Original article
Systematic skin cancer screening in Northern Germany

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Background

The incidence of skin cancer is increasing worldwide. For decades, opportunistic melanoma screening has been carried out to respond to this burden. However, despite potential positive effects such as reduced morbidity and mortality, there is still a lack of evidence for feasibility and effectiveness of organized skin cancer screening.

Objective

The main aim of the project was to evaluate the feasibility of systematic skin cancer screening.

Methods

In 2003, the Association of Dermatological Prevention was contracted to implement the population-based SCREEN project (Skin Cancer Research to Provide Evidence for Effectiveness of Screening in Northern Germany) in the German state of Schleswig-Holstein. A two-step program addressing malignant melanoma and nonmelanocytic skin cancer was implemented. Citizens (aged ≥20 years) with statutory health insurance were eligible for a standardized whole-body examination during the 12-month study period. Cancer registry and mortality data were used to assess first effects.

Results

Of 1.88 million eligible citizens, 360,288 participated in SCREEN. The overall population-based participation rate was 19%. A total of 3103 malignant skin tumors were found. On the population level, invasive melanoma incidence increased by 34% during SCREEN. Five years after SCREEN a substantial decrease in melanoma mortality was seen (men: observed 0.79/100,000 and expected 2.00/100,000; women: observed 0.66/100,000 and expected 1.30/100,000).

Limitations

Because of political reasons (resistance as well as lack of support from major German health care stakeholders), it was not possible to conduct a randomized controlled trial.

Conclusions

The project showed that large-scale systematic skin cancer screening is feasible and has the potential to reduce skin cancer burden, including mortality. Based on the results of SCREEN, a national statutory skin cancer early detection program was implemented in Germany in 2008.

Section snippets

The SCREEN project

The project was carried out between July 2003 and June 2004 in Schleswig-Holstein, the northernmost state of Germany. Of 2.8 million inhabitants, 1.88 million met the eligibility criteria: resident of Schleswig-Holstein, age 20 years or older, and policyholder of statutory health insurance, which applies to approximately 85% of the German population. People receiving skin cancer aftercare or active treatment were excluded.

The project did not require ethical approval as skin cancer screening

The SCREEN project

High participation rates of the practice-based physicians were achieved, with 116 of 118 dermatologists (98%) and 1673 of 2614 eligible nondermatologists (64%) taking part in the SCREEN project. A total of 360,288 inhabitants of Schleswig-Holstein were examined during the 1-year screening period. Table I and Fig 1 provide an overview of the results of the project. The male to female ratio was 1:3. In all, 278,741 (77.4%) participants chose pathway A (step 1: nondermatologist) of whom 26.4% were

Discussion

The SCREEN project is the world’s largest systematic population-based skin cancer screening program. One aim of our project was to investigate the feasibility of a systematic population-based skin cancer screening intervention. With 98% of dermatologists and almost two thirds of nondermatologists attending the 1-day training course, participation rates suggest high acceptance of skin cancer screening (ie, whole-body examination) among physicians.

An ad hoc participation of the population of 19%

References (24)

  • J.L. Bulliard et al.

    Evaluation of the Euromelanoma skin cancer screening campaign: the Swiss experience

    J Eur Acad Dermatol Venereol

    (2008)
  • A. Stratigos et al.

    Melanoma/skin cancer screening in a Mediterranean country: results of the Euromelanoma screening day campaign in Greece

    J Eur Acad Dermatol Venereol

    (2007)
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    Supported by German Cancer Aid (Deutsche Krebshilfe e. V.), the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung), and the head associations of health insurance funds (Spitzenverbände der Krankenkassen).

    Conflicts of interest: None declared.

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