Melanoma mortality following skin cancer screening in Germany

Abstract

Objectives: In 2003, a skin cancer screening campaign based on total body skin examination was launched in the federal state of Schleswig-Holstein, Germany. 20% of adults aged 20 and over were screened. In 2008, a 48% decline in melanoma mortality was reported. In the same year, skin screening was extended to the rest of Germany. We evaluated whether melanoma mortality trends decreased in Germany as compared with surrounding countries where skin screening is uncommon. We also evaluated whether the initial decreasing mortality trend observed in Schleswig-Holstein was maintained with a longer follow-up.

Setting and participants: Regional and national melanoma mortality data from 1995 to 2013 were extracted from the GEKID database and the Federal Statistical Office. Mortality data for Germany and surrounding countries from 1980 to 2012 were extracted from the WHO mortality database.

Primary and secondary outcome measures: Age-adjusted (European Standard Population) mortality rates were computed and joinpoint analysis performed for Schleswig-Holstein, Germany and surrounding countries.

Results: In Schleswig-Holstein, melanoma mortality rates declined by 48% from 2003 to 2008, and from 2009 to 2013 returned to levels observed before screening initiation. During the 5 years of the national programme (2008-2012), melanoma mortality rates increased by 2.6% (95% CI -0.1 to 5.2) in men and 0.02% (95% CI -1.8 to 1.8) in women. No inflexion point in trends was identified after 2008 that could have suggested a decreasing melanoma mortality. Trends of cutaneous melanoma mortality in Germany from 1980 to 2012 did not differ from those observed in surrounding countries.

Conclusions: The transient decrease mortality in Schleswig-Holstein followed by return to pre-screening levels could reflect a temporal modification in the reporting of death causes. An in-depth evaluation of the screening programme is required.

Keywords: Melanoma; Mortality; Screening.

Figure 1

Trend in cutaneous melanoma mortality in the screened area Schleswig–Holstein (SH) as compared with the whole of Germany. Data from the Federal Statistical Office (http://www.gbe-bund.de) as of 15 December 2014 and from GEKID as of 10 December 2014. Box=period of SCREEN project (Skin Cancer Research to Provide Evidence for Effectiveness of Screening in Northern Germany) (July 2003–June 2004).

Figure 2

Trend in cutaneous melanoma incidence in Germany. Data from GEKID as of 10 December 2014. Vertical line=introduction of screening at a national level. Note that for better display, Y-axis starts at 10 cases per 100 000 person-years.

Figure 3

Trend in cutaneous melanoma mortality in Germany and surrounding countries in (A) men and (B) women. Data from the WHO mortality database (November 2014 release). Each dot represents the actual age-standardised rate for each country and year, and the corresponding regression lines were computed by the joinpoint model.