Does skin cancer screening save lives? A detailed analysis of mortality time trends in Schleswig-Holstein and Germany

Abstract

Background: After a pilot study on skin cancer screening was performed between 2003 and 2004 in Schleswig-Holstein, Germany, the country implemented what to the authors' knowledge is the first nationwide skin cancer screening program in the world in 2008. The objective of the current study was to provide details regarding mortality trends in Schleswig-Holstein and Germany in relation to the screening.

Methods: Annual age-standardized mortality rates for skin melanoma (using the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems [ICD-10] code C43) and malignant neoplasms of ill-defined, secondary, and unspecified sites (ICD-10 code C76-C80) were analyzed. The European Standard population was used for age standardization. A bias analysis was performed to estimate the number of skin melanoma deaths that may have been incorrectly counted as ICD-10 code C76-C80 when the skin melanoma mortality declined in Schleswig-Holstein.

Results: The observed mortality decline in Schleswig-Holstein 5 years after the pilot study was accompanied by a considerable increase in the number of deaths due to malignant neoplasms of ill-defined, secondary, and unspecified sites (ICD-10 code C76-C80) that is not explainable by an increase in the incidence of these neoplasms. Incorrect assignment of 8 to 35 and 12 to 23 skin melanoma deaths per year among men and women, respectively, as ICD-10 code C76-C80 during 2007 through 2010 could explain the transient skin melanoma mortality decline observed in Schleswig-Holstein. Five years after implementation of the program, the nationwide skin melanoma mortality increased (age-standardized rate change of +0.4 per 100,000 person-years [95% confidence interval, 0.2-0.6] in men and +0.1 per 100,000 person-years [95% confidence interval, -0.1 to 0.2] in women).

Conclusions: Although the current analyses raise doubts that the skin cancer screening program in Germany can reduce the skin cancer mortality rate, the authors do not believe the program should be immediately stopped. Further in-depth evaluations are required. Cancer 2016;122:432-437. © 2015 American Cancer Society.

Keywords: incidence; mortality; neoplasms; screening; skin cancer.