Evaluation of a Population-Based Targeted Screening Approach for Skin Cancer with Long-Time Follow-Up in Austria including Potential Effects on Melanoma Mortality
Abstract
:Simple Summary
Abstract
1. Introduction
2. Patients and Methods
2.1. The Skin Cancer Screening Program as Part of the Vorarlberg Health Monitoring and Promotion Program (VHM&PP)
2.2. Study Design
2.3. Exposure and Covariates
2.4. Outcome
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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VHM-Skin | VHM-Health Exam | |||
---|---|---|---|---|
All | ||||
n | 8997 | 92,760 | ||
Age at baseline examination (years), mean ± SD | 40.0 ± 15.0 | 44.8 ± 15.3 | ||
Follow-up * (years), median (IQR) | 26.8 (25.8–28.5) | 27.8 (25.4–29.3) | ||
Overall deaths, n (%) | 1438 (16.0%) | 24,210 (26.1%) | ||
Women | ||||
n | 5528 | 51,412 | ||
Age at baseline examination (years), mean ± SD | 39.4 ± 14.9 | 45.2 ± 15.8 | ||
Follow-up * (years), median (IQR) | 26.9 (25.8–28.6) | 28.0 (25.6–29.4) | ||
Overall deaths, n (%) | 771 (13.9%) | 12,602 (24.5%) | ||
Men | ||||
n | 3469 | 41,348 | ||
Age at baseline examination (years), mean ± SD | 40.8 ± 15.2 | 44.3 ± 14.8 | ||
Follow-up * (years), median (IQR) | 26.7 (25.6–28.4) | 27.6 (25.2–29.2) | ||
Overall deaths, n (%) | 667 (19.2%) | 11,608 (28.1%) |
1985–1989 | 1990–1994 | 1995–1999 | 2000–2004 | 2005–2009 | 2010–2014 | 2015–2019 | ||
---|---|---|---|---|---|---|---|---|
All | ||||||||
Invasive melanoma (C43) | 8.10 | 12.52 | 14.92 | 23.11 | 27.27 | 24.84 | 20.61 | |
Melanoma in situ (D03) | 1.04 | 6.42 | 9.31 | 12.00 | 13.89 | 18.35 | 16.56 | |
Melanoma mortality | 3.56 | 3.59 | 3.16 | 2.64 | 3.35 | 3.23 | 2.63 | |
Women | ||||||||
Invasive melanoma (C43) | 9.65 | 11.92 | 15.92 | 21.28 | 24.05 | 24.22 | 19.35 | |
Melanoma in situ (D03) | 1.44 | 7.00 | 11.38 | 13.09 | 14.11 | 18.90 | 15.64 | |
Melanoma mortality | 3.83 | 2.77 | 3.19 | 2.41 | 2.82 | 2.80 | 2.54 | |
Men | ||||||||
Invasive melanoma (C43) | 6.50 | 13.13 | 13.89 | 25.00 | 30.58 | 25.47 | 21.90 | |
Melanoma in situ (D03) | 0.64 | 5.83 | 7.18 | 10.88 | 13.66 | 17.78 | 17.50 | |
Melanoma mortality | 3.28 | 4.44 | 3.13 | 2.88 | 3.90 | 3.67 | 2.72 |
ΔIRR * per 5-Year Intervals (95%-CI) | |||||
---|---|---|---|---|---|
(1985–1990)– (2015–2019) | (2000–2004)– (2015–2019) | (1985–1990)– (2000–2004) | (2005–2009)– (2015–2019) | ||
All | |||||
Invasive melanoma (C43) | 1.18 (1.13–1.22) | 0.96 (0.90–1.03) | - | - | |
Melanoma in situ (D03) | 1.32 (1.26–1.38) | 1.13 (1.07–1.20) | - | - | |
Melanoma mortality | 0.96 (0.91–1.01) | 0.99 (0.88–1.11) | 0.90 (0.78–1.03) | 0.90 (0.76–1.06) | |
Women | |||||
Invasive melanoma (C43) | 1.13 (1.09–1.18) | 0.97 (0.91–1.03) | - | - | |
Melanoma in situ (D03) | 1.24 (1.19–1.29) | 1.08 (1.01–1.16) | - | - | |
Melanoma mortality | 0.95 (0.89–1.03) | 1.01 (0.85–1.20) | 0.88 (0.73–1.06) | 0.96 (0.74–1.24) | |
Men | |||||
