Center for Clinical Epidemiology, c/o: Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
School of Public Health, Department of Epidemiology, Boston University, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA.
Eur J Epidemiol. 2018 Mar;33(3):303-312. doi: 10.1007/s10654-017-0348-6. Epub 2018 Jan 2.
Germany is the first nation that implemented a nationwide skin cancer screening program in 2008. The aim is to study the effect of the program on skin cancer rates and to estimate the number needed to screen for an unselected and a hypothetical high-risk population in Germany. We used population-based data on skin cancer incidence (2000-2014), mortality, hospitalization and sick leave (2000-2015) from North Rhine-Westphalia, Germany (18 million population). We calculated annual age-standardized rates per 100,000 person years and calculated the relative change of the rates (%) including 95% confidence intervals (95% CI). Between 2007 and 2014, the estimated annual percentage change (EAPC) of the age-standardized incidence rate of skin melanoma was 3.8% among men and women. These increases were accompanied by increases of the age-standardized mortality rates (EAPC men 3.2%, women 2.0%) and age-standardized sick leave rates (EAPC men 11.0%, women 6.1%). Hospitalization rates showed barely any change. All types of rates for nonmelanoma skin cancer showed marked increases. The number needed to screen for skin melanoma death would be 34,000 if the risk reduction due to screening would be 50%. In a hypothetical high-risk approach with 10% of the population at high risk, that is, a relative risk of melanoma death of 4.0, a skin melanoma mortality risk reduction of 50% among these people due to screening would result in a reduction of the skin melanoma mortality by 15% in the total population. However, this reduction would require a number needed to screen of 11,141. Seven years after the introduction of the skin cancer screening program, there is no discernible beneficial effect at population level. The estimated number needed to screen for skin melanoma in an unselected approach is high and a realistic high-risk approach is currently not feasible.
德国是 2008 年第一个实施全国性皮肤癌筛查计划的国家。其目的是研究该计划对皮肤癌发病率的影响，并估算在德国对非选择性和假设高危人群进行筛查所需的人数。我们使用了德国北莱茵-威斯特法伦州基于人群的皮肤癌发病率（2000-2014 年）、死亡率、住院率和病假率（2000-2015 年）数据。我们计算了每 10 万人年的年龄标准化率，并计算了包括 95%置信区间（95%CI）在内的发病率（%）的相对变化。2007 年至 2014 年，男性和女性皮肤黑色素瘤的年龄标准化发病率的估计年平均变化率（EAPC）为 3.8%。这些增加伴随着年龄标准化死亡率（EAPC 男性 3.2%，女性 2.0%）和年龄标准化病假率（EAPC 男性 11.0%，女性 6.1%）的增加。住院率几乎没有变化。所有非黑色素瘤皮肤癌类型的发病率均显著增加。如果筛查的风险降低 50%，则筛查黑色素瘤死亡人数将为 34000 人。在一种假设的高危方法中，将 10%的人口视为高危人群，即黑色素瘤死亡的相对风险为 4.0，那么这些人中由于筛查导致黑色素瘤死亡率降低 50%，将导致总人口中黑色素瘤死亡率降低 15%。然而，这需要进行 11141 次筛查。在皮肤癌筛查计划实施 7 年后，目前在人群层面还没有发现明显的有益效果。在非选择性方法中估计需要筛查的黑色素瘤人数较高，目前也无法实现现实的高危方法。
