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Association between risk factors and detection of cutaneous melanoma in the setting of a population-based skin cancer screening

Hübner, Joachima; Waldmann, Annikaa; Eisemann, Noraa; Noftz, Mariaa; Geller, Alan C.c; Weinstock, Martin A.d,e,f; Volkmer, Beateg; Greinert, Rüdigerg; Breitbart, Eckhard W.h; Katalinic, Alexandera,b

European Journal of Cancer Prevention: November 2018 - Volume 27 - Issue 6 - p 563–569
doi: 10.1097/CEJ.0000000000000392
Research Papers: Skin Cancer

Early detection is considered to improve the prognosis of cutaneous melanoma. The value of population-based screening for melanoma, however, is still controversial. The aim of this study was to evaluate the predictive power of established risk factors in the setting of a population-based screening and to provide empirical evidence for potential risk stratifications. We reanalyzed data (including age, sex, risk factors, and screening results) of 354 635 participants in the Skin Cancer Research to provide Evidence for Effectiveness of Screening in Northern Germany (SCREEN)project conducted in the German state of Schleswig-Holstein (2003–2004). In multivariable analysis, atypical nevi [odds ratio (OR): 17.4; 95% confidence interval (CI): 14.4–20.1], personal history of melanoma (OR: 5.3; 95% CI: 3.6–7.6), and multiple (≥40) common nevi (OR: 1.3; 95% CI: 1.1–1.6) were associated with an increased risk of melanoma detection. Family history and congenital nevi were not significantly associated with melanoma detection in the SCREEN. The effects of several risk-adapted screening strategies were evaluated. Hypothesizing a screening of individuals aged more than or equal to 35 years, irrespective of risk factors (age approach), the number needed to screen is 559 (95% CI: 514–612), whereas a screening of adults (aged ≥20) with at least one risk factor (risk approach) leads to a number needed to screen of 178 (95% CI: 163–196). Converted into one screen-detected melanoma, the number of missed melanomas is 0.15 (95% CI: 0.12–0.18) with the age approach and 0.22 (95% CI: 0.19–0.26) with the risk approach. The results indicate that focusing on individuals at high risk for melanoma may improve the cost-effectiveness and the benefit-to-harm balance of melanoma screening programs.

aInstitute of Social Medicine and Epidemiology

bInstitute of Cancer Epidemiology, University of Lübeck, Lübeck, Germany

cDepartment of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

dCenter for Dermatoepidemiology, VA Medical Center Providence

eDepartment of Dermatology, Rhode Island Hospital, Providence

fDepartments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA

gDermatology Center, Division of Molecular Cell Biology, Elbe Clinics Stade-Buxtehude, Buxtehude

hAssociation of Dermatological Prevention e.V., Hamburg, Germany

Correspondence to Joachim Hübner, MD, Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany Tel: +49 451 500 51216; fax: +49 451 500 51204; e-mail: joachim.huebner@uksh.de

Received September 27, 2016

Accepted June 12, 2017

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.