Skin cancer screening: Does it help?

When more people are screened for skin cancer, more malignant tumors are found, according to results from a recent German study. What s more, a related study found that, following the introduction of a state-wide screening program, deaths from skin cancer fell by about 50 percent. It remains an open question, however, whether the screenings are actually responsible for the lowered rate.

For their study, published in The Archives of Dermatology, the researchers examined data from a skin cancer screening program that was conducted in a single German state between 2003 and 2004. The data drew from the screenings of over 360,000 people aged 20-50 years; of these patients, 16,000 had a biopsy, and doctors identified 3,100 malignant tumors over 500 of which were dangerous melanomas among this cohort. That works out to 116 people screened and five people biopsied in order to find one malignant tumor a rate that is quite good, said one of the study s co-authors.

As for the corresponding drop in death rates, the researchers can t be sure whether to attribute it to the screening itself or to an increased awareness of skin cancer. There does seem to be some kind of relationship, though, between the screening program and the lowered death rates: The rate of skin cancer deaths in nearby regions without screening saw no change during the same period. However, ACSH's Dr. Gilbert Ross points out that, unlike malignant melanoma, the most common skin cancers basal cell and squamous cell carcinomas are rarely fatal.

In the U.S., where about two million people are treated every year for basal or squamous cell cancers and 76,000 people are diagnosed with melanomas, the U.S. Preventive Service Task Force said in 2009 that not enough evidence existed to recommend full-body exams for skin cancer in adults. Dr. Ross wonders if, given the evidence in the German study, the Task Force might reach a different conclusion when it next reviews its guidelines. This is a very important study, he says. It does make one wonder whether a screening program should be introduced here in the U.S. But as with all such concepts, the cost-benefit ratio will be taken into consideration.