Antje Wienecke

Changes in cancer incidence attributable to tobacco smoking in Germany, 1999-2008.

Tobacco smoking, a major cancer risk factor, is very common in Germany as in many other high‐income countries. Few studies have assessed the burden of tobacco‐associated cancer incidence in the German population. We calculated the proportion of cancers attributable to tobacco smoking to estimate the burden of tobacco‐associated cancer in 1999 and 2008. Smoking prevalence was determined from national surveys of a representative sample of the German population in 1998 and 2008–2011, and data on relative risks were obtained from meta‐analyses. Cancer incidence for the years 1999 and 2008 was estimated by the German Centre for Cancer Registry Data at the Robert Koch Institute. We estimate that 72,208 incident cancer cases were attributable to tobacco smoking in Germany in 2008, an increase of >6,200 cases over 1999 levels. Among the cases in 2008 were 55,057 cases among men (22.8% (95% CI, 21.3–24.1) of all new cases) and 17,151 cases among women (7.9% (95% CI, 7.21–8.68) of all new cases). The highest proportions attributable to smoking were estimated for cancer of the lung, larynx, pharynx and the lower urinary tract. Tobacco smoking is currently responsible for more than one in five cancer cases among men and nearly 1 in 12 among women. Considering the increasing trends in cancer incidence and, until very recently, rising prevalence of smoking among women, it can be expected that the number of tobacco‐attributable cancer cases will rise further.

Leukemia incidence and survival in Germany according to current standardized categories

BACKGROUND Leukemias include a large number of diverse malignancies concerning the blood-forming system. Population-based comparisons and time trends are complicated by inconsistent definitions and classifications. In the course of the European HAEMACARE project, a consensus grouping system was created based on the morphology codes of the ICD-O-3 (International Classification of Diseases-Oncology, third revision), consistent with the WHO classification published in 2008 and useful for epidemiologic and public health purposes. For the first time leukemia incidence and survival in Germany are presented according to this system on the basis of cancer registry data.. MATERIAL AND METHODS A set of leukemia cases diagnosed during 2001-2010 was extracted from the data submitted by German population-based cancer registries to the Robert Koch Institute in early 2013 and grouped according to the HAEMACARE system. Direct age-standardized incidence rates were calculated. To estimate the prognosis of adult leukemia patients diagnosed during 2008-2010, the 5-year relative survival was computed using the period approach. RESULTS AND DISCUSSION Based on 23,328 predominantly leukemic malignancies ascertained for six federal states over a 10-year period, the age-standardized incidence rates were 4.1 (per 100,000) for chronic lymphocytic leukemia, 3.1 for acute myeloid leukemia, and 2.4 for myeloproliferative neoplasms, similar to other European regions. The 5-year relative survival of leukemia in Germany currently ranges between 8 and 95% according to sex, age, and category, and is thus considerably better compared with results derived from a European data pool referring to 2000-2002.

Inzidenz und Überleben bei Leukämien in Deutschland nach aktuellen standardisierten Kategorien

BACKGROUND Leukemias include a large number of diverse malignancies concerning the blood-forming system. Population-based comparisons and time trends are complicated by inconsistent definitions and classifications. In the course of the European HAEMACARE project, a consensus grouping system was created based on the morphology codes of the ICD-O-3 (International Classification of Diseases-Oncology, third revision), consistent with the WHO classification published in 2008 and useful for epidemiologic and public health purposes. For the first time leukemia incidence and survival in Germany are presented according to this system on the basis of cancer registry data.. MATERIAL AND METHODS A set of leukemia cases diagnosed during 2001-2010 was extracted from the data submitted by German population-based cancer registries to the Robert Koch Institute in early 2013 and grouped according to the HAEMACARE system. Direct age-standardized incidence rates were calculated. To estimate the prognosis of adult leukemia patients diagnosed during 2008-2010, the 5-year relative survival was computed using the period approach. RESULTS AND DISCUSSION Based on 23,328 predominantly leukemic malignancies ascertained for six federal states over a 10-year period, the age-standardized incidence rates were 4.1 (per 100,000) for chronic lymphocytic leukemia, 3.1 for acute myeloid leukemia, and 2.4 for myeloproliferative neoplasms, similar to other European regions. The 5-year relative survival of leukemia in Germany currently ranges between 8 and 95% according to sex, age, and category, and is thus considerably better compared with results derived from a European data pool referring to 2000-2002.