Invasive melanoma (C43) | 1.19 (1.13–1.26) | 0.94 (0.89–1.01) | - | - | |
Melanoma in situ (D03) | 1.35 (1.28–1.44) | 1.18 (1.08–1.27) | - | - | |
Melanoma mortality | 0.96 (0.89–1.04) | 0.97 (0.83–1.12) | 0.92 (0.72–1.17) | 0.85 (0.68–1.07) |
VHM-Skin | GP-CC | IRR ** (95%-CI) | ||||||
---|---|---|---|---|---|---|---|---|
n | Person-Years | IR */MR * | n | Person-Years | IR */MR * | |||
Invasive melanoma (C43) | ||||||||
All | 207 | 232,524 | 89 | 1734 | 5,521,093 | 31.4 | 2.92 (2.49–3.41) | |
Women | 94 | 144,309 | 65.1 | 789 | 2,826,810 | 27.9 | 2.40 (1.93–2.98) | |
Men | 112 | 88,215 | 127 | 945 | 2,694,283 | 35.1 | 3.38 (2.77–4.12) | |
Melanoma in situ (D03) | ||||||||
All | 187 | 232,524 | 80.4 | 1106 | 5,521,093 | 20 | 4.13 (3.53–4.83) | |
Women | 115 | 144,309 | 79.7 | 538 | 2,826,810 | 19 | 4.43 (3.61–5.43) | |
Men | 71 | 88,215 | 80.5 | 568 | 2,694,283 | 21.1 | 3.67 (2.86–4.71) | |
Melanoma deaths | ||||||||
All | 16 | 232,524 | 6.9 | 250 | 5,521,093 | 4.5 | 1.66 (1.00–2.75) | |
Women | 8 | 144,309 | 5.5 | 112 | 2,826,810 | 4 | 1.64 (0.80–3.37) | |
Men | 8 | 88,215 | 9.1 | 138 | 2,694,283 | 5.1 | 1.64 (0.80–3.34) |
Full Follow-Up | Follow-Up until 31 December 1994 | 0–10 Years | >10–20 Years | 20+ Years | |||
---|---|---|---|---|---|---|---|
Incident invasive melanoma (C43) | |||||||
All | |||||||
(sub)cohort size, n/N | 8997/92,760 | 8997/92,760 | 8997/92,760 | 8644/87,072 | 8045/78,123 | ||
cases, n/N | 207/790 | 30/27 | 61/165 | 99/338 | 47/287 | ||
HR (95%-CI) * | 3.02 (2.59–3.52) | 18.50 (10.92–31.33) | 4.33 (3.22–5.82) | 3.27 (2.61–4.10) | 1.94 (1.42–2.65) | ||
Women | |||||||
(sub)cohort size, n/N | 5528/51,412 | 5528/51,412 | 5528/51,412 | 5367/48,754 | 5053/44,076 | ||
cases, n/N | 95/371 | 14/12 | 29/91 | 45/152 | 21/128 | ||
HR (95%-CI) ** | 2.55 (2.03–3.21) | 19.14 (8.75–41.87) | 3.44 (2.26–5.25) | 2.87 (2.05–4.02) | 1.59 (1.00–2.53) | ||
Men | |||||||
(sub)cohort size, n/N | 3469/41,348 | 3469/41,348 | 3469/41,348 | 3277/38,318 | 2992/34,047 | ||
cases, n/N | 112/419 | 16/15 | 32/74 | 54/186 | 26/159 | ||
HR (95%-CI) ** | 3.46 (2.81–4.27) | 18.80 (9.21–38.39) | 5.56 (3.67–8.43) | 3.61 (2.67–4.90) | 2.24 (1.48–3.40) | ||
Incident melanoma in situ (D03) | |||||||
All | |||||||
(sub)cohort size, n/N | 8997/92,760 | 8997/92,760 | 8997/92,760 | 8653/87,123 | 8066/78,235 | ||
cases, n/N | 187/562 | 17/23 | 50/98 | 80/231 | 57/233 | ||
HR (95%-CI) * | 3.90 (3.30–4.61) | 12.76 (6.74–24.16) | 6.22 (4.41–8.77) | 3.78 (2.93–4.88) | 3.04 (2.27–4.07) | ||
Women | |||||||
(sub)cohort size, n/N | 5528/51,412 | 5528/51,412 | 5528/51,412 | 5360/48,782 | 5041/44,127 | ||
cases, n/N | 115/276 | 9/13 | 33/56 | 49/110 | 33/110 | ||
HR (95%-CI) ** | 4.37 (3.50–5.44) | 10.78 (4.52–25.74) | 6.77 (4.38–10.46) | 4.27 (3.04–6.01) | 3.26 (2.19–4.83) | ||
Men | |||||||
(sub)cohort size, n/N | 3469/41,348 | 3469/41,348 | 3469/41,348 | 3293/38,341 | 3025/34,108 | ||
