Skin Cancer Screening In Germany Research Articles

Evaluation of skin cancer screening in Germany – Spatiotemporal associations between skin cancer screening and skin cancer mortality based on ambulatory claims data

SummaryBackgroundThere are regional differences in skin cancer screening uptake in Germany. So far, it is unclear whether a high uptake of screening services leads to a reduction in mortality. This article presents study results on the investigation of spatiotemporal associations between skin cancer screening and mortality. The methods used are discussed regarding their suitability.Material and methodsThe basis is ambulatory claims data on the utilization of early skin cancer detection as well as data on skin cancer mortality from the cause‐of‐death statistics of the years 2011–2015 at county level in Germany. In addition to a descriptive evaluation, spatiotemporal cluster analyses and regression models were used to investigate the relationship between the uptake of early detection and mortality. In addition to age, adjustments were also made for other selected socio‐economic and socio‐graphical variables.ResultsThe descriptive results show striking spatial patterns of skin cancer screening and mortality. Cluster analyses identified regions with significantly higher and lower cases of early detection and skin cancer mortality. The spatiotemporal regression analyses show no clear association. Only early detection by a dermatologist, adjusted for age, shows an association with mortality.ConclusionsNo clear association between early skin cancer detection and mortality can be derived from the results. However, the study design used with a spatiotemporal cluster and regression analysis has shown that these methods allow in‐depth statements about the relationship between early skin cancer detection and mortality.

Evaluation of skin cancer screening in Germany – participation, tumor detection and interval tumors based on SHI data

SummaryBackground and goalsThe rising incidence of skin cancer in Germany has increased the need for secondary prevention measures. For this purpose, a statutory skin cancer screening for insured persons aged 35 and older was introduced on 1 June 2008. The aim of this work package in the Innovation Fund project “Perspectives of a multimodal evaluation of early skin cancer detection” (Pertimo) was to test an evaluation of skin cancer screening using secondary data.Patients and methodsThe data basis was statutory insured persons of the DAK Health from the age of 35 who were insured as of 31 December 2010 and were followed up until the end of 2015. The rates of participation, skin tumors detected in skin cancer screening (tumor detections), and interval tumors that occurred within two years after a finding‐free skin cancer screening were calculated.ResultsThe biennial skin cancer screening take‐up rate in 2014 and 2015 was 33.6% for women and 32.6% for men. Of those screened, 4.2% had a skin cancer finding (tumor detection) in the course of skin cancer screening. Of all incident skin cancer diagnoses (2012–2015), 50.1% were detected in skin cancer screening. In 1.5% of the insured persons with skin cancer screening without findings, an incidental skin tumor was diagnosed in the following two years (interval tumor).ConclusionsThe data from the statutory health insurance mapped the skin cancer screening occurrence in Germany and highlighted the importance of dermatologists in the screening process. The analysis provided important new insights.

The impossibility of mortality evaluation of skin cancer screening in Germany based on health insurance data: a case–control study

BackgroundThe aim of this paper was to perform a mortality evaluation of skin cancer screening (SCS) in Germany using General Local Health Insurance Fund (AOK) data. MethodsAOK-insured men and women aged 35–99 years who died of cutaneous malignant melanoma in 2015–2016 were identified. Controls were AOK-insured people who survived to the end of each case's year of death. For each case, 10 controls were matched. The SCS history of each individual was reconstructed using the billing codes 01745 and 01746. ResultsIn total, 1037 melanoma deaths and 10,370 controls were included. Cumulative SCS prevalence increased among controls over calendar years, as expected (males and females, 2009: 13.5% and 12.5%; 2015: 52.1% and 55.1%). In contrast, among cases, cumulative SCS prevalence was already high in 2009 and did not show a monotonic increase over the years of diagnosis. Of the 1037 melanoma deaths, 224 (21.6%) had at least one SCS settled in the 12 months after diagnosis. DiscussionA mortality evaluation with health insurance data alone is not possible because SCS billing codes are not only used for real SCS but also for occasion-related diagnostic work-up of abnormal skin findings. A mortality evaluation with health insurance data requires an individual linking with data of the screening physician and the cancer registries.