Zeitliche Trends in der Inzidenz und Sterblichkeit respiratorischerKrankheiten von hoher Public-Health-Relevanz in Deutschland

Erkrankungen der Atemwege und der Lunge sind weltweit wichtige Ursachen von Krankheitslast und Sterblichkeit. In Deutschland haben neben akuten respiratorischen Erkrankungen (ARE) vor allem chronische Lungenerkrankungen – darunter Lungenkrebs, chronisch obstruktive Lungenerkrankung (COPD) und Asthma bronchi ale – hohe gesellschaftliche und wirtschaftliche Bedeutung. ARE-Neuerkrankungsraten unterscheiden sich deutlich nach Alter, Jahreszeit und Jahr. Sie werden als wöchentliche Konsultationsinzidenz über ausgewählte Einrichtungen der ambulanten und stationären Versorgung erfasst. Zwischen 2009 und 2016 liegen die Neuerkrankungsraten im ambulanten sowie im stationären Bereich (für schwere Krankheitsverläufe, SARI) bei Kleinkindern mit Werten von bis zu 9,4 % bzw. 0,2 % am höchsten. Auch die ARE-Sterblichkeit unterliegt saisonalen und jähr lichen Schwankungen. Sie wird mit jährlich mehr als 17.000 Todesfällen über die amtliche Todesursachenstatistik nur unzureichend erfasst, da häufig ein vorbestehendes chronisches Grundleiden anstelle der akuten Infektion als zum Tode führende Ursache kodiert wird. Zusätzlich sind daher Einschätzungen der ARE-Übersterblichkeit im Zusammenhang mit Grippewellen notwendig. Bei Lungenkrebs, COPD und Asthma ist insbesondere die langfristige zeitliche Entwicklung des Neuerkrankungsund Sterbegeschehens von gesundheitspolitischem Interesse. Daten der amtlichen Todesursachenstatistik von 1998 bis 2015 zeigen, dass Sterberaten für Lungenkrebs und COPD bei Männern im Mittel um 1,8 % bzw. 1,1 % pro Jahr sanken, während sie bei Frauen um 2,5 % bzw. 2,3 % anstiegen. Dennoch starben im Jahre 2015 immer noch mehr Männer als Frauen an Lungenkrebs (29.378 vs. 15.881) bzw. COPD (17.300 vs. 13.773). Sterberaten für Asthma bronchiale sind im gleichen Zeitraum pro Jahr um durchschnittlich 8,3 % bei Frauen und 11,2 % bei Männern gesunken und dabei zuletzt auf 659 Todesfälle bei Frauen und 393 bei Männern zurückgegangen. Neuerkrankungsraten für Lungenkrebs bewegen sich ab 1998 auf fast gleichem Niveau wie die Sterberaten. Für COPD und Asthma sind keine entsprechenden Daten verfügbar. Ausbau und Verstetigung von koordinierten Surveillance-Aktivitäten zu respiratorischen Krankheiten im Rahmen internationaler Aktionspläne zur Krankheitsprävention sind notwendig. RESPIRATORISCHE ERKRANKUNGEN · LUNGENERKRANKUNGEN · INZIDENZ · MORTALITÄT · SURVEILLANCE Journal of Health Monitoring Zeitliche Trends in der Inzidenz und Sterblichkeit respiratorischer Krankheiten von hoher Public-Health-Relevanz in Deutschland

Cancers Potentially Preventable through Excess Weight Reduction in Germany in 2010

Objective: In order to quantify the preventive potential of body weight reduction in Germany, population-attributable risks (PARs) were estimated for 13 cancer types. Methods: PARs were calculated using body weight prevalence from a nationwide survey from 1998, cancer incidence estimates for 2010 from cancer registry data and relative risk estimates from published meta-analyses. Three counterfactual scenarios were evaluated: reducing BMI to maximally 21 kg/m² (main analysis) and weight reductions among overweight and obese persons of 5% and 10%. Results: An estimated 9% of all incident cancer cases in Germany - 40,748 cases - could be attributed to excess body weight in 2010. The highest proportions were estimated for endometrial cancer (48%) and oesophageal adenocarcinoma (48% for women, 46% for men). The largest case numbers were estimated for postmenopausal breast (9,081 cases), colorectal (8,002 cases among men, 3,297 cases among women) and endometrial cancer (5,468 cases). The additional counterfactual scenarios suggested that weight reductions of 5% and 10% could prevent 5,572 cases and 11,427 cases, respectively. Conclusions: In Germany there is a considerable preventive potential for cancers associated with excess body weight. Efforts to prevent further weight gain and encourage weight loss should be promoted.

