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Evidence on survival of malignant mesothelioma (MM) and other rare thoracic cancers is limited due to the rarity of these cancer sites. Here, we provide a comprehensive overview of MM incidence and survival after MM and other rare thoracic cancers in Germany and the United States (US). Incidence was estimated from a German National Cancer Database and from the Surveillance, Epidemiology and End Results (SEER) 18 database for 2000-2014. Patients diagnosed in 1997-2013 with malignant epithelial tumors of the trachea (Etra), epithelial tumors of the thymus (Ethy) and MM were extracted from a German cancer survival database and from the SEER 13 database. Period analysis was employed to compute 5-year relative survival (RS). During 2000-2014, an annual average of 0.9 and 0.6 MM cases per 100,000 person-years was diagnosed in Germany and the US. Rates decreased in Germany and in the US. Patients with Ethy had highest 5-year RS with US patients surviving longer (69.1% compared to 63.7%, p = 0.02). Survival after Etra was comparable in both countries (Germany 33.6%, US 34.4%, p = 0.07). Survival in MM patients was poor overall (Germany 11.8%, US 12.1%, p < 0.01). Survival improvements were only observed in MM patients in Germany (10.8% [2002-2007] vs. 13.0% [2008-2013], p < 0.01). The lack of progress in survival for Etra and Ethy patients underlines the need of novel preventive, therapeutic and diagnostic approaches. MM incidence significantly decreased in Germany and in the US. Further monitoring of MM incidence is warranted given that a peak in incidence is expected in 2020-2030 in Western countries., (© 2020 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

Inferior vena cava (IVC) diameter can be used to approximate right atrial pressure in patients admitted for acute decompensated heart failure (ADHF). Recent studies linked IVC dilation to an increased risk of early re-admission and short-term mortality. Moreover, renal insufficiency (RI) is an established risk factor for mortality in ADHF and is associated with congestion. We hypothesized that the IVC diameter is a marker of all-cause mortality but its prognostic impact may be influenced by kidney function. We analyzed data of 1101 patients admitted for ADHF with available echocardiography of the IVC by chart review and death registry linkage. Patients were dichotomized according to a cut-off value of 21 mm. Cox proportional hazards model was used to identify mortality predictors. A dilated IVC was detected in 474 (43.1%) patients. Overall, 400 (36.3%) patients died within 3 years. All-cause mortality was significantly higher in patients with dilated IVC [hazard ratio 1.45 (confidence interval 1.21-1.74); p < 0.001]. However, a dilated IVC was only associated with all-cause mortality in patients with RI function [hazard ratio 1.60 (confidence interval 1.26-2.03); p < 0.001] but not in patients with a preserved kidney function [hazard ratio 1.04 (confidence interval 0.72-1.50); P = 0.84]. IVC diameter was identified as an independent predictor for all-cause mortality in a Cox proportional hazards model with a significant interaction between IVC diameter and baseline kidney function. In conclusion, IVC dilation is a marker of high mortality risk in patients admitted for ADHF. However, this observation was confined to patients with RI.

Simple Summary: The incidence of keratinocyte skin cancer has rapidly been increasing over the last five decades in fair skinned populations throughout the world. About 20% account for squamous cell carcinoma (SCC), and mainly the elderly are affected. Although the mortality rate is low, keratinocyte skin cancer is associated with a high morbidity, especially if multiple tumors occur, and pose a problem for the healthcare system. Here, we present the epidemiology of keratinocyte skin cancer, with a focus on SCC in Queensland, Australia; the United States and the north of Europe, and give an outlook to further challenges. Keratinocyte skin cancer, consisting of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), is by far the most common cancer in white-skinned populations, with rapid increases over the last 50 years. While the age-standardized incidence rates increase worldwide, the age-standardized mortality rates are variable. The incidence rates of keratinocyte skin cancer are much higher compared to those of melanoma, and are largely attributed to the raising exposure to ultraviolet (UV) radiation, the most important causal risk factor for skin cancer. Whereas the development of BCC is mainly due to intense UV exposure during childhood and adolescence, the development of SCC is related to chronic, cumulative UV exposure over decades. Although mortality rates are relatively low, SCC is an increasing problem for healthcare services, significantly causing morbidity, especially in older age groups. This review reports on the epidemiology of keratinocyte skin cancer, with a focus on SCC, in Australia, the United States, and the north of Europe, with an outlook on further challenges health systems will be confronted with in the next 20 years. [ABSTRACT FROM AUTHOR]

