Benefits and Risks of Skin Cancer Screening

Accessible online at: www.karger.com/ort Fax +49 761 4 52 07 14 Information@Karger.com www.karger.com Anders/Breitbart/Choudhury/Greinert/ Katalinic/Keilholz/Tacke/Volkmer urement [10], the prognosis of MM is highly dependent on stage at diagnosis. If detected at an early stage, 5-year survival rates are over 90%. In contrast, if MM is diagnosed at stage IV, only about 15–20% of patients are still alive 5 years after receiving their diagnosis [11]. In addition to the personal impact, the economic burden of skin cancer is considerable. In Germany, for example, annual hospitalization costs for 2003 amounted to 50–60 million Euros for the treatment of MM and 105–130 million Euros for the treatment of NMSC [4]. The total costs caused by skin cancer, which cover more than the costs for inpatient treatment, are hardly assessable; however, in Sweden, for example, annual direct and indirect costs are estimated to be EUR 142.4 million (EUR 15/inhabitant) [12]. In 2000, the loss of disease-adjusted life years worldwide was estimated to be 345,100–621,200 for MM and 88,100– 134,800 for squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) [13]. The natural history of skin cancer is known. NMSCs are usually slow-growing tumors with a long preclinical phase. NMSCs therefore predominantly appear in older people. Over 80% of cases occur in people above 60 years [14, 15]. For SCC, actinic keratosis represents the precancerous lesion. Compared with NMSC, MM is a fast growing cancer that often spreads (20–25%) but is also detectable at an early stage. There is mounting evidence that both MM and NMSC are induced by ultraviolet (UV) radiation. This is supported by the International Agency for Research on Cancer (IARC) that recently defined UV radiation as a carcinogen [16]. The increase in skin cancer incidence may therefore be attributed to an increase in life exposure to UV radiation. While higher life expectancy is one of the reasons for the high incidence of skin cancer in older people, with particularly high incidence rates of MM in men 65 years and above [17], changes in behavior are further reasons for the increase in life exposure to UV radiation and possibly the increase in skin cancer incidence. Examples of such changes in behavior include more time spent outdoors without being sufficiently protected by clothes and/or sunscreen, increased use of solaria, and more frequent travelling to regions closer to the equator [18–20]. To reduce both the burden of skin cancer and the exposure to UV radiation, primary and secondary preventive activities Benefits and Risks of Skin Cancer Screening Pro: Eckhard W. Breitbart Kohelia Choudhury Markus P. Anders Beate Volkmer Rüdiger Greinert Alexander Katalinic a Association of Dermatological Prevention, Hamburg, Germany b Center of Dermatology, Elbe Clinics, Buxtehude, Germany c Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany