Priorities and challenges for skin cancer prevention in Europe

Abstract

The incidence, mortality, and survival rates of melanoma vary significantly across Europe, likely related to persistent inequalities between European countries in the areas of skin cancer early detection, case registration, and prevention. To enhance the planning of prevention strategies for skin cancer in Europe, we solicited the direct opinion of European experts in the field of dermato-oncology on the main obstacles, needs, and priorities for the reduction of the skin cancer burden on this continent. We surveyed European dermatologists with leading positions in European and international organizations active in skin cancer prevention by means of written, single-choice and multiple-choice questionnaires. Fifty-two dermatologists from 32 European countries completed the survey (response rate 80%). Fewer respondents in Eastern Europe compared with Western Europe reported the presence of governmental (12 vs. 46%) or nongovernmental (35 vs. 65%) initiatives for skin cancer prevention. Most respondents in Eastern (73%) and Western Europe (69%) reported the existence of national cancer registries, but the confidence in the accuracy of melanoma registration was low. Public and professional education for early detection were top priorities for skin cancer campaigns across Europe and the perceived obstacles were similar in both regions: the lack of a national program of public education, insufficient public authority initiatives, and insufficient training of physicians on skin cancer. Our survey highlighted several areas requiring intervention for skin cancer prevention and found that the main issues and obstacles appear to be similar across Europe, creating the premise for coordinated, pan-European action.

Melanoma Epidemiology and Early Detection in Europe: Diversity and Disparities

“…A regional reference center in Romania reported a stage distribution of 18% T1 and 48.73% T4 [41]. An expert survey in 33 European countries estimated that melanomas thicker than 2 mm represented 46% of melanomas diagnosed in Eastern Europe, vs only 19% in Western Europe [42]. Encouragingly, earlier diagnosis of thinner tumors appears also in the CEE countries with longer-established PCRs, such as the Czech Republic, where between 1977 and 2008 the incidence rates increased at an estimated annual percentage change of 38%, for T1 tumors vs 5% for T4 tumors [43].…”

“…The disparities in incidence and early diagnosis across the Continent relate to significant differences in the level of population awareness and available primary and secondary prevention campaigns. Nordic and Western European countries have a several decades long tradition of public education campaigns for skin cancer prevention and early detection [34,37,42,45,46]. Germany is the only country implementing a national skin cancer screening program [47][48][49], while diverse, high-risk-based selective screening programs are reported in Western countries [50][51][52].…”

The evolving field of Dermato‐oncology and the role of dermatologists: Position Paper of the EADO, EADV and Task Forces, EDF, IDS, EBDV–UEMS and EORTC Cutaneous Lymphoma Task Force

“…A significant challenge to ensuring quality care for all skin cancer patients is the high disparities across the whole continuum of cancer care, manifest in Europe along a North‐South, West‐East gradient. Eastern European countries have reported poorer outcomes of skin cancer, 40,41 face more frequent late diagnosis, 42,43 have less capacity for skin cancer registration and reporting, 44 lag behind in preventive efforts, 45 are less well equipped for early diagnosis 46 and struggle with important shortcomings in access to innovative life‐saving therapies for skin cancers 47 . Therefore, the European guidelines, recommendation of best practice, certification and other initiatives of quality assurance must be accompanied by a constant preoccupation of supporting and monitoring their implementation in countries facing challenges, so that the minimal requirements for quality cancer care in skin cancer 48 are met across the entire continent, without painful gaps.…”

Melanoma in Europe: North meets South, East meets West

“…2). Population-based information on stage distribution and thickness at diagnosis is also scarce, with the few available reports suggesting however that thick tumors are significantly more frequently diagnosed in CEE countries than in the rest of the continent [3,6,7]. As treatment in advanced stages of melanoma remains elusive, these significant disparities in tumor burden and prognosis between European countries are likely related to the differences in prevention efforts, public awareness, and in the systems of early detection and management of primary tumors.…”

“…3). An expert survey of European opinion leaders in dermato-oncology conducted from the Harvard School of Public Health [7] pointed to the public and professional education for tumor early detection as the top priorities for reducing the melano- Melanoma incidence and the number of deaths have increased steadily in most European countries and the trend is expected to continue. However, the melanoma burden is unequally distributed across the Continent, with important variations of melanoma incidence, mortality and survival between European regions.…”