The Effectiveness of a Population-Based Skin Cancer Screening Program : Evidence from Germany

In this paper, we analyze how a nationwide population-based skin cancer screening program (SCS) implemented in Germany in 2008 has impacted the number of hospital discharges following malignant skin neoplasm diagnosis (ICD–10 code C43_C44) and the malignant melanoma mortality rate (ICD–10 code C43) per 100,000 inhabitants. Our panel data, drawn from the Eurostat database, cover subregions in 22 European countries, measured at the lowest nomenclature of territorial units for statistics (NUTS) level for 2000–2013. To assess the causal relation between SCS program implementation and our outcome variables of diagnosis and mortality, we apply a fixed effects model using different covariates, including physician density and socioeconomic factors. Although we find a significantly positive and robust effect of the German SCS on the number of patients diagnosed with malignant skin neoplasm, the program does not significantly influence the melanoma mortality rate. This finding conflicts with the decreased melanoma mortality rate found for the 2003–2004 pilot screening in Northern Germany. Our results indicate that Germany's nationwide SCS program contributes to an improvement in the early detection of skin cancer. They also point to the possibility of skin cancer overdiagnosis, although the effect on the melanoma mortality rate should be interpreted cautiously because of the relatively short time period since program implementation. Future research might thus extend our analysis using longer time periods