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Summary: Background: There are regional differences in skin cancer screening uptake in Germany. So far, it is unclear whether a high uptake of screening services leads to a reduction in mortality. This article presents study results on the investigation of spatiotemporal associations between skin cancer screening and mortality. The methods used are discussed regarding their suitability. Material and methods: The basis is ambulatory claims data on the utilization of early skin cancer detection as well as data on skin cancer mortality from the cause‐of‐death statistics of the years 2011–2015 at county level in Germany. In addition to a descriptive evaluation, spatiotemporal cluster analyses and regression models were used to investigate the relationship between the uptake of early detection and mortality. In addition to age, adjustments were also made for other selected socio‐economic and socio‐graphical variables. Results: The descriptive results show striking spatial patterns of skin cancer screening and mortality. Cluster analyses identified regions with significantly higher and lower cases of early detection and skin cancer mortality. The spatiotemporal regression analyses show no clear association. Only early detection by a dermatologist, adjusted for age, shows an association with mortality. Conclusions: No clear association between early skin cancer detection and mortality can be derived from the results. However, the study design used with a spatiotemporal cluster and regression analysis has shown that these methods allow in‐depth statements about the relationship between early skin cancer detection and mortality. [ABSTRACT FROM AUTHOR]

Cutaneous squamous cell carcinoma (cSCC) incidences are increasing but scarcely available separated. We analysed incidence rates of cSCC over three decades with an extrapolation to 2040. Cancer registries from the Netherlands, Scotland and two federal states of Germany (Saarland/Schleswig-Holstein) were sourced for separate cSCC incidence data. Incidence and mortality trends between 1989/90 and 2020 were assessed using Joinpoint regression models. Modified age-period-cohort models were applied to predict incidence rates up to 2044. Rates were age-standardised using the new European standard population (2013). Age-standardised incidence rates (ASIR, per 100,000 persons per year) increased in all populations. The annual percent increase ranged between 2.4% and 5.7%. The highest increase occurred in the age groups ≥60 years, especially in men aged ≥80 years, with a three to 5-fold increase. Extrapolations up to 2044 showed an unrestrained increase in incidence rates in all countries investigated. Age-standardised mortality rates (ASMR) showed slight increases between 1.4 and 3.2% per year in Saarland and Schleswig-Holstein for both sexes and for men in Scotland. For the Netherlands, ASMRs remained stable for women but declined for men. There was a continuous increase of cSCC incidence over three decades with no tendency for levelling-off, especially in the older populations as males ≥80 years. Extrapolations point to a further increasing number of cSCC up to 2044, especially among ≥60 years. This will have a significant impact on the current and future burden on dermatologic health care which will be faced with major challenges. • Age standardised incidence rates separated of cutaneous squamous cell carcinoma from four European registries were analysed. • An annual increase between +2.4% and +5.7% was observed over three decades. • Highest increases occurred in ages ≥60, especially in men ≥80. • Age-standardised mortality rates are rising in Germany and Scotland. • In extrapolations until 2044, an increase up to 5-fold in ages ≥60 is expected. [ABSTRACT FROM AUTHOR]

