Population Skin Cancer Screening and Melanoma Mortality Rates

Le résumé fourni par la source

Importance: In Germany, a population-based skin cancer screening (SCS) program was implemented in 2008. The benefit of the intervention is unclear. Objective: To determine whether the German SCS program was associated with reduced melanoma mortality. Design, Setting, and Participants: This population-based, ecological comparative effectiveness study compared trends in melanoma mortality from 2009 to 2022 in Germany with those in neighboring countries without population-based SCS using data on melanoma mortality from the official cause-of-death statistics. The total populations of 15 federal states of Germany and 9 neighboring countries were examined. The German federal state of Schleswig-Holstein was excluded from the analysis due to a potential lasting effect of a preceding pilot project, conducted in 2003 and 2004. Data were analyzed from November 7, 2025, to February 11, 2026. Exposure: The German SCS program entitles men and women aged 35 years and older to a visual skin examination every 2 years, regardless of their individual skin cancer risk. The 2-year participation rate was estimated at approximately 32%. Main Outcomes and Measures: Pooled estimates of annual percentage changes (APCs) in age-standardized melanoma mortality rates in German and non-German control regions were calculated using a random-effects model. Results: Data include a mean of 79.1 million inhabitants in Germany and 164.8 million inhabitants in 9 neighboring countries. Between 2009 and 2022, age-standardized melanoma mortality rates decreased in each included region. In Germany, APCs ranged from -3.8% (95% CI, -5.5% to -2.2%) to -0.1% (95% CI, -1.7% to 1.5%). In the control regions, mortality rates decreased between -3.8% (95% CI, -4.9% to -2.7%) and -1.0% (95% CI, -1.9% to -0.2%) per year. Pooled APC estimates are -1.8% (95% CI, -2.3% to -1.4%) for Germany and -2.2% (95% CI, -2.8% to -1.6%) for the non-German control regions; the difference was not statistically significant (P = .42). Conclusions and Relevance: The findings of this ecological study are in line with previous studies that failed to show a melanoma mortality benefit associated with the German SCS program. To enable a well-founded decision on the future of the program, the causes of its poor performance should be investigated.

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