Nationwide skin cancer screening in Germany

Abstract

Skin cancer is the most frequent form of cancer. Altogether, every year in Germany more than 195,000 people are newly diagnosed as having skin cancer (basal cell, prickle cell, malignant melanoma carcinoma). The joint federal committee decided on the nationwide introduction of skin cancer screening from July 1st, 2008. Their decision was based on the results found in Schleswig-Holstein. From the age of 35 years, everyone has the right to an early diagnosis examination every two years. The worldwide largest quality assured skin cancer screening programme began in Germany. The objective of early screening for skin cancer is to discover malignant melanoma, basal cell carcinoma and spinocellular carcinoma in time. The examination includes targeted medical history, visual, according to the education program standardized full body inspection of the entire skin including the scalp and all intertriginous areas, findings report with related consultation and documentation. If the visual inspection of the skin by a general practitioner gives rise to suspicion of the presence of a target disease, then additional clarification by a specialist for skin and venereal diseases is to be performed. This physician carries out an additional full-body inspection, if he is not the first examiner, he checks in particular abnormal findings of the previous examiner and, where applicable, orders the histopathological examination to confirm the diagnosis. The histopathological evaluation can only be performed by pathologists as well as by dermatologists with additional credentials in dermatohistology corresponding to the stipulations of the respective further education ordinance. Obligatory prerequisite for approval by the responsible SHI-accredited physician association regarding the implementation and billing of early screening for skin cancer is proof of successful completion of an eight-hour further education program certified by the SHI-accredited physician association. The course must include the following subjects in particular: (1) potential benefits and risks of early screening measures, criteria for evaluating early screening measures (2) program for early screening, health examinations and early awareness of the patient (3) measures regarding how to address insurance holders (4) etiology of skin cancer, clinical pattern, frequency, risk factors or groups, medical history, standardized visual full-body inspection, visual diagnostics (5) process of early screening for skin cancer (6) presentation and discussion of case examples (7) documentation measures (8) interdisciplinary cooperation. The measures for ‘early screening of skin cancer’ are evaluated with regard to quality and goal achievement through regular evaluation of the documentation. During this process the National Association of Statutory Health Insurance Physicians and the Head Association of Health Insurance Funds agree on the type and scope of evaluation and publication. The objective parameters for the evaluation include in particular the following: (1) participant rates differentiated according to physician groups, age, sex (2) simultaneous utilization of the health screening by family doctors (3) number of suspected diagnoses differentiated according to physician groups (4) number of diagnoses confirmed by dermatologists (5) number of false-positive findings (6) detection rate (participant rate/number of discovered skin cancers and the histopathological grading) (7) evaluation differentiated according to the SHI-accredited physician association areas. To answer additional specific questions separate studies (e.g. for determining the number of false-negative findings, moving the diagnosis time forward) should be carried out. If necessary, the data from the routine documentation will be made available for this while adhering to the data protection guidelines.