Aims Cardiac resynchronization therapy (CRT) is an established treatment for heart failure. There is contradictory evidence whether defibrillator capability improves prognosis in patients receiving CRT. We compared the survival of patients undergoing de novo implantation of a CRT with defibrillator (CRT-D) option and CRT with pacemaker (CRT-P) in a large health claims database. Methods and results Using health claims data of a major German statutory health insurance, we analysed patients with de novo CRT implantation from 2014 to 2019 without indication for defibrillator implantation for secondary prevention of sudden cardiac death. We performed age-adjusted Cox proportional hazard regression and entropy balancing to calculate weights to control for baseline imbalances. The analysis comprised 847 CRT-P and 2722 CRT-D patients. Overall, 714 deaths were recorded during a median follow-up of 2.35 years. A higher cumulative incidence of all-cause death was observed in the initial unadjusted Kaplan–Meier time-to-event analysis [hazard ratio (HR): 1.63, 95% confidence interval (CI): 1.38–1.92]. After adjustment for age, HR was 1.13 (95% CI: 0.95–1.35) and after entropy balancing 0.99 (95% CI: 0.81–1.20). No survival differences were found in different age groups. The results were robust in sensitivity analyses. Conclusion In a large health claims database of CRT implantations performed in a contemporary setting, CRT-P treatment was not associated with inferior survival compared with CRT-D. Age differences accounted for the greatest part of the survival difference that was observed in the initial unadjusted analysis. [ABSTRACT FROM AUTHOR]

Effective population‐based mammography screening should impact breast cancer (BC) incidence, age and stage‐specific incidence and BC mortality. We aim to investigate such effects in a time period of 10 years after implementation of the German mammography screening program. Data on 323,719 breast cancer patients from 2003 to 2014 for defined regions covering a population of 30 million inhabitants and official mortality data from 1998 to 2016 for almost the whole of Germany were used. We compared incidence and mortality rates for the prescreening time period (2003/2004) and the latest available data (2013/2014 and 2015/2016, respectively) and performed trend analyses using joinpoint regression models. In the screening exposed age groups (50–59 and 60–69 years), BC incidence showed a typical prevalence peak with the introduction of the mammography screening, mainly driven by an increase of early‐stage BC. For Stage III and IV BC incidence in 2013/2014 was 24.2 and 23.0% (age group 50–59 years) and 28.3 and 24.2% (age group 60–69 years) lower than in the prescreening period. From 2003/2004 to 2015/2016 BC mortality decreased by 25.8 and 21.2%, respectively. As corresponding trends in nonexposed age groups were distinctly unfavorable, the reduction of late‐stage BC incidence and BC mortality in the screening exposed age groups in Germany is most likely to be attributed to the introduction of the national mammography screening program. These positive effects are bought at the cost of a moderate occurrence of overdiagnosis, especially by a sharp increase of in situ cancers. What's new? Effective mammography screening should have an impact on breast cancer (BC) incidence and mortality. Until today, however, there is little information available on the population‐based outcomes of the national breast cancer screening program in Germany. Here, the authors present age‐specific population‐based data before and after implementation of the program. Compared to non‐exposed age groups, screening‐eligible women showed more favorable trends regarding the incidence of late‐stage BC and BC mortality. A persistent excess of BC incidence, mainly driven by an increase of in situ cancers, indicated a moderate amount of overdiagnosis. [ABSTRACT FROM AUTHOR]

Objective The main purpose of skin cancer screening is melanoma mortality reduction. Before the implementation of nationwide German skin cancer screening, the pilot project SCREEN was conducted in Schleswig-Holstein in 2003–2004. We aimed to determine whether the pilot project had achieved a mortality reduction. Methods Using an incidence-based approach (patients with both melanoma diagnosis and death in 2003–2008), we compared the observed melanoma mortality of the SCREEN cohort to the melanoma mortality expected without screening in the general population of Saarland. Results The age- and sex-standardized melanoma mortality ratio (SMR) for 5.5 years of follow-up was 0.59 (95% confidence interval, 0.40–0.83). Conclusion Our results indicate reduced mortality in the SCREEN cohort. Several potential biases cannot be excluded, but most of them tend to inflate the SMR. [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.