Statutory skin cancer screening in Germany : Motivation and motives for participation versus nonparticipation

HintergrundIm Jahr 2008 wurde in Deutschland das gesetzliche Hautkrebsscreening (gHKS) für gesetzlich Versicherte ab 35 Jahren eingeführt. Primäres Ziel ist es, maligne Veränderungen der Haut frühzeitig zu diagnostizieren, die Mortalität zu reduzieren sowie die Morbidität und Lebensqualität zu verbessern. Obwohl das gHKS vor mehr als einer Dekade eingeführt wurde, wird dieses nur von einem Teil wahrgenommen.Ziel der ArbeitWelche Gründe bestehen für die geringe Teilnahmequote am gHKS in der berechtigten Normalbevölkerung?MethodikIn computergestützten Telefoninterviews mit einer repräsentativen Bevölkerungsstichprobe (N = 1015) gesetzlich Versicherter ab 18 Jahren wurden im Januar 2019 die Einstellung zum Thema Hautkrebs, die Rate der Inanspruchnahme des gHKS sowie die Gründe für die Nichtteilnahme erhoben. Ein Teil der Daten wurde mit vorausgehenden Erhebungen aus den Jahren 2011, 2013 und 2015 verglichen.ErgebnisseUnter den 1015 Teilnehmern wurde das Thema Hautkrebs von 40 % als besorgniserregend eingestuft. Zum gHKS waren 75,4 % der Befragten berechtigt. Von diesen hatten 52,6 % bisher noch nie am gHKS teilgenommen. Die Inanspruchnahme nahm im Alter jedoch zu. Ferner war die Nichtteilnehmerquote bei gehobenem Schulabschluss mit 45 % deutlich niedriger als bei niedrigem Schulabschluss mit 58 %. Der Anspruch auf das gHKS war 35 % der Nichtteilnehmer nicht bekannt. Als Grund für die Nichtteilnahme nannten 20 % Zeitmangel, 58 % sahen keine Notwendigkeit, weil sie sich gesund fühlen. Generell hielten aber 91 % aller 1015 Befragten Früherkennungsuntersuchungen für sinnvoll und hatten zu 66 % bereits an anderen Vorsorgeuntersuchungen teilgenommen.DiskussionDie mit etwa 50 % geringe Teilnehmerquote am gHKS sowie die abnehmende Besorgnis in der Bevölkerung um das Thema Hautkrebs legen nahe, dass eine weitere, auch risikogruppenorientierte Aufklärung der Bevölkerung über die Relevanz des Themas Hautkrebs notwendig ist.

Is the quality of skin cancer screening in Germany related to the specialization of the physician who performs it?: Results of a nationwide survey among participants of skin cancer screening.

Skin cancer screening (SCS) is an important measure for secondary prevention of skin cancer, which is the most common cancer type worldwide. This study aimed to describe patient-reported quality of SCS in Germany according to the specialization of the performing physician and different patient characteristics. Data from 1260 participants 35-65years of age (54.4% female) who underwent SCS and participated in National Cancer Aid Monitoring in 2019 were evaluated using chi-squared tests. Waiting times for SCS from a dermatologist were significantly longer than those for other physicians (31.1 versus [vs.] 15.7days; P<.001). Each body area examined during the standardized inspection was examined significantly more frequently by dermatologists than by other physicians (eg, upper body, 96.6% vs. 91.7%; P<.001). Dermatologists more often offered consultation for skin cancer prevention (74.0% vs. 67.6%; P=.026) and provided written information (47.8% vs. 34.8%; P<.001). Patients with statutory insurance had to pay more frequently for additional services during SCS from a dermatologist than from other physicians (24.7% vs. 17.1%, P=.012). Results of this study revealed differences in the provision of preventive information and the quality of visual examination during SCS between dermatologists and other physicians. These results highlight the need for quality assurance measures.

Costs of routine skin cancer screening in Germany: a claims data analysis.

In 2008, a routine skin cancer screening (rSCS) programme was implemented in Germany. Since then, its medical and economical effects have been evaluated and critically discussed. To compare costs for patients diagnosed with skin cancer with preceding rSCS vs. those diagnosed without rSCS. We conducted a retrospective observational study using claims data from a large German health insurance company for the period 2013-2016. We applied entropy balancing, difference-in-differences estimation and generalized linear models to compare costs for patients with cancer with and without rSCS. We conducted sensitivity analyses to test for the robustness of results. In total, 12790 patients with skin cancer were included in the analyses, of whom 6041 were diagnosed by rSCS. Treatment costs were €467 higher for patients in the control group (without rSCS). However, the screening costs were higher. For all people covered by the health insurance company, there were additional costs of €1339-1431 per patient with skin cancer diagnosed by rSCS. Thus, total costs, including costs for treatment and screening, were €872-964 higher for patients diagnosed by rSCS. Based on our analysis, rSCS has the potential to reduce treatment costs; however, the screening costs exceed these savings.

