Nora Eisemann

Does skin cancer screening save lives?: an observational study comparing trends in melanoma mortality in regions with and without screening.

From July 1, 2003 to June 30, 2004, a population‐based skin cancer screening project was conducted in Schleswig‐Holstein, Germany. In total, 360,288 individuals aged ≥20 years were screened by means of a whole‐body examination. In this report, the authors compare trends in melanoma mortality in Schleswig‐Holstein with those in all adjacent regions, none of which had population‐based skin cancer screening.

Non-Melanoma Skin Cancer Incidence and Impact of Skin Cancer Screening on Incidence

Non-melanoma skin cancer (NMSC) is the most common malignancy, whose public health significance is often unrecognized. This analysis has two objectives: first, to provide up-to-date incidence estimates by sex, age group, histological type, and body site; and second, to study the impact of skin cancer screening. The impact of screening on NMSC incidence in Schleswig-Holstein, Germany, is analyzed by comparing four time periods of different screening settings (no screening (1998-2000), pilot project (Skin Cancer Research to Provide Evidence for Effectiveness of Screening in Northern Germany, SCREEN, 2003-2004), after SCREEN (2004-2008), and nation-wide skin cancer screening (2008-2010)) to a reference region (Saarland, Germany). Age-standardized (Europe) NMSC incidence was 119/100,000 for women and 145/100,000 for men in the most recent screening period in Schleswig-Holstein (2008-2010). During implementation of SCREEN (2003-2004), incidence increased from 81.5/100,000 to 111.5/100,000 (1998-2000) by 47% for women and 34% for men. All age groups in women were affected by the increase, but increases for men were mostly limited to the older age groups. Incidence in Saarland first increased slowly, but increased steeply with the introduction of the nation-wide skin cancer screening in 2008 (+47% for women and +40% for men, reference 2004-2008). Observed changes are most likely attributed to screening activities.

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

Background:The SCREEN (Skin Cancer Research to provide Evidence for Effectiveness of Screening in Northern Germany) project involved population-wide skin cancer screening with whole-body examination by general physicians and dermatologists. It was conducted in the German state of Schleswig-Holstein (July 2003–June 2004), but not in the German state of Saarland.Methods:The population-based registries of Schleswig-Holstein and Saarland provided data on melanoma incidence before, during, and after SCREEN to assess the association of skin cancer screening with incidence.Results:Approximately 19% of the Schleswig-Holstein population participated in SCREEN (women: 27%, men: 10%). A total of 52% of all melanomas diagnosed during SCREEN in Schleswig-Holstein were detected as part of the project. Melanoma incidence increased during SCREEN (invasive melanoma in women: +8.9 per 100 000 (95% confidence intervals (CI): 6.1; 11.7); men: +4.0 per 100 000 (95% CI: 1.6; 6.4)) and decreased afterwards (women: −10.6 per 100 000 (95% CI: −13.3; −7.9); men: −4.1 per 100 000 (95% CI: −6.5; −1.7)). Similar changes were not observed in Saarland that had no such project. The differences between the two states were greatest among women, the group with the greater SCREEN participation.Conclusion:The SCREEN project had a substantial impact on melanoma incidence. This is consistent with the impact of effective screening for other cancers.

Imputation of missing values of tumour stage in population-based cancer registration

BackgroundMissing data on tumour stage information is a common problem in population-based cancer registries. Statistical analyses on the level of tumour stage may be biased, if no adequate method for handling of missing data is applied. In order to determine a useful way to treat missing data on tumour stage, we examined different imputation models for multiple imputation with chained equations for analysing the stage-specific numbers of cases of malignant melanoma and female breast cancer.MethodsThis analysis was based on the malignant melanoma data set and the female breast cancer data set of the cancer registry Schleswig-Holstein, Germany. The cases with complete tumour stage information were extracted and their stage information partly removed according to a MAR missingness-pattern, resulting in five simulated data sets for each cancer entity. The missing tumour stage values were then treated with multiple imputation with chained equations, using polytomous regression, predictive mean matching, random forests and proportional sampling as imputation models. The estimated tumour stages, stage-specific numbers of cases and survival curves after multiple imputation were compared to the observed ones.ResultsThe amount of missing values for malignant melanoma was too high to estimate a reasonable number of cases for each UICC stage. However, multiple imputation of missing stage values led to stage-specific numbers of cases of T-stage for malignant melanoma as well as T- and UICC-stage for breast cancer close to the observed numbers of cases. The observed tumour stages on the individual level, the stage-specific numbers of cases and the observed survival curves were best met with polytomous regression or predictive mean matching but not with random forest or proportional sampling as imputation models.ConclusionsThis limited simulation study indicates that multiple imputation with chained equations is an appropriate technique for dealing with missing information on tumour stage in population-based cancer registries, if the amount of unstaged cases is on a reasonable level.

Skin Cancer Screening in Germany. Documenting Melanoma Incidence and Mortality From 2008 to 2013.

BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION 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.

