Association of Dermatological Prevention, Hamburg, Germany.
J Am Acad Dermatol. 2012 Feb;66(2):201-11. doi: 10.1016/j.jaad.2010.11.016. Epub 2011 Nov 8.
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.
The main aim of the project was to evaluate the feasibility of systematic skin cancer screening.
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.
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).
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.
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.
皮肤癌的发病率在全球范围内呈上升趋势。几十年来，一直进行机会性黑色素瘤筛查以应对这一负担。然而，尽管有降低发病率和死亡率等潜在积极影响，但仍缺乏关于有组织皮肤癌筛查可行性和有效性的证据。
该项目的主要目的是评估系统性皮肤癌筛查的可行性。
2003 年，皮肤病预防协会受委托在德国石勒苏益格-荷尔斯泰因州实施基于人群的 SCREEN 项目（皮肤癌研究为德国北部的筛查提供有效性证据）。实施了一项针对恶性黑色素瘤和非黑色素瘤性皮肤癌的两步方案。在 12 个月的研究期间，有法定健康保险的公民（年龄≥20 岁）有资格接受标准化全身检查。利用癌症登记处和死亡率数据评估初步效果。
在 188 万符合条件的公民中，有 360288 人参加了 SCREEN。总体人群参与率为 19%。共发现 3103 例恶性皮肤肿瘤。在人群水平上，SCREEN 期间侵袭性黑色素瘤的发病率增加了 34%。SCREEN 五年后，黑色素瘤死亡率显著下降（男性：观察到 0.79/100000，预期为 2.00/100000；女性：观察到 0.66/100000，预期为 1.30/100000）。
由于政治原因（抵抗以及德国主要医疗保健利益相关者的缺乏支持），无法进行随机对照试验。
该项目表明，大规模系统的皮肤癌筛查是可行的，并且有可能降低皮肤癌负担，包括死亡率。基于 SCREEN 的结果，德国于 2008 年实施了国家法定皮肤癌早期检测计划。