Skin cancer screening in Germany: review after ten years

In 2008, anationwide population-based skin cancer screening program was introduced in Germany. Its potential to reduce the skin cancer-related burden of disease is the subject of acontroversial debate. This article gives an overview on the epidemiology of cutaneous melanoma of the skin and nonmelanoma skin cancer, on the history and practice of the current program, and appraises the evidence of screening for skin cancer based on aselective search for literature and data.The incidence of skin cancer has increased markedly throughout the last decades. The available evidence indicates efficacy of screening for skin cancer, but on alow level. Randomized controlled trials are lacking and the available evidence is based largely on the pilot study SCREEN which was conducted in 2003/2004 in Schleswig-Holstein, Germany. Following this pilot study, amarked decline of melanoma mortality was observed. After implementation of nationwide skin cancer screening, amortality reduction has not appeared so far.Acomparison of nationwide skin cancer screening and the SCREEN project suggests alower intensity of the current screening program. Its process and outcome quality requires further investigations. Improved documentation allowing for alinkage between screening procedures conducted by nondermatologists and dermatologists is desirable. Personal invitations could help to reach individuals who currently make little or no use of skin cancer screening but might benefit from it.

Nationwide skin cancer screening in Germany: Evaluation of the training program.

In July 2008, the German statutory health insurance introduced a nationwide skin cancer screening program. Before the introduction, eligible physicians had to qualify to perform the screening test and counsel their patients on skin cancer screening. To educate physicians, a curriculum and training materials were developed. Since 2015 a revised curriculum and training materials have been used. The purpose of this paper is to provide information about the curriculum and to evaluate the revised training program. A total of 573 completed pre- and posttests were analyzed with regard to changes in the identification of skin cancer, diagnostic accuracy, knowledge, and physicians' self-assessed-confidence. For statistical analysis, Mann-Whitney U test, Cohen's d, and chi-square test were used. General practitioners (GPs) diagnosed 7.45 of 12 skin lesions correctly before and 9.26 after the training course (P < 0.001). Compared to GPs, dermatologists' accuracy was higher at pre- and posttest (pre: 10.03, post: 10.21, P = 0.160). The mean of correctly answered questions increased significantly in knowledge on screening and early detection (4.46-5.14, P < 0.001) as well as skin cancer and skin cancer screening (5.51-6.39, P < 0.001). Participating physicians got a comprehensive understanding of skin cancer screening and counseling through the training and increased their diagnostic skills. In particular, GPs identified and diagnosed significantly more skin lesions correctly after the training compared to before the training, while dermatologists' diagnostic skills were high at both times, before and after.

Participation and health care provision of statutory skin cancer screening in Germany - a secondary data analysis.

In Germany, skin cancer screening was introduced nationwide in July 2008. From the age of 35 years, members of the statutory health insurance are eligible for screening every 2 years. The aim of this study is to calculate the participation rates and the proportions of health care providers of statutory skin cancer screening in Germany on a population-based level. Data were provided by a nationwide German statutory health insurance, approximately 6.1 million members, covering the years 2008/2009. Participation rates were calculated per yearly quarter and were adjusted for age, gender and federal state. Approximately 920,000 insurants were screened from the third quarter of 2008 until the last quarter of 2009. Mean participation rate of skin cancer screening was 30.8%. Women had higher participation rates (31.9%) than men (29.7%). After adjusting for gender and federal state, high rates for pensioners at the age of 65-74 were confirmed at 39.4% on average for all yearly quarters. One of the highest gender- and age-adjusted rates was observed in the state of Schleswig-Holstein, where a population based pilot project had been implemented before the start of the nationwide screening programme. In general, without taking into account Berlin, former East Germany had a much lower gender- and age-adjusted participation rate (23.9%) than West Germany (33.3%). At the first quarter after implementation of screening, 58.5% of the screenings were provided by dermatologists and 41.5% by general practitioners. Participation rates and health care providers of skin cancer screening can be calculated from secondary data and contribute to identify group- and region-specific participation patterns in order to improve early detection of skin cancer.

