A Population-Based Screening Program
versus Opportunistic Screening and Early
DetectionSancy Leachman, MD, PhD
Australian Skin and Skin Cancer Research Center
Melanoma Screening Summit
Monday, March 25, 2019
2
Disclosures
• Potentially Discussed in Q&A:
– DermDetect (Mobile Dermoscopy)
– MoleMapper – Free & Open Source Research Kit
• Not Discussed:
– Myriad Genetics Laboratory
– Castle Biosciences
– Orlucent, Inc.
– VeriSkin, Inc.
– Merck
A Control Strategy That Works
“Deadly” “Controlled”
Pathogen or
Etiology Discovered
Vulnerability Identified
&Targeted
Successful HumanTrials
Performed
Becomes Medical
CommunityStandard
Becomes Mainstream
ThroughPublic Health
Cervical Cancer(HPV)
Vaccine with VLP
NEJMPaper
Available Everywhere
ControversyContinues
Melanoma Can Be A Model for Applied
Early Detection
“Deadly” “Controlled”
Mechanism and Targets
Discovered
Effective TreatmentIdentified
Patients Needing
TreatmentIdentified
Treatment Applied
To Patients
TreatmentsBroadly
Applied toCommunity
Identification Of Early DetectionMethod or Device
Identification and TreatmentIn Appropriate
Populations
Most Cancers
Melanoma (our eyes)
The Vision (AKA BHAG): Seek Out
& Destroy Every Lethal Melanoma
Early Detection Works for Melanoma
SEER 18 2008-2014, All Races, Both Sexes by SEER Summary Stage 2000
Five-Year Relative Survival
Skin awareness is inversely
associated with lesion thickness and
death.
Berwick M, et al. JNCI Vol 97(3):195-199; 2005
The Concept: Oregon’s Version of
Schleswig-Holstein
Testing the hypothesis that melanoma mortality can be decreased by almost half through early detection/education.
The War Plan: A Statewide Population
Sciences Experiment Overview!Experimental Design
Baseline Measures:• Melanoma Literacy• Tumor Depth/Stage• Cost• Comparison to controls
Repeated Measures
Successful
Un
succ
essf
ul
Refine & Repeat
Massive Public Education CampaignProviders Skin Care Services Lay Public
Grass Roots AND Top-Down Discovery of Suspicious Lesions
Screening & Biopsy If Needed
Early Stage Removal If Needed
Expansion To Other StatesIN
TER
VEN
TIO
N
10
War on MelanomaTM: Major Outcomes
Professional Public Health Campaign For Those that
Don’t Care
Interrelated Hypotheses
ImprovedMelanoma
Literacy
ReducedCost for Care
Lives Saved
Knowledge &Behavior Survey
OR, WA, UT
All PayersAll ClaimsDatabase
Cancer Registry• Depth• Stage• Incidence• MortalityBaseline and Post-Campaign
Amplification: • Grass Roots• WoM Registry• Skin Care Services• Providers
11
Communications Methodology
Solutions for All
Just Look & Act Campaign
Education: Lay to ExpertReferrals: Derm & PCPsMole Mapper Tracking AppDermDetect Screening ExamsTelederm E-VisitsRegistry ParticipationCollaboration: Derm & PCP
Social MediaBillboardsRegular Updates
Web Page
Different Populations
LOWERRISK
HIGHERRISK
MelanomaPatient
General Population1 in 100 Affected
Moderate Risk Population1 in 25-50 Affected
2-4 fold risk
Suspicious Lesion
Suspicious LesionsHigh-Risk Population1 in 10-20 Affected
5-10 fold risk
Ultra-High RiskHereditary Population
1 in 2-3 Affected30 fold risk
Strategic Screening Methodology
Different Populations, Different Tools
LOWERRISK
HIGHERRISK
MelanomaPatient
General Population1 in 100 Affected
Moderate Risk Population1 in 25-50 Affected
2-4 fold risk
Suspicious Lesion
Suspicious LesionsHigh-Risk Population1 in 10-20 Affected
5-10 fold risk
