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In the article, the authors discuss the trends in breast-cancer-specific mortality in Germany from 2003 to 2018. The study used data from the Information System of the Federal Health Monitoring database. Also cited are the nationwide implementation of mammography screening in the country since 2003 and the debates over the benefits and disadvantages of screening.

Copyright of Deutsches Ärzteblatt International is the property of Deutscher Aerzte-Verlag GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Deutsches Ärzteblatt International is the property of Deutscher Aerzte-Verlag GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The author comments on a research by Hermann Brenner and colleagues about the burden of and modifiable risk factors for cancer in Germany. Topics discussed include the application and calculation of the concept of population-attributable fraction (PAF) for cancer risk factors, the primary prevention of cancer, and the role of evidence-based early diagnosis in reducing cancer-associated morbidity and mortality.

A letter to the editor is presented in response to the article "Declining Bowel Cancer Incidence and Mortality in Germany--An Analysis of Time Trends in the First Ten Years After the Introduction of Screening Colonoscopy" by Hermann Brenner and colleagues in the July 2016 issue, along with the authors' reply.

The article presents a study which discusses how process quality of an early detection program can be described comprehensively and transparently through carefully collected data. It depicts the significance of comprehensive evaluation of colonoscopy as a tool for preventing colorectal carcinoma. Details on the results of the study are also considered.

Background: Infection with human papillomavirus (HPV) is one of the more common sexually transmitted diseases in Germany. Vaccination against HPV was introduced in Germany in 2007. In this study, we sought to detect a population-based decline in the incidence of cervical cancer in women under age 30 who were eligible for vaccination in the first 11 years after its introduction., Methods: Data on new diagnoses of HPV-associated cervical cancer from 2004 to 2018 were obtained from the cancer registries of the German federal states (Bundesländer) through the German Center for Cancer Registry Data (ZfKD). Trends in the incidence of invasive and in situ cervical cancer were determined with log-linear joinpoint regression and age-period-cohort models., Results: The incidence of cervical cancer, which had been rising in the previous decades, has been falling since 2010, with a marked decline among women in all age groups eligible for vaccination (e.g., from 70.0 to 41.8 cases per 100 000 persons per year from 2010 to 2018 in women aged 24 to 26). Women born in 1992 were the first to become eligible for vaccination and have a 24% lower incidence than the reference cohort of women born in 1989 (relative risk 0.76, 95% confidence interval [0.68; 0.86]). Larger effects were found in later birth cohorts, in which vaccination was more widespread., Conclusion: Eleven years after the introduction of HPV vaccination, a drop in the incidence of cervical cancer was observable at the population level in the birth cohorts eligible for vaccination.

Introduction: The effectiveness of mammographic screening has been proven at evidence level 1A. Mammography offers the best ratio of benefits to side effects of any screening method tested to date. In this literature review, we ask whether early detection might be improved still further by combining mammography with other imaging modalities., Methods: The authors performed a selective literature search for combined key words in the Medline and Cochrane Library databases from 1/2000 to 11/2007, screened all titles, and evaluated the full text of all original articles. We selected articles for further analysis according to systematic criteria (minimum numbers, avoidance of overlap) and also considered published guidelines., Results: No screening studies of comparable size to those for mammography are available for ultrasound or MRI. Smaller studies have indicated that the use of these two modalities might lead to the detection of additional cancers in selected subgroups. For mass screening an increase in the detection rate of 10% to 15% might become possible. This increase would probably be associated with a tripling of the breast biopsy rate, compared to mammography alone. The number of indeterminate cases in which short-term follow-up (i.e., at 6 months) would be recommended would increase roughly tenfold with MRI, and to an unknown extent with ultrasound. The related quality-assurance issues remain to be addressed., Discussion: Randomized controlled studies are needed for a realistic assessment of the achievable benefits and unavoidable side effects of combined screening. For women whose risk of breast cancer is not elevated, mammography remains the standard screening method.

Introduction: It is unclear whether the care of breast cancer patients complies with the German breast cancer guideline and achieves the appropriate standard of care. For this reason the guideline's requirements were compared with the empirically determined health care provision in the German state of Schleswig-Holstein., Methods: The OVIS-study is based on a postal questionnaire survey of medical care in 1927 breast cancer patients between 02/2003 to 02/2005. Statements such as "should be carried out" and "mandatory procedure" were cross-referenced with specific reference ranges., Results: Locally invasive tumors were rare (pT 3/4: 8%). Preoperatively, 95% of patients received mammography, 78% breast ultrasound, 92% a chest x-ray, and 81% an abdominal ultrasound. 71% of all patients had breast conserving treatment, of whom 96% had irradiation of the remaining breast tissue. Axilla lymph node dissection was reported for 91%, axillary irradiation for 36%, and a systemic therapy for 95%., Discussion: Local quality indicators comply in general with the German guideline. The high rate of axillary irradiation could be viewed as inadequate provision.