Skin Cancer Screening in Germany

Nationwide skin cancer screening was introduced in Germany in 2008. The positive results of a pilot project carried out in 2003-4 in the federal state of Schleswig-Holstein had implied that screening would lower the mortality from melanoma. Data on the incidence of invasive malignant melanoma of the skin (MM; ICD-10: C43) were extracted from the databases of the Association of Population-based Cancer Registries in Germany (GEKID) and from the Schleswig-Holstein cancer registry. Mortality rates were extracted from the official cause-of-death statistics. With the beginning of nationwide screening in 2008, the age-standardized incidence rate in Germany increased by approximately 28% to 18.2 cases per 100 000 persons in 2010. In Schleswig-Holstein, the incidence fell after the pilot project ended and has been comparable to the nationwide incidence since 2008. For Germany overall, there has been no downward trend in MM mortality since the introduction of nationwide screening; in 2013, the mortality rate was 2.3 deaths per 100 000 persons per year. In the area of the pilot study, mortality declined to a level of 1.0/100 000/year until 2008 and then began to rise again. At present, the mortality due to MM in Schleswig- Holstein is once again the same as that in Germany overall (2.4/100 000/year). The introduction of nationwide skin cancer screening in 2008 has not yet led to any measurable decline in mortality due to melanoma. The current method of screening seems to be less thorough than that used in the pilot project; this may explain the absence of a decline in MM-related mortality in Germany overall up to the year 2013, as well as the rising mortality in Schleswig-Holstein since the end of the pilot program. The generation of a robust set of data on how skin cancer screening can be optimized now seems urgently necessary.

Melanoma mortality following skin cancer screening in Germany

ObjectivesIn 2003, a skin cancer screening campaign based on total body skin examination was launched in the federal state of Schleswig-Holstein, Germany. 20% of adults aged 20 and over were...

Skin cancer screening in Germany : The situation in 2014 with suggestions for the future

Based on the skin cancer screening model of Germany a critical statement is presented about skin cancer epidemiology, the total body examination and time intervals. The number of skin cancer cases will increase and the number of dermatologists will probably decrease; thus a fundamental and pragmatic strategy is required for further education and planning to comply with the increased dermato-oncological demand of an aging population. Hereby dermoscopy should be a basic diagnostic tool for the early recognition of skin cancer and precursors as well as to avoid unnecessary excisions of benign skin lesions. The excision ratio between malignant and benign skin tumours should be optimized.

Skin cancer prevention

Prevention signifies the avoidance of diseases. It also includes the early detection of diseases and taking measures to avoid worsening of an existing disease. Prevention is divided into primary, secondary and tertiary prevention. The prevention of skin cancer is particularly important due to the rising incidence of skin cancer in recent years. In Germany, 195.000 new cases of skin cancer, including non melanoma skin cancer and melanoma are occurring. Therefore, skin cancer is among the most common cancer diseases. Primary prevention comprises the reduction of skin cancer risk behavior, including education about the danger of UV exposure and the right way of dealing with natural and artificial UV radiation. The implementation of a systematic skin cancer screening in Germany contributes to secondary prevention. First data from the initial project in Schleswig-Holstein, Germany's most northern state, indicate for the first time that the incidence and mortality of melanoma can be reduced by secondary prevention. For tertiary prevention, the national associations recommend a risk-adapted, evidence-based follow-up for all types of skin cancer. From the perspectives of the payers and from the patients, prevention is assessed positively. Prevention can contribute to a reduction of disease burden.

Routine Skin Cancer Screening in Germany: Four Years of Experience from the Dermatologists' Perspective

Background: In 2008, routine skin cancer screening (rSCS) was introduced into routine care for persons ≥35 years in Germany. To date, about 95% of approximately 3,500 office-based dermatologists participate in this program paid by the statutory health insurances. Objective: To evaluate German rSCS from the dermatologists' perspective. Methods: Since 2009, every year standardized questionnaires were sent nationwide to about 2,000 dermatologists, once yearly addressing the actual patients, screenings and treatments, the personal experiences and the dermatologists' attitudes towards rSCS. Descriptive data analysis from 2009, 2010 and 2011 was performed. Results: The average dermatologist -performed 1,380/1,364/1,348 screenings annually (2009/ 2010/2011), with a mean remuneration of EUR 21.50/22.10/ 21.93. 32.9/46.6/53.3% of the dermatologists were rather or very satisfied with rSCS, and a rising number of dermatologists (69.4/80.0/83.1%) perceived a better quality of health care for skin cancer since 2008. Conclusion: rSCS is widely accepted by German dermatologists and is conducted with increasing frequency.

