August 23rd 2017
Population Screening Act: the MoederVlekkenKliniek

The initiator of the MoederVlekkenKliniek (Mole Clinic) wishes to offer low-threshold screening for skin cancer to people with an average risk of developing this form of cancer. The Committee on Population Screening of the Health Council of the Netherlands advises Minister of Health, Welfare and Sport not to grant the requested permit. In the light of current scientific knowledge the Committee is unable to evaluate the scientific validity of the screening proposal and the benefits of the screening do not appear to sufficiently outweigh the risks.

Summary

The initiator of the MoederVlekkenKliniek wishes to offer low-threshold screening for skin cancer to people with an average risk of developing this form of cancer. According to the Population Screening Act (WBO) skin cancer screening can only be carried out with a permit from the Minister of Health, Welfare and Sport (VWS). The Committee on Population Screening of the Dutch Health Council has examined the permit application.The Committee advises the Minister not to grant the permit.

Permit application

The intention is that people would be able to go to the MoederVlekkenKliniek, on their own initiative and at their own expense, for information about the prevention of skin cancer and for screening for skin abnormalities that could indicate skin cancer. At the screening, the skin is inspected with the naked eye and/or a dermatoscope (a strong magnifier with a light source), or by means of mole mapping (a digital method). If one or more suspicious skin abnormalities are found, clients are advised to see their general practitioner to discuss the results, and for further diagnostic measures and/or referral to a dermatologist.

Review against WBO requirements

The WBO definition of population screening

In accordance with the WBO the screening services offered by the MoederVlekkenKliniek are qualified as population screening. The Committee has reviewed these services against the requirements set by the WBO for all population screening that need a permit. The Committee’s advice is based on the evaluation of scientific validity and a risk-benefit analysis.

Scientific validity

Not enough is known about the sensitivity, the specificity or the positive and negative predictive values of the skin cancer screening that the MoederVlekkenKliniek wishes to offer to the general population. For this reason, the Committee is unable to evaluate the scientific validity of the proposed form of screening.

Risk-benefit balance

In the light of current scientific knowledge, the risk-benefit balance appears to be insufficiently beneficial. There is no compelling scientific evidence that screening reduces the number of deaths or the burden of disease of skin cancer. In contrast to this, screening is accompanied by risks: false-positive results can lead to further diagnostic tests and unnecessary treatment and feelings of uncertainty; false negative results can lead to unfounded reassurance, and a delay in the diagnostic process and start of treatment. As a result of over-diagnosis, people will be treated for (malignant) skin abnormalities that never caused problems or have led to symptoms.

Advice

The Committee recommends that the permit be denied on the basis of the current state of scientific knowledge, the Committee is unable to evaluate the scientific validity and the risk-benefit balance is insufficiently beneficial.