Expertise of the Robert Koch Institute for the first prevention report: background, aims and approach

derive population-wide and target group-specific prevention needs and potentials. In doing so, data on various risks and protective factors and diseases are taken into account. The following approach was chosen for the preparation of the expertise: In a feasibility study, selection criteria are defined for the eleven target groups named in the Federal Framework Recommendations; this should en able to describe the prevalence of risk and protective factors and diseases that are relevant to the various target groups. This approach will also involve taking into account important aspects such as Germany’s national health targets and current social developments such as the unequal distribution of health burdens among the population. In a second step, data availability is examined. Priority is given to the data of RKI’s health monitoring, but research will also be undertaken into external data sources. Furthermore, the report will also identify data gaps that may exist. This step will be followed by data preparation and descriptive and statistical data analyses. The results and the indication of prevention needs will finally be summarised in the expertise which will be available by the end of 2018. Journal of Health Monitoring · 2018 3(S2) DOI 10.17886/RKI-GBE-2018-053 Robert Koch Institute, Berlin

Time trends in incidence and mortality of respiratory diseases ofhigh public health relevance in Germany

Respiratory diseases are major causes of disease burden and mortality throughout the world. In Germany, alongside acute respiratory infections (ARI), chronic lung diseases – including lung cancer, chronic obstructive pulmonary disease (COPD), and asthma – are of particular socioeconomic importance. ARI incidence rates differ significantly according to age, season and year. They are recorded as weekly consultation rates as reported by selected outpatient and inpatient care facilities. Between 2009 and 2016, the highest incidence rates of severe acute respiratory infection (SARI) were recorded among young children in outpatient (9.4%) and inpatient (0.2%) care. Mortality rates for ARI are also subject to seasonal and annual fluctuations. However, the official statistics on causes of death, which lead to estimates of more than 17,000 annual deaths, provide an inadequate measure of death rates because chronic underlying illnesses are often recorded as the cause of death rather than a more recently acquired acute infection. Therefore, the excess mortality caused by ARI needs to be assessed in the context of influenza outbreaks. Regarding lung cancer, COPD and asthma, the long-term time trends in disease incidence and mortality rates are of particular interest from a health policy perspective. Analyses of data from the official statistics on causes of death for the years 1998 through 2015 show that mortality rates for lung cancer and COPD decreased on average by 1.8% and 1.1% per year respectively, among men, whereas among women they increased by 2.5% (lung cancer) and 2.3% (COPD) annually. Nevertheless, more men than women died of lung cancer or COPD in 2015 in Germany: 29,378 men and 15,881 women died from lung cancer, and 17,300 men and 13,773 women died from COPD. During the same period, the asthma mortality rates decreased on average by 8.3% annually among women and by 11.2% annually among men, and the absolute number of deaths came down to 659 among women and 393 among men. Lung cancer incidence rates have been at similar levels as lung cancer death rates since 1998. No such data are available on time trends in COPD or asthma incidence rates. Coordinated surveillance of respiratory diseases needs to be expanded within the framework of international action plans for disease prevention. RESPIRATORY DISEASES · LUNG DISEASES · INCIDENCE · MORTALITY · SURVEILLANCE Journal of Health Monitoring · 2017 2(3) DOI 10.17886/RKI-GBE-2017-061 Robert Koch Institute, Berlin Authors: Henriette Steppuhn*, Silke Buda*, Antje Wienecke*, Klaus Kraywinkel, Kristin Tolksdorf, Jörg Haberland, Detlef Laußmann, Christa Scheidt-Nave *contributed equally

Inzidenz und Überleben bei Leukämien in Deutschland nach aktuellen standardisierten Kategorien@@@Leukemia incidence and survival in Germany according to current standardized categories

BACKGROUND Leukemias include a large number of diverse malignancies concerning the blood-forming system. Population-based comparisons and time trends are complicated by inconsistent definitions and classifications. In the course of the European HAEMACARE project, a consensus grouping system was created based on the morphology codes of the ICD-O-3 (International Classification of Diseases-Oncology, third revision), consistent with the WHO classification published in 2008 and useful for epidemiologic and public health purposes. For the first time leukemia incidence and survival in Germany are presented according to this system on the basis of cancer registry data.. MATERIAL AND METHODS A set of leukemia cases diagnosed during 2001-2010 was extracted from the data submitted by German population-based cancer registries to the Robert Koch Institute in early 2013 and grouped according to the HAEMACARE system. Direct age-standardized incidence rates were calculated. To estimate the prognosis of adult leukemia patients diagnosed during 2008-2010, the 5-year relative survival was computed using the period approach. RESULTS AND DISCUSSION Based on 23,328 predominantly leukemic malignancies ascertained for six federal states over a 10-year period, the age-standardized incidence rates were 4.1 (per 100,000) for chronic lymphocytic leukemia, 3.1 for acute myeloid leukemia, and 2.4 for myeloproliferative neoplasms, similar to other European regions. The 5-year relative survival of leukemia in Germany currently ranges between 8 and 95% according to sex, age, and category, and is thus considerably better compared with results derived from a European data pool referring to 2000-2002.