Boniol Mathieu, Autier Philippe, Gandini Sara
University of Strathclyde Institute of Global Public Health at iPRI, International Prevention Research Institute, Lyon, France International Prevention Research Institute (iPRI), Lyon, France.
European Institute of Oncology, Milan, Italy.
BMJ Open. 2015 Sep 15;5(9):e008158. doi: 10.1136/bmjopen-2015-008158.
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.
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.
Age-adjusted (European Standard Population) mortality rates were computed and joinpoint analysis performed for Schleswig-Holstein, Germany and surrounding countries.
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.
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.
2003年，德国石勒苏益格－荷尔斯泰因州发起了一项基于全身皮肤检查的皮肤癌筛查活动。对20岁及以上的成年人进行了20%的筛查。2008年，报告称黑色素瘤死亡率下降了48%。同年，皮肤筛查扩展到德国其他地区。我们评估了与皮肤筛查不常见的周边国家相比，德国黑色素瘤死亡率趋势是否下降。我们还评估了石勒苏益格－荷尔斯泰因州最初观察到的死亡率下降趋势在更长的随访期内是否得以维持。
1995年至2013年的地区和国家黑色素瘤死亡率数据从GEKID数据库和联邦统计局提取。1980年至2012年德国及周边国家的死亡率数据从世界卫生组织死亡率数据库提取。
计算年龄调整（欧洲标准人口）死亡率，并对石勒苏益格－荷尔斯泰因州、德国及周边国家进行连接点分析。
在石勒苏益格－荷尔斯泰因州，黑色素瘤死亡率从2003年到2008年下降了48%，从2009年到2013年又回到了筛查开始前观察到的水平。在国家项目的5年期间（2008 - 2012年），男性黑色素瘤死亡率上升了2.6%（95%可信区间 -0.1至5.2），女性上升了0.02%（95%可信区间 -1.8至1.8）。2008年后未发现死亡率趋势的转折点，这可能表明黑色素瘤死亡率下降。1980年至2012年德国皮肤黑色素瘤死亡率趋势与周边国家观察到的趋势无差异。
石勒苏益格－荷尔斯泰因州死亡率短暂下降后又回到筛查前水平，这可能反映了死亡原因报告的时间性变化。需要对筛查项目进行深入评估。
