National skin cancer screening program in Germany appears feasible
NEW YORK — Results from a long-term screening intervention trial in a northern German state showed that a national skin cancer screening process is feasible and can save lives, according to researchers who presented their findings at the HemOnc Today Melanoma and Cutaneous Malignancies meeting.
A national program “could potentially save lives, due to the early detection of melanomas,” said Axel Hauschild, MD, of the department of dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
The SCREEN project was conducted in Schleswig-Holstein. Results from Breitbart and colleagues were published in the Journal of the American Academy of Dermatology in 2012.
Schleswig-Holstein borders Denmark, the North Sea and the Baltic Sea and has “a very unique and homogenous population within Germany, [with] virtually no migration. This was the reason why the study was performed here,” Hauschild said.
In the study, the mortality rates were compared with the populations of all the surrounding states and countries.
From July 2003 to June 2004, about 360,000 healthy volunteers were screened. Screeners included 116 of the 118 dermatologists in the state, and 1,673 of the 2,614 general practitioners (including gynecologists, urologists, surgeons and internists), who received an 8-hour training course.
Two hundred eighty thousand whole-body examinations (73%) were initially conducted by general practitioners and 82,000 were conducted by dermatologists. Of the patients examined by general practitioners, 47,000 received a secondary exam from a dermatologist. Of all patients, there were 16,000 excisions (4.4%), with 3,500 skin cancers (approximately 1%) detected.
In the SCREEN results, tumors were found in 2,911 people, including 20.1% melanoma, 67.4% basal cell carcinoma and 13.5% squamous cell carcinoma. The melanomas included 30% in situ.
Yields showed that for every 620 patients screened, one melanoma was found. The ratio was one melanoma for every 28 excisions, according to a report from Waldmann and colleagues in the Archives of Dermatology.
“This is a question of cost effectiveness,” Hauschild said. “How many patients need to be screened in order to find one melanoma?”
In a 2012 British Journal of Cancer report, the incidence rate of in situ melanoma was increasing during the screenings, with a 108% increase for men and a 133% increase for women from a pre-screening period in January 1998 to the screening period in March 2004.
“But the burning question was … if mortality is changing,” Hauschild said.
Free skin cancer screenings for all Germans was introduced in July 2008. Fourteen million Germans were screened in 3.5 years. The data from these screenings still need to be evaluated, Hauschild said.
Does skin cancer screening save lives?
Mortality changes per year in percent were virtually unchanged from 2000 to 2009 for populations in Denmark and other German states, but in Schleswig-Holstein, it was reduced by 7.4% per year or a cumulative decrease of 52% of mortality during the years of screening, according to a 2012 study by Katalinic and colleagues in the journal Cancer.
“Now that we found these results in the pilot trial, it’s very unlikely that the 5-year trial of free skin cancer screenings for all Germans will be terminated in July of this year,” Hauschild said.
For more information:
Breitbart EW. J Am Acad Dermatol. 2012;66:201-211.
Hauschild A. Is national skin cancer screening feasible? The German experience. Presented at: HemOnc Today Melanoma and Cutaneous Malignancies; March 22-23, 2013; New York.
Katalinic A. Cancer. 2012; 118:5395-5402.
Waldmann A. Arch Dermatol. 2012;148:903-910.
Waldmann A. Br J Cancer. 2012;106:970-974.
Disclosure: Hauschild reports no relevant financial disclosures.