title: Impact of skin cancer screening and secondary prevention campaigns on skin cancer incidence and mortality: A systematic review.
abstract: BACKGROUND
  Benefits of skin cancer screening remain controversial.
  
  
  OBJECTIVE
  We sought to update evidence on the impact of skin cancer screening and secondary prevention campaigns on skin cancer incidence, mortality, stage-specific incidence, and interval cancers after negative screening.
  
  
  METHODS
  We searched MEDLINE and EMBASE for studies published in English or German between January 1, 2005, and February 4, 2015. Two reviewers independently performed study selection, data extraction, and critical appraisal. Results were described in a narrative synthesis.
  
  
  RESULTS
  Of 2066 records identified in databases and 10 records found by manual search, we included 15 articles. Overall, evidence suggests that with implementation of skin cancer screening, incidence of in situ and invasive skin cancer increased; increasing rates of thin and decreasing rates of thick melanoma were observed. After cessation of screening, invasive melanoma incidence decreased. A significant melanoma mortality reduction was shown in a German study; 2 other studies observed fewer deaths than expected. No study on interval cancers was identified.
  
  
  CONCLUSIONS
  Publication bias cannot be ruled out. Most studies are limited because of their ecological design.
  
  
  CONCLUSIONS
  Large ecological studies, a cohort study, a case-control study, and a survey indicate benefits of skin cancer screening, but the evidence level is very low.
authors.affiliation: Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany. Electronic address: alicia.brunssen@uksh.de.
authors.forename: Alicia
authors.initials: A
authors.lastname: Brunssen
authors.affiliation: Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Waldmann
authors.affiliation: Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
authors.forename: Nora
authors.initials: N
authors.lastname: Eisemann
authors.affiliation: Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany; Institute for Cancer Epidemiology, University of Lübeck, Lübeck, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Katalinic
mesh_terms: D055088:Early Detection of Cancer; D006293:Health Promotion; D006801:Humans; D008545:Melanoma / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D055502:Secondary Prevention; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology
keywords: incidence; interval cancers; melanoma; mortality; screening; secondary prevention; skin cancer; stage-specific incidence; systematic review; thickness