Skin cancer screening participation and impact on melanoma incidence in Germany – an observational study on incidence trends in regions with and without population-based screening

Abstract

Background:The SCREEN (Skin Cancer Research to provide Evidence for Effectiveness of Screening in Northern Germany) project involved population-wide skin cancer screening with whole-body examination by general physicians and dermatologists. It was conducted in the German state of Schleswig-Holstein (July 2003–June 2004), but not in the German state of Saarland.Methods:The population-based registries of Schleswig-Holstein and Saarland provided data on melanoma incidence before, during, and after SCREEN to assess the association of skin cancer screening with incidence.Results:Approximately 19% of the Schleswig-Holstein population participated in SCREEN (women: 27%, men: 10%). A total of 52% of all melanomas diagnosed during SCREEN in Schleswig-Holstein were detected as part of the project. Melanoma incidence increased during SCREEN (invasive melanoma in women: +8.9 per 100 000 (95% confidence intervals (CI): 6.1; 11.7); men: +4.0 per 100 000 (95% CI: 1.6; 6.4)) and decreased afterwards (women: −10.6 per 100 000 (95% CI: −13.3; −7.9); men: −4.1 per 100 000 (95% CI: −6.5; −1.7)). Similar changes were not observed in Saarland that had no such project. The differences between the two states were greatest among women, the group with the greater SCREEN participation.Conclusion:The SCREEN project had a substantial impact on melanoma incidence. This is consistent with the impact of effective screening for other cancers.

Incidence and survival in patients with cutaneous melanoma by morphology, anatomical site and TNM stage: A Danish Population-based Register Study 1989–2011

“…A video clip on sunbed use on YouTube achieved viral dissemination, with 14 million viewings, and was followed by a decrease in the use of indoor tanning beds [40]. Sun prevention campaigns (awareness) and melanoma screening programmes are associated with increased melanoma incidence rates through the detection of prevalent, slow-growing tumours [2,47,48]. Hence, the campaign in Denmark is likely to have contributed to the reported increase in stage I disease by increasing awareness in both the medical community and in the general population, resulting in increased skin self-examination, more physician consultations, and earlier detection.…”

Risk Prediction Models for Melanoma: A Systematic Review

“…As earlier diagnosis is the principal factor that can improve the prognosis of patients with melanoma (6), there is considerable interest in the development of screening programs. The SCREEN project in northern Germany suggested that population screening may have a substantial impact on melanoma incidence and 5-year mortality (7,8) leading to the implementation of a national statutory skin cancer early detection program in Germany in 2008. However, such mass screening is not currently recommended by the U.S. Preventive Services Task Force (9) or in other countries.…”

Benefits and Risks of Skin Cancer Screening

“…Incidence effects of the SCREEN project were analyzed and compared to Saarland, a federal state of Germany where no population-based screening took place. The incidence of MM increased during the SCREEN period and decreased when screening activities stopped in Schleswig-Holstein, while no such changes in incidence were seen in Saarland [31]. A rise in incidence during the SCREEN period has also been observed for BCC and SCC in Schleswig-Holstein, but not in Saarland [32].…”