Ultra-High RiskHereditary Population
1 in 2-3 Affected30 fold risk
Social Media Educational Campaigns
Mobile Phone AppsSkin-Related ServicesOpportunistic Screens
Basic Screenings• Primary Care• Dermatology
TeledermatologyTeledermoscopyDermatologyDiagnostic Imaging• Dermoscopy• In-Vivo Confocal• OCT• Photoaccoustic
Molecular Diagnostics• GEP• Tape-stripping• Molecular Pathology
Genetic TestingPigmented Lesion ClinicMultidisciplinary CareWhole Body Imaging
Lesion RegistrationDeep Learning / Artificial IntelligenceImage Recognition & Non-invasive Bx
Strategic Screening Methodology
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Summary: The Full-Spectrum Operations Pyramid
Melanoma Community
Registry
Oregon Health Authority
State Medical Boards
& Societies, PCPs
Oregon Dermatologic
Society
Dermatology & Multi-
disciplinary Melanoma
Clinics
MoleMapper, Mobile
ScreeningGeneral Population (1:100)
Moderate Risk (1:25-1:50)Red hair, Light skin, UVR damage
High-Risk Population (1:10-1:20)Personal Hx; Atypical Moles
Ultra-High-Risk (1:3-1:10)Genetic Predisposition
E-visits, e-consults, in-person clinics
Modified INFORMED Curriculum
Telederm, in-person clinics,
referrals, dermoscopy, biopsies
CODE, specialty clinics,
advanced skin imaging
Population Outreach Method Screening Technique
15
Timeline: WoM Early Detection Campaign2013 20192014 2015 2016 2017 2018
KnightEarly Detection
Challenge
WoMRegistry
MoleMapperTracking App
OregonHealth
Authority
E-ConsultsE-Visits
OutreachRoadshow
CurriculumDevelopment
Literacy Survey
Development
Cost Analysis
OSCaRSEER
Registry
PCPCouncil
CME EventsOregonDerm
Society
BroadPublic
CampaignFederated
States
16
WoM Early Detection Campaign
2019 20252020 2021 2022 2023 2024
CampaignLaunched
May 18
Baseline Metrics:• Literacy• Tumor• Cost • Controls
“Just Look!” Campaign“If you see something, solve it!”
OHA: Skin Service Professionals
Americans Reached
Lay: Curriculum (melanoma, self-exams, empowerment); E-visits
Repeated Measures: Literacy, Tumor Data, Cost, #Participants, Social Media
Literacy Improved
PCP: CME, E-Consults
ODS: Board Certified Dermatologists
Melanoma Detected
Earlier
SURVEY
Technology: MoleMapper; Mobile Imaging, Imaging Center
CostsReduced
Lives SavedFE
DER
ATED
STA
TES
17
Acknowledgements: WoM Oregon
OHSU &
Institutional Partners/Collborators
Legal, COI, Integrity, Security, Business Dev, Contracts & IRBAlice Cuprill ComasMelanie MauriceSteve ConklinRuth EplingKara DroletKathryn SchuffDeborah Golden Eppelein
Andrew WatsonAbhijit BanerjeeHilde WetteCassandra ForbessKellie GuentertJason Davis
Eric Smith
Community Outreach Programs
Jackie ShannonGabriel FloresPaige Ferris
Niyati Desai Kim Brown
Mark O’Hollaren
Marketing & Web Development
Sockeye Team: Yen Nguyen, Shelley Stevens,
Kara SkaflestadAllen TomlinsonNewman Team: Susan Kendall Newman, Jason Rosenblatt, Christa Terry, Kathleen McClane
Pop Sciences & Social PsychPepper Shedin Kerri Winters Stone
Jerusha Detweiler-BedellBrian Detweiler-Bedell
Yelena Wu Lisa Aspinwall
Foundation
Knight Cancer Institute
& CEDAR
School of Public Health
ORPRN
Oregon Health
Authority
Oregon State Cancer Registry
&
Oregon Dermatologic
SocietyOCHIN Lewis & Clark
College
Big Data & StatisticsKemal SonmezReid ThompsonJodi LapidusRuth EtzioniTomi MoriAlison Grossblatt-Wait
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Acknowledgements: WoM Oregon Primary Care
