Article
Impact of skin cancer screening and secondary prevention campaigns on skin cancer incidence and mortality: a systematic review
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Published: | February 23, 2016 |
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Background: Based on one observational study, the German S3-guideline “prevention of skin cancer” recommends skin cancer screening (SCS). The German Society for General and Family Medicine dissented though, rating the evidence for benefits of a general SCS as insufficient. The benefit of SCS is still controversially discussed.
Objective: To update the evidence on the impact of SCS and secondary prevention campaigns on skin cancer incidence, mortality, stage-specific incidence, and interval carcinomas.
Methods: We systematically searched for studies published between January 1, 2005 and February 4, 2015 assessing the impact of skin cancer screening or secondary prevention campaigns on skin cancer incidence, mortality, stage-specific incidence, or interval carcinomas. We searched MEDLINE and EMBASE for publications in English or German and checked reference lists for relevant studies. Two reviewers independently performed title and abstract screening, data extraction and critical appraisal. For the latter we used checklists of the NICE Institute. Results were described in a narrative synthesis.
Results: Of 2066 records identified in databases and ten additional records from manual search, we assessed 204 full-text articles for eligibility and included 14 articles. Results of included studies indicate that SCS and secondary prevention campaigns lead to more skin cancer diagnoses. One cohort study and a registry study (three publications) showed an increase in incidence of melanoma in situ. Screening implementation also increased incidence of invasive melanoma, but after cessation incidence decreased and was lower than before screening.
Registry studies from Germany and France, a cohort study from the USA and a case-control study from Australia examined the impact of SCS on stage-specific incidence. They reported an increased incidence of thin melanoma and a decrease in incidence of thick melanoma.
The influence of SCS on melanoma mortality was investigated in four publications. Two articles based on a German screening project showed a significant reduction in melanoma mortality in the federal state of Schleswig-Holstein. In a registry study from Australia and a cohort study from the USA, fewer deaths were observed than expected.
We did not identify any published study on interval carcinomas.
Conclusions: The body of evidence has grown by large registry studies, a cohort study and a case-control study, but randomized controlled trials are still lacking.