Residents of rural Michigan counties are significantly more likely to get melanoma, or skin cancer, than urban residents, according to a study.
One reason: a lack of dermatologists in rural counties.
“Michigan has nearly double the number of dermatologists per capita practicing in urban counties,” the research team said.
Thirty-eight of the state’s 62 rural counties have no dermatologists, according to the study published in the journal Cancer Reports.
Nationally, melanoma is the third most common cancer in rural America for men and women combined, behind lung and colorectal cancers.
“Our results highlight the lack of care and resources, and demonstrate its link to patient outcomes,” the study says.
Lead researcher Richard Shellenberger, an internal medicine specialist at Trinity Health Ann Arbor Hospital in Ypsilanti, said: “The lack of doctors in rural areas was a big factor. It takes a special person to say, “I want to practice in the Upper Peninsula, I want to practice in the northern rural part of the Lower Peninsula.” » »
Some patients have to travel to another county to see a doctor, even for primary care, Shellenberger said. Its co-authors are from Michigan Medicine in Ann Arbor, Methods Consultants at Ypsilanti, Harvard University and Northwell Health Cancer Institute in New York.
“That sounds alarming these days,” Shellenberger said, noting that the farther patients have to drive for medical care, the less likely they are to seek that care.
Research shows that rural residents also have higher rates of breast, prostate, cervical, and colorectal cancer, lower preventive screening rates, and higher death rates from these types of cancers. cancer than urban residents.
The study used 2015-2018 data from the Michigan Department of Health and Human Services and the Centers for Disease Control and Prevention for incidence and mortality rates.
Among the counties with the highest rate of new melanomas were Lenawee, Emmet, Ottawa, Bay, Jackson, Livingston and Cheboygan. Six other counties with the highest rates of new melanoma also have no dermatologists: Leelanau, Missaukee, Charlevoix, Wexford, Antrim and Benzie.
Among the other 32 counties without a dermatologist are Branch, Ionia, Oceana, Montcalm, Mason, Lake, Clare, Montmorency, Mackinac, Iron and Baraga.
Late diagnosis can lead to serious complications, even death, experts have said.
“The deeper melanomas invade the skin, the more likely they are to metastasize, spread to internal organs, and be fatal,” said Dearborn dermatologist Karen Chapel.
“Therefore, early diagnosis of melanoma while they’re thin offers the best chance of a cure,” said Chapel, who chairs the Michigan Dermatological Society’s committee that deals with patient access.
Society President Steven Daveluy said rural residents are more than three times more likely to work outdoors than their urban counterparts, increasing their exposure to the sun, which is the main risk factor for melanoma. .
Fair-skinned people are much more likely to get skin cancer, and the white population in rural counties is 21% higher than in urban areas, according to the study.
Daveluy, who is a professor at Wayne State University School of Medicine, described the case of a farmer he treated at the Karmanos Cancer Institute in Detroit.
“After years of exposure to the sun working outdoors, he found an open, non-healing wound on his scalp,” Daveluy said. “He didn’t like going to the doctors, and he was busy working on his farm to keep everything running, so he delayed coming for treatment.”
“When he came, the wound had grown considerably,” he said. “Because of her delay in getting treatment, her surgery was more extensive.”
Daveluy said the shortage of dermatologists in Michigan reflects a national shortage, and many of those working in rural communities are independent practitioners.
“It can be challenging because working in a group with colleagues gives you the opportunity to discuss difficult cases, share best practices and new information, and have rewarding social interactions at work,” he said. .
There are also economic factors.
Rural residents generally have lower incomes. Daveluy said the average per capita income in rural Michigan is 17.9% lower than in urban areas, making health care and insurance coverage less affordable.
Shellenberger of Trinity Health noted that doctors earn more in urban areas and have better access to sophisticated equipment and other specialists than in rural areas.
“It takes someone who wants to be in a rural area to be a doctor there,” he said.
As for closing the gap between rural and urban areas, Daveluy said federal funding for physician residencies favors health systems and hospitals. This means less money for specialties such as dermatology which focus primarily on outpatient medicine.
Telehealth techniques could help provide access to experts, medical schools could provide more opportunities for their students to treat rural residents, and the federal government could fund more residency slots in underserved areas, Chapel said. .
Chapel and Shellenberger said the government could offer financial incentives to new doctors who want to practice in rural communities.
Shellenberger said other steps include paying off student loans, and he noted that many aspiring doctors borrow “outrageous sums, $200,000 and more, to go to medical school.”
Other ways to close the access gap are for the government to cover the expenses of starting a practice and establishing clinics with specialists in rural areas, he said.
“Public health in the United States needs to improve a lot,” Shellenberger said, with better access to medical care, testing and treatment.
Eric Freedman is a professor of journalism and former associate dean of international studies and programs at Michigan State University. He is also a Pulitzer Prize winner and director of the Capital News Servic University.e.
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