Providers Council
Melanoma Multidisciplinary TeamSancy Leachman – Melanoma & Skin Cancer DirectorJohn Vetto – Tumor Board Director, SurgeryElizabeth Berry – Pigmented Lesions ChampionDale Han – Multidisciplinary Clinic ChampionReid Thompson – Clinical Trial ChampionRaj Kulkarni – Translational Science ChampionDermatology: Sancy Leachman, Elizabeth Berry, Debbie Miller, Susan Tofte Dermatopathology & Surgical Pathology: Stephanie Mengden-Koon, Kevin White, Christopher CorlessSurgery: Anna Bar (Mohs), Justin Leitenberger (Mohs), John Vetto (Surg Onc), Dale Han (Surg Onc), Jeremy Ciporen (Neurosurg), Pamela Russell (Surg OncRN) Pediatric: Sabra LeitenbergerMedical Oncology: Matthew TaylorNuclear Imaging & Radiology: Nadine Mallak, Jeff StevensRadiation Oncology: Reid Thompson, Josh Walker, Charles ThomasOphthalmology: Alison Skalet, David WilsonNeurosurgery: Jeremy CiporenGenetics: & Genetic Counseling: Jone Sampson, Kelly Hamman, Brianne BreirBasic & Translational Science: Pam Cassidy, Amanda Lund, Raj Kulkarni, Melissa Wong, Stephen Lloyd, Amanda McCullough, Arup Indra, Catherine Morgans, Chelsey Kline, Guillaume Thibault, Tracy Petrie, Ravi Samatham, William Bisson, Young Hwan Chang, Sara Courtneidge, Robert Duvoisin, Philip Stork
Survey & Curriculum Development
Elizabeth Stoos – Instructional designAdrienne Zell
Elizabeth WenzelElizabeth Berry
Ruth EtzioniSancy Leachman
Telehealth ProgramMark LovgrenDarren MalinoskiDavid AdelsonAdrienne BuesaDon GlazierMelissa SwartzTreva ScottDeanna SmithElizabeth Berry
Volunteers & Fundraisers
Matt McNairRebecca DeboTim CoffeyMeghan KnowlesAbhijit BanerjeeMelissa KrzeminskiMarcia WalshLarry ChadwickDebbie MaddenJeff GausShon RameySharon LiesePeter Gray
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Acknowledgements: WoM Oregon
Melanoma Community Registry
Elizabeth StoosPatrick KinghornDuncan ChisolmRavi SamathamTracy Petrie
Larry FindletonRoger SparksRob SchumacherRoxanne MautinoDebbie MillerElizabeth BerryTracy PetrieDon Glazier
MoleMapper Research Kit AppDesign & Programming Team: Tracy Petrie, Ravi Samatham, Daniel Webster, Andrew Trister, Lisa DomenicoSage Bionetworks: Stephen Friend, Brian BottApple: Divya Nag, Mike O’Reilly, Jeff WilliamsThought Leaders: Lee Eberting, David Norris, Diane Baker, Darrell Rigel, Karen Edison, Jeff Gershenwald, Jim Kean, John Kirkwood, Marianne Berwick, Mohammed Kashani-Sabet, Oliver Wisco, Rick Edelson, Susan Swetter, Paul Tumeh, Valerie Guild
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Acknowledgements: WoM Federated States
Rhoda Alani & Debjani SahniBoston University
Kelly NelsonM.D.
Anderson
Clara CurielAZCC
Susan SwetterStanford
Suephy ChenEmory
Karen EdisonU. Of Missouri
Lynn CorneliusWashington U.
Elizabeth BerryOHSU
Julia CurtisUtah
Debbie MillerOHSU
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Acknowledgements: Foundations & Advisors
Advisors & Faculty Supporters
• Marianne Berwick John Kirkwood
• Alan Geller Suzanne Olbricht
• Martin Weinstock John Zone
• Susan Swetter Lisa Aspinwall
• Clara Curiel Brian Druker
• Allan Halpern Sadik Esener
• Suephy Chen Mo Kashani-Sabet
• Valerie Guild
Melanoma PreventionWorking Group• ECOG• SWOG• CALGB• Pigmented Lesion
Subcommittee
Foundations:• Melanoma Research Alliance• AIM at Melanoma & IMWG• Melanoma Research Foundation• Impact Melanoma:Skinny on Skin• SolSurvivors
Thank you!
