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Myths and realities of cancer screening discussed at next President’s Lecture

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Dr. Celette Sugg Skinner

Imagine two female patients. One has multiple risk factors for cervical cancer and never received the human papillomavirus (HPV) vaccine. The other has no known risk factors, got the HPV vaccine as an adolescent, and has never had a Pap test with abnormal results. Should both women undergo the same screening for cervical cancer – a yearly Pap smear?

Similarly, many patients are familiar with screening options for colorectal cancer: colonoscopy or a stool sample test. Although multiple factors affect which screening method is best for you, at what age to start, and how often to repeat the test, providers may recommend the same screening regimen for all patients.

There is no one-size-fits-all strategy for these cancer screenings – a point that Dr. Celette Sugg Skinner, Chair of the Department of Clinical Sciences, aims to emphasize to both patients and providers. For years, she has been conducting research on how the health care industry can most effectively communicate the right screening procedures and intervals to the right providers and patients. Her findings have influenced the way health care systems deliver cancer screening – and she plans to share some of them during her lecture, “Screening for Cancer: The Promise and the Reality,” at 4 p.m. Thursday, Oct. 18, as the final talk in the 2018 President’s Lecture Series. Her presentation will touch on patient-, provider-, and system-level factors influencing cancer screening.

Dr. Skinner, Chief of the Division of Behavioral and Communication Sciences in the Department of Clinical Sciences, is dedicated to optimizing cancer screenings for varied patient populations using a dynamic approach – considering factors such as risk level, race, sex, age, proximity to large medical centers, medical history, access to health insurance, and more. She and her team take their findings and advise administrative, provider, and patient communities on how to put them into practice.

“The idealized concept behind cancer screening is this: Everyone will have the tests recommended to them, the costs will be very low, the tests will be totally safe, they will work perfectly, and we’ll get rid of cancer once and for all,” said Dr. Skinner, also Associate Director of Population Research and Cancer Control at the Harold C. Simmons Comprehensive Cancer Center. “But the reality is that we don’t have a perfect test for every cancer, and even if we did, not every person would be screened, and not all early treatment would be effective.”

Dr. Skinner’s commitment to spreading this message grew from an early interest in persuasive communications. In high school, she was a state-champion debater and member of the National Forensics League. Her undergraduate studies were in political science.

“Because I had been a debater and was a political science major, people assumed I would go to law school,” Dr. Skinner said. “But I was always more interested in factors that influenced people’s opinions and behaviors, and how communications could affect those factors. Eventually, I realized that I was most interested in communications that would lead to improved health, which is why I decided to pursue a doctorate in health behavior.”

Before obtaining her Ph.D. from the University of North Carolina School of Public Health, Dr. Skinner earned a master’s degree in communications research from the Wheaton Graduate School.

She has a passion for identifying the things in society that influence individuals to make certain decisions, especially in health care.

“Public health and population health communication can be tricky, because you’re trying to give a message to thousands, perhaps millions of people, but that message is not going to be absolutely true for everyone,” Dr. Skinner said. “For example, a drug may be effective for most people with a certain disease, but not for every single patient. It gets very complicated to deliver the right message to the right person. Our research seeks to find the best ways to do this.”

She and her team have found interventions that effectively educate patients, especially those in minority populations. For example, in the ’90s, older African-American women were very unlikely to get mammograms, so the team developed communications that helped reduce racial disparities in breast cancer screening. Most recently, she has focused on effective communications related to colorectal cancer screening.

“Colon cancer is one of the most preventable cancers, yet it still kills more than 50,000 people in the U.S. every year,” Dr. Skinner said. “It doesn't have to be that way. If we could get more people the screening and follow-up care they need, we could save years and save lives. We have a wonderful opportunity to do that here in North Texas.”

Recruited to UT Southwestern in 2007, Dr. Skinner formerly served as Associate Director for Population Research for the Duke Comprehensive Cancer Center. She also was a member of the Siteman Cancer Center of Washington University in St. Louis (1993-1998) and the Indiana University Simons Cancer Center (1991-1993). As lead author of the first tailored intervention trial for cancer screening in 1994, Dr. Skinner developed messages that contained different combinations of content based on responses women gave in a survey regarding their perceptions about breast cancer screening. 

“There was a ‘library’ of potential messages that they could get, depending on what issues were important for them,” she said. “Some got messages about factors like discomfort or cost associated with mammography, whereas others got messages addressing fear of finding cancer or beliefs that they were not at risk and therefore didn’t need to be screened.”

Dr. Skinner has continued to participate in National Cancer Institute (NCI) working groups on the state of the science. In 2016, she served on the Implementation Science Working Group of the NCI’s Beau Biden Cancer Moonshot Blue Ribbon Panel, where she focused on priorities for implementing and disseminating research findings into routine care.

In her President’s Lecture, Dr. Skinner will share findings from her breadth of experiences – see it at 4 p.m. Thursday, Oct. 18, in the Tom and Lula Gooch Auditorium.

This story was updated Oct. 1, 2018.

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