cases, n/N | 72/286 | 8/10 | 17/42 | 31/121 | 24/123 | ||
HR (95%-CI) ** | 3.32 (2.56–4.30) | 15.35 (5.98–39.40) | 5.37 (3.06–9.45) | 3.16 (2.13–4.70) | 2.75 (1.77–4.26) | ||
Melanoma deaths | |||||||
All | |||||||
(sub)cohort size, n/N | 8997/92,760 | 8997/92,760 | 8997/92,760 | 8701/87,214 | 8182/78,531 | ||
cases, n/N | 16/97 | 2/4 | 4/20 | 8/37 | 4/40 | ||
HR (95%-CI) * | 2.12 (1.25–3.61) | 10.40 (1.88–57.64) | 2.62 (0.89–7.67) | 2.61 (1.21–5.62) | 1.36 (0.49–3.82) | ||
Women | |||||||
(sub)cohort size, n/N | 5528/51,412 | - | - | - | - | ||
cases, n/N | 8/38 | - | - | - | - | ||
HR (95%-CI) ** | 2.49 (1.16–5.37) | - | - | - | - | ||
Men | |||||||
(sub)cohort size, n/N | 3469/41,348 | - | - | - | - | ||
cases, n/N | 8/59 | - | - | - | - | ||
HR (95%-CI) ** | 1.83 (0.87–3.83) | - | - | - | - |
VHM-Skin | VHM-Health Exam | GP-CC | |||||||
---|---|---|---|---|---|---|---|---|---|
Breslow thickness (mm) | |||||||||
n | median (IQR) | n | median (IQR) | p * | n | median (IQR) | p * | ||
All | 185 | 0.5 (0.3–0.8) | 652 | 0.6 (0.4–1.3) | <0.05 | 1443 | 0.6 (0.4–1.4) | <0.01 | |
Women | 84 | 0.5 (0.3–0.8) | 298 | 0.6 (0.4–1.2) | 0.29 | 631 | 0.6 (0.4–1.4) | 0.11 | |
Men | 101 | 0.5 (0.3–0.8) | 354 | 0.6 (0.4–1.3) | <0.05 | 812 | 0.7 (0.4–1.5) | <0.05 | |
Clark´s level (1–5) | |||||||||
n | mean (±SD) | n | mean (±SD) | p * | n | mean (±SD) | p * | ||
All | 176 | 3.0 ± 0.7 | 630 | 3.1 ± 0.8 | <0.05 | 1368 | 3.2 ± 0.9 | <0.01 | |
Women | 81 | 3.0 ± 0.8 | 295 | 3.1 ± 0.8 | 0.36 | 744 | 3.1 ± 0.9 | 0.11 | |
Men | 95 | 3.0 ± 0.6 | 335 | 3.1 ± 0.9 | <0.05 | 624 | 3.2 ± 0.8 | <0.01 |
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Brozek, W.; Clemens, P.; Ulmer, H.; Häring, N.; Concin, H.; Zitt, E.; Nagel, G. Evaluation of a Population-Based Targeted Screening Approach for Skin Cancer with Long-Time Follow-Up in Austria including Potential Effects on Melanoma Mortality. Cancers 2024, 16, 1283. https://doi.org/10.3390/cancers16071283
Brozek W, Clemens P, Ulmer H, Häring N, Concin H, Zitt E, Nagel G. Evaluation of a Population-Based Targeted Screening Approach for Skin Cancer with Long-Time Follow-Up in Austria including Potential Effects on Melanoma Mortality. Cancers. 2024; 16(7):1283. https://doi.org/10.3390/cancers16071283
Chicago/Turabian StyleBrozek, Wolfgang, Patrick Clemens, Hanno Ulmer, Nina Häring, Hans Concin, Emanuel Zitt, and Gabriele Nagel. 2024. "Evaluation of a Population-Based Targeted Screening Approach for Skin Cancer with Long-Time Follow-Up in Austria including Potential Effects on Melanoma Mortality" Cancers 16, no. 7: 1283. https://doi.org/10.3390/cancers16071283
APA StyleBrozek, W., Clemens, P., Ulmer, H., Häring, N., Concin, H., Zitt, E., & Nagel, G. (2024). Evaluation of a Population-Based Targeted Screening Approach for Skin Cancer with Long-Time Follow-Up in Austria including Potential Effects on Melanoma Mortality. Cancers, 16(7), 1283. https://doi.org/10.3390/cancers16071283