regarding “symptoms of” and risks for skin cancer and the fact that skin cancer may be asymptomatic.
Citation Information: Cancer Prev Res 2011;4(10 Suppl):B28.