gms | German Medical Science

Indroduction: Incidence of skin cancer is increasing constantly over the last years. For malignant melanoma a doubling of age-standardized incidence rates can be observed within the last ten years for Germany. About 13,700 new cases are diagnosed every year and the 5-year prevalence is estimated with 40,000 to 50,000 cases. In Schleswig-Holstein (SH), which has the highest incidence rate in Germany, a country wide skin cancer screening was performed for one year. Using data from the epidemiological cancer registry we analysed its population based effects on incidence and tumour stage.

Methods: Skin cancer (malignant melanoma ICD-10: D03/C43 and non melanotic skin cancer D04/C44) is recorded for the whole area of SH by the local cancer registry with a completeness of more than 95%. The epidemiologic data of the cancer registry will be compared for both cancer sites in the year before (Jul02/Jun03) and the year during the screening. Age-standardized incidence rates (Europe standard) and stage distribution according to the UICC will be used.

Results: Age-adjusted incidence of malignant melanoma (including in situ) increased in men from 21.5/100,000 (before screening) to 24.9/100,000 (during screening) (+16%). For women a clearly higher increase of 29% was observed (before: 27.7/100,000, during: 35.7/100,000). Looking only at melanoma in situ, an increase by 29% was found. Also the incidence of non melanotic skin cancer (including in situ) increased by 18% (men: 12%, women 25%). During the screening period tumour stage distribution for malignant melanoma was more favourable than before. UICC stage ‘0’ was detected in 56.3% before and in 58.9% during the screening. Stage I increased from 32.7% to 34.3%, advanced stages (II-IV) decreased from 10.9% to 6.7%.

Discussion: During the one-year period of skin cancer screening in Schleswig-Holstein typical effects of new screening programmes could be observed: increasing incidence and stage shift towards favourable tumours. Taking into account that only 28% of the target population attended to the screening, the population based effect is remarkable. The significant differences in the increase of incidence between men and women can be explained by different participation rates. In fact more women than men (3:1) attended to the screening programme. We consider that the external evaluation of screening programmes with data of an epidemiological cancer registry can give important evidence on its effectiveness.