Joachim Kieschke

Krebs in Deutschland 2003-2004 Häufigkeiten und Trends

Die Broschüre »Krebs in Deutschland« wird alle zwei Jahre als gemeinsame Publikation der Gesellschaft der epidemiologischen Krebsregister e. V. (GEKID) und des Robert KochInstituts (RKI) herausgegeben. Die vorliegende 6. Auflage erscheint mit neuem Design erstmalig in der Reihe der Berichte der Gesundheitsberichterstattung (GBE) des Bundes. Sie enthält Angaben zu den in Deutschland im Zeitraum von 1980 bis zum Jahr 2004 insgesamt aufgetretenen Krebsneuerkrankungen und zu ausgewählten Einzellokalisationen, die jeweils kurz und übersichtlich dargestellt werden (Erkrankungsund Sterberaten, Risikofaktoren, Trendverläufe, Überlebensaussichten). Die aktuellen Schätzungen des RKI basieren auf den Daten vollzählig erfassender epidemiologischer Krebsregister in Deutschland. Für das Jahr 2004 weist diese Schätzung insgesamt 436.500 Krebsneuerkrankungen aus (Männer 230.500, Frauen 206.000). Damit sind im Vergleich zur vorangegangenen Schätzung, die mit dem Jahr 2002 abschloss, im Jahr 2004 etwa 12.000 Krebsneuerkrankungen mehr aufgetreten. Bei Frauen blieb die Gesamtzahl dieser Erkrankungen gegenüber 2002 unverändert. Die zusätzlichen Erkrankungsfälle im Jahr 2004 sind überwiegend auf Erkrankungen der Männer an Prostatakrebs zurückzuführen, der mit etwa 58.500 Erkrankungsfällen die häufigste Krebserkrankung bei Männer darstellt. Bei den Frauen steht, wie in den vorangegangenen Schätzungen auch, der Brustkrebs mit etwa 57.000 Neuerkrankungen an erster Stelle. Im Jahr 2004 verstarben insgesamt 208.800 Personen in Deutschland an Krebs, im Jahr 2002 waren es noch 209.900. Die Überlebensaussichten mit Prostatakrebs und Brustkrebs haben sich so weit verbessert, dass die Zahl der Krebssterbefälle daran mittlerweile abnimmt. Im Jahr 2004 verstarben 11.200 Männer an Prostatakrebs und 17.600 Frauen an Brustkrebs. Das sind jeweils 200 Sterbefälle weniger als noch zwei Jahre zuvor. Angaben zu Krebs erkrankungen bei Kindern werden vom Kinderkrebsregister Mainz in einem eigenen Abschnitt der Broschüre dargestellt.

Recent Trends in Survival of Patients with Pancreatic Cancer in Germany and the United States

Objectives Survival improvement for pancreatic cancer has not been observed in the last 4 decades. We report the most up-to-date population-based relative survival (RS) estimates and recent trends in Germany and the United States. Methods Data for patients diagnosed in 1997 to 2010 and followed up to 2010 were drawn from 12 population-based German cancer registries and the US SEER (Surveillance, Epidemiology and End Results) 13 registries database. Using period analysis, 5-year RS for 2007 to 2010 was derived. Model-based period analysis was used to assess 5-year RS time trends, 2002–2010. Results In total 28,977 (Germany) and 34,793 (United States) patients aged 15 to 74 years were analyzed. Five-year RS was 10.7% and 10.3% in Germany and the United States, respectively, and strongly decreased with age and tumor spread. Prognosis slightly improved from the period 2002–2004 to 2008–2010 (overall age-adjusted RS: +2.5% units in Germany and +3.4% units in the United States); improvement was particularly strong for regional stage and head and body subsites in Germany and for localized and regional stages and tail subsite in the United States. Conclusions Although pancreatic cancer survival continues to be poor for advanced-stage patients, our study disclosed encouraging indications of first improvements in 5-year RS after decades of stagnation.