Reducing mortality in individuals at high risk for advanced melanoma through education and screening

Incidence and mortality rates of melanoma throughout most of the developed world have increased in the past 25 years. We propose that reduction of deaths from melanoma can be best enhanced by strong collaborations between experts in dermatology, primary care, oncology, cancer education and health systems research, epidemiologists, and behavioral scientists, among others. Public and professional educational campaigns should be guided by an understanding of 3 underlying but overlapping roots: epidemiology and preventable mortality (an understanding of who is most likely to be given the diagnosis of thick or late-stage melanoma), biology (an investigation of tumor types that are relatively common but potentially most lethal), and sociology (an analysis of the changes needed in social structures to improve access to those most in need of early detection programs). We review these major concepts, concentrating on the key risk factors for advanced melanoma.

Skin cancer screening in Germany – perception by the public

In 2008, community skin cancer screening (cSCS) was introduced into routine care of the German statutory health insurances (SHI). In the meantime, more than 13 million individuals have been screened. To date, no data are available on the perception of cSCS by the general public. Evaluation of public perception of cSCS in Germany. From 10 to 17th March 2011, a phone survey on a population-based sample of n = 1 014 German adults with SHI status was conducted by the Forsa Institute, including 12 questions on the use, knowledge and attitude regarding cSCS. Of the interviewees 48 % were concerned about skin cancer, 29 % of all persons and 31 % of those eligible had already undergone cSCS. Of these, a major proportion (80 %) had been screened by dermatologists. Of the interviewees 75 % would (again) consult a dermatologist for the next cSCS, and less than 10 % would consult the general practitioner. Although about 93 % considered health screenings useful, only 44 % were informed about the legal right to undergo free cSCS after the age of 35. In Germany cSCS is highly accepted in the community. Leading care providers are the dermatologists. Knowledge about the right to free cSCS needs better public propagation.

Nationwide skin cancer screening in Germany

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.

Routine skin cancer screening in Germany: First data on the impact on health care in dermatology

On July 1st 2008, community skin cancer screening (cSCS) was established in routine care of the German statutory health insurances (SHI). This study aimed at gathering preliminary data on the impact of community SCS on health care provision in German dermatology practices. Standardized questionnaires were sent to about 2,000 German dermatology practices. Data were analyzed descriptively and with bivariate tests. In total, 693 (34.7%) questionnaires were returned. Each practice performed an average of 354 SCS per quarter, the mean payment being euro 21.50. About 78% named an increase in SCS with an average increase of 36.7%. About 54% of practices performed SCS under SHI payment combined with individual health services paid by the patients ("IGeL"), 38% only as SHI and 8% exclusively as "IGeL". In 85% of practices, the number of surgical procedures had increased since the start of community SCS. 40% had an increase in drug prescriptions related to SCS. 32% were satisfied with SCS, while 40% were unsatisfied. 29 % would prefer SCS only as covered by SHI, 29% only as IGeL, and 42% in a combined fashion. 70% regarded the quality of health care of patients with skin cancer in Germany better since the introduction of cSCS. Dermatologists in Germany have mainly accepted their role in providing skin cancer as standard care covered by SCS. The regulatory and economic conditions for this need further improvement.

A nationwide population-based skin cancer screening in Germany: Proceedings of the first meeting of the International Task Force on Skin Cancer Screening and Prevention (September 24 and 25, 2009)

Skin cancer incidence is increasing worldwide in white populations and mortality rates have not declined throughout most of the world. An extraordinarily high proportion of at-risk individuals have yet to be screened for melanoma but guidelines from esteemed bodies do not currently endorse population-based screening. Evidence for the effectiveness of skin cancer screening is imperative. To this end, scientists in Germany have launched a nationwide skin cancer screening campaign. Herein, we review pilot screening data from Schleswig-Holstein, discuss the launch of the major new national initiative, review issues related to evaluation of that program, and propose seven recommendations from the International Task Force on Skin Cancer Screening and Prevention that was held in Hamburg, Germany, on September 24 and 25, 2009.