BACKGROUND: From July 1, 2003 to June 30, 2004, a population-based skin cancer screening project was conducted in Schleswig-Holstein, Germany. In total, 360,288 individuals aged ≥20 years were screened by means of a whole-body examination. In this report, the authors compare trends in melanoma mortality in Schleswig-Holstein with those in all adjacent regions, none of which had population-based skin cancer screening. METHODS: Trends in melanoma mortality rates for Schleswig-Holstein and the adjacent regions (Denmark and the German federal states of Mecklenburg-Vorpommern, Hamburg, and Lower Saxony) and in Germany excluding Schleswig-Holstein were compared. Log-linear regression was used to assess mortality trends. RESULTS: In Schleswig-Holstein during the pre skin cancer screening period (1998-1999), the age-standardized melanoma mortality rate (World standard population) was 1.9 per 100,000 for men and 1.4 per 100,000 for women. Melanoma mortality declined by 47% to 1.0 per 100,000 men and by 49% to 0.7 per 100,000 women by 2008/2009. The annual percentage change in the most recent 10-year period (2000-2009) was −7.5% (95% confidence interval, −14.0, −0.5) for men and −7.1% (95% confidence interval, −10.5, −2.9) for women. In each of the 4 adjacent regions and in the rest of Germany, mortality rates were stable, and the decline in Schleswig-Holstein was significantly different from the changes observed in all of the other areas studied. CONCLUSIONS: The current data represent strong evidence, but not absolute proof, that the skin cancer screening program produced a reduction in melanoma mortality in Schleswig-Holstein. Cancer 2012. © 2012 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common cancer among women in Germany with high public health impact. In the last decade rapid changes in risk factor patterns, early breast cancer detection, and therapy have taken place. Their effects on breast cancer epidemiology in Germany are described. Materials and Methods: A register-based survey using recent incidence data from German cancer registries was performed. Mortality data were provided by the Central Federal Statistical Office. We calculated age-standardized rates and 5- and 10-year trends. Results: Breast cancer incidence increased until the year 2002, thereafter a discreet decline occurred until 2005 (– 6.8%). In the age group 50–59 years this reduction was most pronounced (– 12%). Mortality declined from 1996/7 to 2004/5 by 19%, with the strongest effect in women younger than 55 years (approximately 30%). Regional patterns of breast cancer incidence and mortality revealed differences within Germany of greater than 30%. Conclusion: Declining hormone replacement therapy prescription is the most likely factor to explain the drop in breast cancer incidence. The reduction in mortality might be caused by better therapy and enhanced early detection during the last decade. Differences in breast cancer incidence and mortality between Eastern and Western Germany give reason for further research and discussion. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

In the TeleGuard trial, 1500 patients with established coronary artery disease (CAD) were recruited and randomized to control or intervention groups. Patients in the intervention group were equipped with a 12-lead event recorder and could contact a call centre and transmit an ECG whenever they wished. In a 12-month study, the composite endpoint (all-cause mortality, myocardial infarction, re-hospitalization or re-vascularization) was seen in 40% of the intervention patients and in 38% of the control patients. In both groups, approximately 40% were re-hospitalized. In total, 73 patients experienced re-vascularization, 75 showed an infarction and 33 died. Equipping CAD patients with a 12-lead ECG device and providing a telemedicine centre with 24-hour availability did not decrease risk for the composite endpoint (re-hospitalization, re-vascularization, (subsequent) myocardial infarction and/or death). It is likely that the clinical pathway used in the telemedicine centre led to an increased hospital admission rate in the intervention group. [ABSTRACT FROM AUTHOR]