On-going improvement and persistent differences in the survival for patients with colon and rectum cancer across Europe 1999-2007 - Results from the EUROCARE-5 study

BACKGROUND Previous population-based studies revealed major variation in survival for patients with colorectal cancer (CRC) in Europe by age and between different countries and regions, but also a sustained improvement in survival for patients with CRC in recent years. This EUROCARE-5 paper aims to update available knowledge from previous studies and to provide the latest survival estimates for CRC patients from Europe. METHODS The study analysed data of patients diagnosed with CRC from population-based cancer registries diagnosed in 29 European countries. Estimates of 1-year and 5-year relative survival (RS) were derived for patients diagnosed in 2000-2007 by European region, country and age at diagnosis. Additionally to these cohort estimates, time trends in 5-year RS were obtained for the calendar periods 1999-2001 and 2005-2007, using the period analysis methodology. RESULTS European average 5-year RS for patients diagnosed with colon and rectum cancer was 57% and 56%, respectively. The analyses showed persistent differences in cancer survival across Europe with lowest survival for CRC patients observed in Eastern Europe. The analyses further showed a strong gradient in age-specific survival. Even though the study revealed sustained improvement in patient survival between 1999-2001 and 2005-2007 (absolute increase of 4 and 6 percentage points for colon and rectum, respectively), the differences in the survival for CRC patients observed at the beginning of the millennium persisted over time. CONCLUSION Although survival for CRC patients in Europe improved markedly in the study period, significant geographic variations and a strong age gradient still persisted. Enhanced access to effective diagnostic procedures and treatment options might be the keys to reducing the existing disparities in the survival of CRC patients across Europe.

Up-to-date results on survival of patients with melanoma in Germany

Background  Prior analyses of survival of patients with primary cutaneous malignant melanoma from Germany were based only on small populations and need to be updated.

Incidence trends of nonmelanoma skin cancer in Germany from 1998 to 2010

Nonmelanoma skin cancer (NMSC) is the most common malignant neoplasm in Germany. However, little is known about incidence trends of NMSC and its main subtypes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in Germany.

Impact of skin cancer screening and secondary prevention campaigns on skin cancer incidence and mortality: A systematic review

Background: Benefits of skin cancer screening remain controversial. Objective: We sought to update evidence on the impact of skin cancer screening and secondary prevention campaigns on skin cancer incidence, mortality, stage‐specific incidence, and interval cancers after negative screening. Methods: We searched MEDLINE and EMBASE for studies published in English or German between January 1, 2005, and February 4, 2015. Two reviewers independently performed study selection, data extraction, and critical appraisal. Results were described in a narrative synthesis. Results: Of 2066 records identified in databases and 10 records found by manual search, we included 15 articles. Overall, evidence suggests that with implementation of skin cancer screening, incidence of in situ and invasive skin cancer increased; increasing rates of thin and decreasing rates of thick melanoma were observed. After cessation of screening, invasive melanoma incidence decreased. A significant melanoma mortality reduction was shown in a German study; 2 other studies observed fewer deaths than expected. No study on interval cancers was identified. Limitations: Publication bias cannot be ruled out. Most studies are limited because of their ecological design. Conclusion: Large ecological studies, a cohort study, a case‐control study, and a survey indicate benefits of skin cancer screening, but the evidence level is very low.

The ProCaSP study: quality of life outcomes of prostate cancer patients after radiotherapy or radical prostatectomy in a cohort study urological oncology

BackgroundThis study describes and compares health-related quality of life (HRQOL) of prostate cancer patients who received either radical prostatectomy (nerve-sparing, nsRP, or non-nerve-sparing, nnsRP) or radiotherapy (external RT, brachytherapy, or both combined) for treatment of localised prostate cancer.MethodsThe prospective, multicenter cohort study included 529 patients. Questionnaires included the IIEF, QLQ-C30, and PORPUS-P. Data were collected before (baseline), three, six, twelve, and twenty-four months after treatment. Differences between groups’ baseline characteristics were assessed; changes over time were analysed with generalised estimating equations (GEE). Missing values were treated with multiple imputation. Further, scores at baseline and end of follow-up were compared to German reference data.ResultsThe typical time trend was a decrease of average HRQOL three months after treatment followed by (partial) recovery. RP patients experienced considerable impairment in sexual functioning. The covariate-adjusted GEE identified a significant - but not clinically relevant - treatment effect for diarrhoea (b = 7.0 for RT, p = 0.006) and PORPUS-P (b = 2.3 for nsRP, b = 2.2 for RT, p = 0.045) compared to the reference nnsRP. Most of the HRQOL scores were comparable to German norm values.ConclusionsFindings from previous research were reproduced in a specific setting of a patient cohort in the German health care system. According to the principle of evidence-based medicine, this strengthens the messages regarding treatment in prostate cancer and its impacts on patients’ health-related quality of life. After adjustment for baseline HRQOL and other covariates, RT patients reported increased symptoms of diarrhoea, and nnsRP patients decreased prostate-specific HRQOL. RP patients experienced considerable impairment in sexual functioning. These differences should be taken into account by physicians when choosing the best therapy for a patient.