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Background: In October 2002, screening colonoscopy from age 55 onward was introduced as part of the German national statutory cancer screening program. Screening colonoscopy is intended to lower both the mortality and the incidence of bowel cancer by enabling the detection and removal of precursor lesions. Method: The authors studied trends in bowel cancer incidence and mortality in Germany from 2003 to 2012 on the basis of data from the epidemiological cancer registries and from cause-of-death statistics. Results: Over the period of investigation, the age-standardized incidence of bowel cancer (with the European population as a standard) fell from 66.1 to 57.0 cases per 100 000 persons per year (-13.8%) in men and from 42.6 to 36.5 per 100 000 persons per year (-14.3%) in women. In parallel with these changes, the age-standardized mortality from bowel cancer fell by 20.8% in men and by 26.5% in women. In the age groups 55-64,65-74, and 75-84 years, the cumulative risk of receiving a diagnosis of bowel cancer fell by 17-26%; in persons under age 55, this risk fell by only 3% in men, but increased by 14% in women. Long-term data from the cancer registry in the German federal state of Saarland revealed that the incidence of bowel cancer, but not its mortality, had risen over the decades preceding the study; it was only during the period of investigation that the trend reversed itself. Conclusion: Within 10 years of the introduction of screening colonoscopy in Germany, the incidence of bowel cancer in persons over age 55 fell by 17-26%, after having risen steadily over the preceding decades. [ABSTRACT FROM AUTHOR]

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.

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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.