Background Benefits of skin cancer screening remain controversial. Objective We sought to update evidence on the impact of skin cancer screening and secondary prevention campaigns on skin cancer incidence, mortality, stage-specific incidence, and interval cancers after negative screening. Methods We searched MEDLINE and EMBASE for studies published in English or German between January 1, 2005, and February 4, 2015. Two reviewers independently performed study selection, data extraction, and critical appraisal. Results were described in a narrative synthesis. Results Of 2066 records identified in databases and 10 records found by manual search, we included 15 articles. Overall, evidence suggests that with implementation of skin cancer screening, incidence of in situ and invasive skin cancer increased; increasing rates of thin and decreasing rates of thick melanoma were observed. After cessation of screening, invasive melanoma incidence decreased. A significant melanoma mortality reduction was shown in a German study; 2 other studies observed fewer deaths than expected. No study on interval cancers was identified. Limitations Publication bias cannot be ruled out. Most studies are limited because of their ecological design. Conclusion Large ecological studies, a cohort study, a case-control study, and a survey indicate benefits of skin cancer screening, but the evidence level is very low. [ABSTRACT FROM AUTHOR]

Cutaneous melanoma (CM) and keratinocyte cancer (KC) cause considerable morbidity and mortality. We analysed long-term trends of CM and KC in different white populations. Age-standardised (European Standard Population 2013) incidence and mortality rates (ASIR, ASMR) of CM were extracted from cancer registries in Denmark, New Zealand and the US SEER-Database. ASIRs of KC were sourced from registries of the German federal states Saarland and Schleswig–Holstein, and from Scotland. Age-period-cohort models were used to project melanoma incidence trends. In Denmark between 1943 and 2016, melanoma ASIR increased from 1.1 to 46.5 in males, and from 1.0 to 48.5 in females, estimated to reach 60.0 and 73.1 in males and females by 2036. Melanoma mortality in Denmark (1951–2016) increased from 1.4 to 6.7 (males) and 1.2 to 3.7 (females). In New Zealand between 1948 and 2016, ASIR increased from 2.7 to 81.0 (males) and from 3.8 to 54.7 (females), slight declines are estimated by 2036 for both genders. Melanoma mortality increased six-fold in New Zealand males between 1950 and 2016; smaller increases were observed in females. We observed three- to four-fold increases in melanoma incidence in US whites, predicted to rise to 56.1 and 36.2 in males and females until 2036. Melanoma mortality also increased among US whites between 1970 and 2017, female melanoma mortality remained stable. Similar trends are shown for KC. In white populations, incidence of CM and KC significantly increased. CM incidence continues to rise in the short term but is predicted to decline in future. • Cutaneous melanoma (CM) incidence 73 years of observation and 20 years of projection. • Incidence increase of CM 15–48 times. • Similar trends in keratinocyte cancer. • Age standardised with European standard population 2013 instead of crude rates. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the effect of the Quality assured Mamma Diagnostic programme (QuaMaDi) introduced in 2001 on breast cancer and mortality on a population basis. QuaMaDi provides a standardized diagnostic process for symptomatic or at risk women of all ages. The process includes independent double-reading of mammograms, additional ultrasound, and if suspicious an expert reading and assessment. We tested the hypothesis that QuaMaDi has influenced breast cancer epidemiology and survival positively. Methods: The QuaMaDi cohort of breast cancer patients, diagnosed within the programme between 2001 and 2007, was linked to the cancer registry dataset of all breast cancer cases in Schleswig-Holstein, Germany. By this record-linkage procedure participants of QuaMaDi could be marked in the cancer registry data. Overall survival rates of 3096 patients diagnosed within QuaMaDi were compared to 5417 patients diagnosed outside QuaMaDi, matched by year of diagnosis, using multivariate Cox proportional hazard models. Results: Crude hazard ratio for overall survival was HR 0.43 (95% CI 0.35–0.52) for breast cancer cases detected inside QuaMaDi versus those diagnosed outside the programme. After stepwise adjustment for age, grading, histology, treatment, and tumour stage, the survival advantage in QuaMaDi diagnosed breast cancer patients was still statistically significant (HR 0.78, 95% CI 0.64–0.96). Conclusion: Evidence is provided that the QuaMaDi programme has a beneficial impact on the first 5-year overall survival rate after breast cancer beyond a favourable tumour stage distribution. Thus, we conclude that QuaMaDi contributes to improved health care for women, who are not eligible for mammography screening. [Copyright &y& Elsevier]