Skin cancer rates in North Rhine-Westphalia, Germany before and after the introduction of the nationwide skin cancer screening program (2000–2015)

Abstract

Germany is the first nation that implemented a nationwide skin cancer screening program in 2008. The aim is to study the effect of the program on skin cancer rates and to estimate the number needed to screen for an unselected and a hypothetical high-risk population in Germany. We used population-based data on skin cancer incidence (2000-2014), mortality, hospitalization and sick leave (2000-2015) from North Rhine-Westphalia, Germany (18 million population). We calculated annual age-standardized rates per 100,000 person years and calculated the relative change of the rates (%) including 95% confidence intervals (95% CI). Between 2007 and 2014, the estimated annual percentage change (EAPC) of the age-standardized incidence rate of skin melanoma was 3.8% among men and women. These increases were accompanied by increases of the age-standardized mortality rates (EAPC men 3.2%, women 2.0%) and age-standardized sick leave rates (EAPC men 11.0%, women 6.1%). Hospitalization rates showed barely any change. All types of rates for nonmelanoma skin cancer showed marked increases. The number needed to screen for skin melanoma death would be 34,000 if the risk reduction due to screening would be 50%. In a hypothetical high-risk approach with 10% of the population at high risk, that is, a relative risk of melanoma death of 4.0, a skin melanoma mortality risk reduction of 50% among these people due to screening would result in a reduction of the skin melanoma mortality by 15% in the total population. However, this reduction would require a number needed to screen of 11,141. Seven years after the introduction of the skin cancer screening program, there is no discernible beneficial effect at population level. The estimated number needed to screen for skin melanoma in an unselected approach is high and a realistic high-risk approach is currently not feasible.

Incidence of Melanoma in Catalonia, Spain, Is Rapidly Increasing in the Elderly Population. A Multicentric Cohort Study

“…All these findings could be explained by accumulated harm from UV (ultraviolet) radiation since childhood as UV exposure and resulting from occupations with high sun exposure (>20 years) leading to the development of melanoma [ 27 ]. Large public initiatives to decrease sun exposure have been carried out for many years [ 5 , 6 , 7 , 8 , 9 , 35 ], but unfortunately, these campaigns will not benefit older people today who could have already had intense sun exposure during childhood. This could explain the significant increase in incidence from age 50 years onwards which we have seen in our study and the important increase in the lentigo maligna melanoma subtype.…”

“…Despite the fact that major primary prevention campaigns have been implemented in recent decades [ 5 , 6 , 7 , 8 , 9 ], the number of melanoma cases continues to rise every year [ 10 , 11 ]. Recent data from the Surveillance, Epidemiology, and End Results (SEER) registry indicate that the incidence of melanoma is rapidly increasing, especially in older patients [ 10 ].…”

The iris signal: blue periphery, tan collaret and freckles pattern – strong indicators for epidermal skin cancer in South‐Eastern Europe

“…The need to reduce skin cancer mortality, especially for melanoma has led to implementation of population-based screening programmes, like the first nationwide skin cancer screening (SCS) programme in the world, in 2008, in Germany. 23 In spite of this effort, there was no discernible beneficial effect at population level. Furthermore, SCS may profit from a high-risk strategy instead of population-wide screening.…”

Technology-enabled activation of skin cancer screening for hematopoietic cell transplantation survivors and their primary care providers (TEACH)

“…If the group main effect is significant, interactions of the group main effect with other variables will be examined. Power calculation: We will assume that 10 to 30% of patients will have a concerning mole or lesion for which they will seek care from their PCP or a dermatologist during the study period [12,59,60]. Mean wait time (time between call for appointment and definitive diagnosis by their PCP or a dermatologist, if equivocal) was assumed to be 30 days [51], with a range of standard deviations (SD = 5 to 15).…”