Incidence patterns and trends of malignant gonadal and extragonadal germ cell tumors in Germany, 1998-2008

BACKGROUND Malignant gonadal (GGCT) and extragonal germ cell tumors [GCT (EGCT)] are thought to originate from primordial germ cells. In contrast to well reported population-based data of GGCTs in males, analyses of GGCTs in females and EGCTs in both sexes remain limited. METHODS In a pooling project of nine population-based cancer registries in Germany for the years 1998-2008, 16,883 malignant GCTs and their topographical sites were identified using ICD-O morphology and topography for persons aged 15 years and older. We estimated age-specific and age-standardized incidence rates. RESULTS Among males, the incidence of testicular GCTs increased over time. In contrast, there was no increase in the incidence of EGCTs. Among females, rates of ovarian GCTs were stable, while rates of EGCTs declined over time. The most frequent extragonadal sites were mediastinum among males and placenta among females. CONCLUSIONS Our results underline different incidence trends and distinct age-specific incidence patterns of malignant GGCTs and EGCTs, as reported recently by several population-based registries. The differences suggest that GGCT and EGCT may have different etiologies.

Comparison of prostate cancer survival in Germany and the USA: can differences be attributed to differences in stage distributions?

To better understand the influence of prostate‐specific antigen (PSA) screening and other health system determinants on prognosis of prostate cancer, up‐to‐date relative survival (RS), stage distributions, and trends in survival and incidence in Germany were evaluated and compared with the United States of America (USA).

Opening Up Data Analysis for Medical Health Services: Data Integration and Analysis in Cancer Registries with CARESS

Dealing with cancer is one of the big challenges of the German healthcare system. Todays efforts regarding the analysis of cancer data incorporate detection of spatial clusters as well as complex health services research and quality assurance. Recently, guidelines for a unified evaluation of German cancer data were developed which demand the execution of comparative survival analyses [1]. In this paper, we present how the CARLOS Epidemiological and Statistical Data Exploration System CARESS, a sophisticated data warehouse system that is used by epidemiological cancer registries ECR in several German federal states, opens up survival analysis for a wider audience. We also discuss several performance optimizations for survival estimation, and illustrate the feasibility of our approach. Moreover we present the CARLOS Record Linkage System CARELIS, a companion tool to CARESS that enables matching new data against already existent disease reports in the ECR under consideration of potential cross references.

Opening up Data Analysis for Medical Health Services: Cancer Survival Analysis with CARESS

Dealing with cancer is one of the big challenges of the German healthcare system. Originally, efforts regarding the analysis of cancer data focused on the detection of spatial clusters of cancer incidences. Nowadays, the emphasis also incorporates complex health services research and quality assurance. In 2013, a law was enacted in Germany forcing the spatially all-encompassing expansion of clinical cancer registries, each of them covering a commuting area of about 1 to 2 million inhabitants [1]. Guidelines for a unified evaluation of data are currently in development, and it is very probable that these guidelines will demand the execution of comparative survival analyses.

Experiences with a workstation prototype for softcopy reading within the Bavarian mammography recertification programme

Abstract In January 2002, the Bavarian Statutory Health Care Administration (“Kassenarztliche Vereinigung Bayerns”, KVB) started a recertification programme for quality assurance and quality improvement in mammography reading. All accredited radiologists and gynecologists are asked to prove their qualification every 1–2 years. The recertification programme requires the physicians to read 50 cases randomly selected from a larger collection of high-quality test cases. The portion of malignant and benign cases corresponds to the requirements of the German National Association of Statutory Health Insurance Physicians (“Kassenarztliche Bundesvereinigung”, KBV). In order to read the mammograms on a softcopy device the images are digitised with a high-quality scanner and converted to DICOM Digital Mammography format. The workstation software has been implemented according to the particular requirements of this programme. To verify the applicability of digitised mammograms for recertification purposes, a comparative study with 32 trained radiologists and gynecologists has been performed. As a result, the study showed that there was no significant difference in the error rate of the reported findings between conventional film and softcopy reading. The first intermediate results of this quality initiative are promising. The introduction of a corresponding federal German recertification programme is intended.