European Journal of Epidemiology

, Volume 33, Issue 3, pp 303–312 | Cite as

Skin cancer rates in North Rhine-Westphalia, Germany before and after the introduction of the nationwide skin cancer screening program (2000–2015)

  • Andreas Stang
  • Karl-Heinz Jöckel
  • Oliver Heidinger


Germany is the first nation that implemented a nationwide skin cancer screening program in 2008. The aim is to study the effect of the program on skin cancer rates and to estimate the number needed to screen for an unselected and a hypothetical high-risk population in Germany. We used population-based data on skin cancer incidence (2000–2014), mortality, hospitalization and sick leave (2000–2015) from North Rhine-Westphalia, Germany (18 million population). We calculated annual age-standardized rates per 100,000 person years and calculated the relative change of the rates (%) including 95% confidence intervals (95% CI). Between 2007 and 2014, the estimated annual percentage change (EAPC) of the age-standardized incidence rate of skin melanoma was 3.8% among men and women. These increases were accompanied by increases of the age-standardized mortality rates (EAPC men 3.2%, women 2.0%) and age-standardized sick leave rates (EAPC men 11.0%, women 6.1%). Hospitalization rates showed barely any change. All types of rates for nonmelanoma skin cancer showed marked increases. The number needed to screen for skin melanoma death would be 34,000 if the risk reduction due to screening would be 50%. In a hypothetical high-risk approach with 10% of the population at high risk, that is, a relative risk of melanoma death of 4.0, a skin melanoma mortality risk reduction of 50% among these people due to screening would result in a reduction of the skin melanoma mortality by 15% in the total population. However, this reduction would require a number needed to screen of 11,141. Seven years after the introduction of the skin cancer screening program, there is no discernible beneficial effect at population level. The estimated number needed to screen for skin melanoma in an unselected approach is high and a realistic high-risk approach is currently not feasible.


Skin neoplasms Melanoma Incidence Mortality Screening Hospitalization Germany 



Dr. Stang receives a grant from the German Federal Ministry of Education and Science (BMBF), Grant Number 01ER1305. The epidemiological cancer registry is permanently funded by the state of North Rhine-Westphalia and covers all operating costs of the epidemiological registry. The clinical cancer registry is permanently funded by the statutory and private health insurances and covers 90% of the operating costs of the clinical registry. The remaining 10% are covered by the state of North Rhine-Westphalia. The Charity German Cancer Aid funded implementation costs of the complex systems and infrastructures to support the obligatory electronical transmission paths for clinical and epidemiological cancer registration.

Supplementary material

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Supplementary material 1 (DOCX 255 kb)


