Presentation (CTI)

OBJECTIVES: In 2008, Germany implemented a nationwide skin cancer screening program. A previous analysis implementing fixed effects methods found no significant effect on melanoma mortality rate through 2012. However, this study was limited by a short post-intervention period, leaving the long-term outcomes of this program unclear. This study revisits the value of this national screening program with a 15-year post-intervention period and a synthetic control approach.
METHODS: Annual age-standardized melanoma mortality rates (1990-2023) were extracted from the Global Burden of Disease study for Germany and 15 other European nations without national skin cancer screening programs. Using synthetic control with uniform weight given to all pre-2008 years, a weighted combination of donor nations was used to reproduce Germany’s pre-2008 melanoma mortality rate. The effect of the program was estimated using the divergence between Germany and the synthetic control during the post-2008 period, and robustness was tested with placebo permutation, leave-one-out donor removal, and a pre-intervention window sweep.
RESULTS: The synthetic Germany, composed primarily of Italy (0.44), Austria (0.35), and Spain (0.20), reproduced pre-intervention mortality with RMSPE of 0.087 (4.7% of mean mortality). Estimates ranged from +0.5% to +6.5% across the pre-intervention window sweep, with no specifications demonstrating a reduction in melanoma mortality. Results were robust to leave-one-out removal.
CONCLUSIONS: Fifteen years after implementation of Germany’s nationwide skin-cancer screening program, this study shows no evidence of benefit in terms of melanoma mortality rate, contrasting with the 14-17% reductions at 5 years projected by previous microsimulation studies. These results bring into question the value of the current German skin cancer screening program.