Evaluation of skin cancer screening in Germany - a Microsimulation.

Background: Comprehensive skin cancer screening was introduced in Germany in 2008. It is unclear whether subsequently observed changes in the epidemiology of malignant melanoma (MM), squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are due to the screening. Simulation models are used to compare different screening scenarios with each other and with observed incidence and mortality trends.

Methods: A microsimulation model for MM, SCC, and BCC was programmed and validated separately by sex on skin cancer-specific mortality data. In addition to the currently practiced screening (biennial offer, annual participation probability 15%), triennial screening, screening with increased participation, e.g., via invitation, and no screening were simulated. Incidence, mortality, costs, and life-years gained were simulated for 30 years from the start of screening.

Results: Compared with no screening, mortality is reduced by 13.8% in the simulation with current conditions. This effect occurs in the first years after screening starts before reaching a stable level. More screening allows for further increases in incidence, life-years gained, and costs and decreases in mortality. Comparing simulated and observed effects shows little agreement.

Conclusions: The model is useful for comparing screening scenarios to identify potential optimization opportunities in SCS. Additional, especially risk-adapted, screening scenarios should be investigated.