  1. 1.
    Katalinic A, Waldmann A, Weinstock MA, et al. Does skin cancer screening save lives?: an observational study comparing trends in melanoma mortality in regions with and without screening. Cancer. 2012;118(21):5395–402.CrossRefPubMedGoogle Scholar
  2. 2.
    Choudhury K, Volkmer B, Greinert R, Christophers E, Breitbart EW. Effectiveness of skin cancer screening programmes. Br J Dermatol. 2012;167(Suppl 2):94–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Breitbart EW, Choudhury K, Anders MP, et al. Benefits and risks of skin cancer screening. Oncol Res Treat. 2014;37(Suppl 3):38–47.CrossRefPubMedGoogle Scholar
  4. 4.
    Trautmann F, Meier F, Seidler A, Schmitt J. Effects of the German skin cancer screening programme on melanoma incidence and indicators of disease severity. Br J Dermatol. 2016;175(5):912–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Boniol M, Autier P, Gandini S. Melanoma mortality following skin cancer screening in Germany. BMJ Open. 2015;5(9):e008158.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Stang A, Jöckel KH. Does skin cancer screening save lives? A detailed analysis of mortality time trends in Schleswig-Holstein and Germany. Cancer. 2016;122(3):432–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Stang A, Garbe C, Autier P, Jöckel KH. The many unanswered questions related to the German skin cancer screening programme. Eur J Cancer. 2016;64:83–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Autier P, Koechlin A, Boniol M. The forthcoming inexorable decline of cutaneous melanoma mortality in light-skinned populations. Eur J Cancer. 2015;51(7):869–78.CrossRefPubMedGoogle Scholar
  9. 9.
    Eisemann N. Routine health data in skin cancer screening evaluation. Br J Dermatol. 2016;175(5):862.CrossRefPubMedGoogle Scholar
  10. 10.
    Eisemann N, Waldmann A, Geller AC, et al. Non-melanoma skin cancer incidence and impact of skin cancer screening on incidence. J Invest Dermatol. 2014;134(1):43–50.CrossRefPubMedGoogle Scholar
  11. 11.
    Waldmann A, Nolte S, Weinstock MA, et al. Skin cancer screening participation and impact on melanoma incidence in Germany–an observational study on incidence trends in regions with and without population-based screening. Br J Cancer. 2012;106(5):970–4.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Breitbart EW, Waldmann A, Nolte S, et al. Systematic skin cancer screening in Northern Germany. J Am Acad Dermatol. 2012;66(2):201–11.CrossRefPubMedGoogle Scholar
  13. 13.
    Organization WH. International statistical classification of diseases and related health problems. 10th ed. Geneva: World Health Organization; 1992.Google Scholar
  14. 14.
    Batzler WU, Bertram H, Hense HW, Kraywinkel K, Mattauch V, Krieg V. Epidemiologisches Krebsregistger Nordrhein-Westfalen. Report 2009.2009. 2 March 2017.
  15. 15.
    Lehnert M, Hense HW, Mattauch V, Krieg V. Krebserkrankungen im Regierungsbezirk Münster, Band 2: Bericht für die Jahre 1995-1999.2002. Accessed 2 March 2017.
  16. 16.
    Stang A, Kaab-Sanyal V, Hense HW, Becker N, Kuss O. Effect of mammography screening on surgical treatment for breast cancer: a nationwide analysis of hospitalization rates in Germany 2005–2009. Eur J Epidemiol. 2013;28(8):689–96.CrossRefPubMedGoogle Scholar
  17. 17.
    Stang A, Stausberg J. Inpatient management of patients with skin cancer in Germany: an analysis of the nationwide DRG-statistic 2005–2006. Br J Dermatol. 2009;161(Suppl 3):99–106.CrossRefPubMedGoogle Scholar
  18. 18.
    Stang A, Katalinic A, Dieckmann KP, Pritzkuleit R, Stabenow R. Network of German Cancer R. A novel approach to estimate the German-wide incidence of testicular cancer. Cancer Epidemiol. 2010;34(1):13–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Richtlinien des Gemeinsamen Bundesausschusses über die Beurteilung der Arbeitsunfähigkeit und die Maßnahmen zur stufenweisen Wiedereingliederung. 2014.
  20. 20.
    Nordrhein-Westfalen LfG. Daten für die Gesundheitsberichtserstattung in NRW. GBE Stat In: Nordrhein-Westfalen LfG, editor.; 2016.Google Scholar
  21. 21.
    Doll R, Cook P. Summarizing indices for comparison of cancer incidence data. Int J Cancer. 1967;2(3):269–79.CrossRefPubMedGoogle Scholar
  22. 22.
    Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409.CrossRefPubMedGoogle Scholar
  23. 23.
    Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet. 2010;375(9726):1624–33.CrossRefPubMedGoogle Scholar
  24. 24.
    Gesundheitswesen IfQuWi. IQWiG-Berichte – Nr. 288 Einladungsschreiben und Merkblatt zum Mammographie-Screening. 2015. Accessed 19 Jan 2017.
  25. 25.
    Cho E, Rosner BA, Feskanich D, Colditz GA. Risk factors and individual probabilities of melanoma for whites. J Clin Oncol. 2005;23(12):2669–75.CrossRefPubMedGoogle Scholar
  26. 26.
    Usher-Smith JA, Kassianos AP, Emery JD, Abel GA, Teoh Z, Hall S, Neal RD, Murchie P, Walter FM. Identifying people at higher risk of melanoma across the U.K.: a primary-care-based electronic survey. Br J Dermatol. 2017;176(4):939–948. Scholar
  27. 27.
    Williams LH, Shors AR, Barlow WE, Solomon C, White E. Identifying Persons at Highest Risk of Melanoma Using Self-Assessed Risk Factors. J Clin Exp Dermatol Res 2011;2(6):1000129.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Moloney FJ, Guitera P, Coates E, et al. Detection of primary melanoma in individuals at extreme high risk: a prospective 5-year follow-up study. JAMA Dermatol. 2014;150(8):819–27.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2017

Authors and Affiliations

  1. 1.Center for Clinical Epidemiology, c/o: Institute of Medical Informatics, Biometry and EpidemiologyUniversity Hospital EssenEssenGermany
  2. 2.School of Public Health, Department of EpidemiologyBoston UniversityBostonUSA
  3. 3.German Consortium for Translational Cancer ResearchPartner Site University Hospital EssenEssenGermany
  4. 4.Institute of Medical Informatics, Biometry and EpidemiologyUniversity Hospital EssenEssenGermany
  5. 5.Cancer Registry of North Rhine-Westphalia, MünsterMünsterGermany

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