Evaluation of a Population-Based Targeted Screening Approach for Skin Cancer with Long-Time Follow-Up in Austria including Potential Effects on Melanoma Mortality
by Wolfgang Brozek, Patrick Clemens, Hanno Ulmer, Nina Häring, Hans Concin, Emanuel Zitt and Gabriele Nagel
MDPI
Date : March 2024
DOI : 10.3390/cancers16071283
Simple Summary
To date, it remains unclear whether population-based skin cancer screening lowers melanoma-specific mortality. We herein evaluated a population-based skin cancer program that followed a pragmatic targeted screening approach conducted in the Austrian province Vorarlberg in 1989–1994 and examined possible effects on melanoma mortality in the general population during follow-up until 2019. Relative to the general population and participants of a health examination program, invasive and in situ melanoma incidences, as well as melanoma mortality, were increased. In the general population of Vorarlberg, however, melanoma mortality declined until 2004, though statistically non-significantly. Arguments for and against a contribution of the program are considered. Given the uncertain effectiveness of expensive population-wide mass screening programs, targeted risk-based skin cancer screening could be considered a viable cost-effective alternative strategy to prevent melanoma deaths.
Abstract
Background: whether screening for skin cancer affects melanoma-specific mortality in a population-based setting remains unclear. Methods: in this population-based cohort study, we characterized and evaluated a skin cancer prevention program following a targeted screening approach conducted in 1989–1994 in the Austrian province Vorarlberg, with follow-up until 2019. The general population and attendees of a health examination program served for comparison. Results: in the screening program including full follow-up until 2019, 207 invasive and 187 in situ melanomas were identified in 8997 individuals. Incidences of invasive and in situ melanomas were elevated compared to the general population (IRR 2.92, 95%-CI 2.49–3.41, and IRR 4.13, 95%-CI 3.53–4.83, respectively) and the health examination program (HR 3.02, 95%-CI 2.59–3.52, and HR 3.90, 95%-CI 3.30–4.61, respectively). Breslow thickness and Clark’s level at time of invasive diagnosis were significantly lower in 1989–2019, but the tumor characteristics of the melanomas diagnosed during 1989–1994 did not differ from the comparison groups. Moreover, melanoma mortality was significantly elevated in the screening program (IRR 1.66, 95%-CI 1.00–2.75 vs. the general population, HR 2.12, 95%-CI 1.25–3.61 vs. the health examination cohort). Melanoma mortality in Vorarlberg declined until 2004, though statistically non-significantly. Conclusions: given the uncertain effectiveness and high public expenditures of population-wide mass screening programs, primary prevention and targeted risk-based skin cancer screening might be promising alternatives. Keywords: skin cancer; melanoma; targeted screening; screening; epidemiology; prevention; mortality; Vorarlberg Health Monitoring and Promotion Program; VHM&PP
