文章：

奥地利基于人群的皮肤癌长期随访靶向筛查评估及其对黑色素瘤死亡率的潜在影响

Evaluation of a Population-Based Targeted Screening Approach for Skin Cancer with Long-Time Follow-Up in Austria including Potential Effects on Melanoma Mortality

原文发布日期：26 March 2024

DOI: 10.3390/cancers16071283

类型: Article

开放获取: 是

英文摘要：

Background: whether screening for skin cancer affects melanoma-specific mortality in a population-based setting remains unclear. Methods: in this population-based cohort study, we characterized and evaluated a skin cancer prevention program following a targeted screening approach conducted in 1989–1994 in the Austrian province Vorarlberg, with follow-up until 2019. The general population and attendees of a health examination program served for comparison. Results: in the screening program including full follow-up until 2019, 207 invasive and 187 in situ melanomas were identified in 8997 individuals. Incidences of invasive and in situ melanomas were elevated compared to the general population (IRR 2.92, 95%-CI 2.49–3.41, and IRR 4.13, 95%-CI 3.53–4.83, respectively) and the health examination program (HR 3.02, 95%-CI 2.59–3.52, and HR 3.90, 95%-CI 3.30–4.61, respectively). Breslow thickness and Clark’s level at time of invasive diagnosis were significantly lower in 1989–2019, but the tumor characteristics of the melanomas diagnosed during 1989–1994 did not differ from the comparison groups. Moreover, melanoma mortality was significantly elevated in the screening program (IRR 1.66, 95%-CI 1.00–2.75 vs. the general population, HR 2.12, 95%-CI 1.25–3.61 vs. the health examination cohort). Melanoma mortality in Vorarlberg declined until 2004, though statistically non-significantly. Conclusions: given the uncertain effectiveness and high public expenditures of population-wide mass screening programs, primary prevention and targeted risk-based skin cancer screening might be promising alternatives.

摘要翻译： 

背景：在基于人群的环境中，皮肤癌筛查是否影响黑色素瘤特异性死亡率仍不明确。方法：在这项基于人群的队列研究中，我们对1989年至1994年在奥地利福拉尔贝格省实施的一项采用针对性筛查方法的皮肤癌预防项目进行了特征描述与评估，随访持续至2019年。研究以普通人群及参与健康体检项目的人群作为对照。结果：在持续至2019年的完整随访期内，该筛查项目在8997名参与者中共检出207例侵袭性黑色素瘤和187例原位黑色素瘤。与普通人群相比，侵袭性与原位黑色素瘤的发病率显著升高（发病率比分别为2.92，95%置信区间2.49–3.41；4.13，95%置信区间3.53–4.83）；与健康体检人群相比亦显著升高（风险比分别为3.02，95%置信区间2.59–3.52；3.90，95%置信区间3.30–4.61）。1989-2019年间侵袭性黑色素瘤确诊时的Breslow厚度和Clark分级显著降低，但1989-1994年诊断的黑色素瘤肿瘤特征与对照组无显著差异。此外，筛查项目的黑色素瘤死亡率显著高于普通人群（发病率比1.66，95%置信区间1.00–2.75）及健康体检队列（风险比2.12，95%置信区间1.25–3.61）。福拉尔贝格省的黑色素瘤死亡率在2004年前呈下降趋势，但无统计学显著性。结论：鉴于全民大规模筛查项目的有效性尚不明确且公共支出高昂，一级预防和基于风险分层的针对性皮肤癌筛查可能是更具前景的替代方案。

原文链接：

Evaluation of a Population-Based Targeted Screening Approach for Skin Cancer with Long-Time Follow-Up in Austria including Potential Effects on Melanoma Mortality