Dermatologists angered by public doubts about cancer screening

Many Germans go regularly to the skin cancer prevention, whose costs are taken over from the 35. Lebensjahr every two years by the health insurance companies. Dermatologists recommend the examination because it can detect early malignant changes and their precursors. However, the ARD magazine "Contrasts" recently questioned the usefulness of screening. The paper said that the number of deaths from skin cancer was not reduced by early detection within five years. The professional association of German dermatologists e.V. (BVDD) criticizes the nature of this reporting in the strongest terms. It is one-sided and suppresses important information, it says in a message.

How useful is the skin cancer screening?
Anyone exposing their skin to UV radiation without protection regularly increases their risk of skin cancer significantly. While bright skin cancer, which includes basal cell carcinoma and squamous cell carcinoma, has good chances of recovery, as it has a low propensity for metastasis, black skin cancer, called melanoma, is more dangerous if not detected early. If it is removed before the melanoma has reached a thickness of one millimeter in the dermal layer, the prognosis is good. If the black skin cancer is detected late, the probability of metastasis in skin, lymph nodes and bones is relatively high. Accordingly, the chances of recovery are worse. For this reason, doctors strongly recommend skin cancer screening, in which the doctor with a dermatoscope, a magnifying glass examines the skin of the patient for signs of skin cancer. About eight million times a year, the investigation is carried out in this country.

However, the ARD magazine comes in its contribution to the topic of skin cancer screening to another assessment: "The skin cancer screening is apparently useless and may even be harmful." The author of the TV article relies on an opinion of the Institute for Quality and Patient Safety (BQS ) on behalf of the Joint Federal Committee, which questions the screening.

Dermatologists want to take action against television coverage
"In the report from the BQS there is no proof for the claim", criticized dermatologist Klaus Strömer from Mönchengladbach in an interview with the online edition of "Welt". The report concludes that the mortality rate for malignant melanoma is consistently low, according to cancer registry data, although the number of cases is increasing. "This is a success and not an indication of uselessness," said Strömer, who is the president of the BVDD. According to the ARD magazine, however, this situation is different. "Five years after the start of the program, just as many people die from melanoma as before screening," according to the author's interpretation. "The clear evidence of effectiveness would be the decrease in mortality, ie mortality. So far we have not been able to show that, "explains skin cancer specialist Reinhard Dummer in the TV report. According to Dummer, the problem of screening is, in particular, that "with the prevention campaigns, especially more thin melanomas, superficial growing melanomas, which are less dangerous" would be found. "The melanomas that cause death are usually thick melanomas, which we still miss despite early detection campaigns."

According to the BVDD, top-quality scientific studies, ie randomized placebo-controlled trials, are difficult to carry out, because on the one hand, people who use skin cancer screening need to be involved and, on the other hand, people who refuse to undergo the examinations. As the dermatologists explain, it is ethically not justifiable to deny cancer screening to a group just to get relevant study data.

Not every case of skin cancer is registered
According to the association, in addition to lowering the mortality rate, screening should also help prevent severe onerous operations by also detecting basal cell and squamous cell carcinoma as well as less common types of skin cancer. Because these would be discovered by the investigation rather. "The report comes with all critical lighting of the improvement possibilities of the legally regulated skin cancer screening screening clearly to the recommendation to continue the skin cancer screening," the newspaper quoted the professional association. "In order to be able to reliably assess mortality trends, a 5-year period is too short," says the association's information service "HautInform". Often, the success of a screening can only be assessed after a decade or two. However, this assumes that each case would be reported and registered. But that is precisely the problem, since only the first occurrence of skin cancer is recorded in epidemiological cancer registries. If a patient becomes ill again, the cancer will not be registered as another case. The BVDD estimates that there are 500,000 new skin cancers a year each year. In 2012, however, only 234,000 cases were enrolled in the cancer registry.

"Skin cancer is already the most common cancer in Germany today," the newspaper quoted the dermatologist Michael Reusch. "The disease can have very good chances of recovery or take a fatal course." Patients were most often affected between the ages of 60 and 80 years. The aging society would inevitably lead to more cases.

The Federal Association wants to submit a complaint to the Broadcasting Council later this week and enforce an injunction of the allegations with a collective action. "Such a deliberately one-sided reporting, which is proven not by bad research, but in the knowledge of all the facts, is for a public broadcaster for our taste

beyond the reputable journalism and thus a case for the broadcaster of the broadcaster, "said Strömer in" HautInform ".

Dermatologists are arguing about the best methods for the early detection of skin cancer
Meanwhile, dermatologists are discussing existing and new methods for early detection of skin cancer, which should also facilitate the collection of data. Researchers at the Fraunhofer Institute for Factory Operation and Automation (IFF), in cooperation with the Department of Dermatology of the University of Magdeburg and industry, have developed a whole-body scanner, the "Dermascanner", which supports the dermatologist in the diagnosis of black skin cancer. First of all, the patient's skin is scanned from different positions, creating about 100 individual images. In addition, 3-D measurement data is collected via several 3-D sensors integrated into the device. The software is able to match these images with previous data and detect changes. "With our technology, you can see growth from half a millimeter," explains Christian Teutsch from the IFF to the newspaper. Every single mole can be precisely located thanks to the precise technique. According to the IFF, the "Dermascanner" is about to be ready for the market.

Another project, scheduled for the second half of 2015, includes video-sharing sessions with five physicians. The provider arztkonsultation.de helps them to discuss skin problems over the Internet with their patients. However, this method also carries risks. "The ban on distance treatment, the question of the place of treatment in an online consultation or the remuneration lag behind the feasible," said Klaus Strömer to the newspaper. Nevertheless, he supports the project. "We can not and do not want to wait that long for the legal provisions to be created." All patients participating in the pilot project must already be known to the doctor. (Ag)