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Bevolkerungsbezogene Krebsregister erfassen, analysieren und publizieren Daten aller Krebserkrankungen (von Patienten mit Wohnort) in Deutschland. Der Artikel zeigt Daten dieser Krebsregister in Deutschland zur Epidemiologie des Mammakarzinoms mit speziellem Blick auf Trends von Tumoren in kleinen Stadien. Es wird gezeigt, dass durch die Einfuhrung des Mammographiescreenings (2005 bis 2009) speziell die Zahlen duktaler Karzinome (NOS, ohne nahere Angabe) in niedrigen Stadien zugenommen haben und aktuell wieder sinken. Das Ausgangsniveau wird allerdings nicht erreicht. Der Anteil lobularer Karzinome blieb zunachst konstant und sinkt aktuell, seltenere histologische Gruppen (kurz: Histologien) treten kaum vermehrt auf. Diese Trends gelten sowohl fur Frauen ab 50 bis 69 Jahren (im Mammographiescreeningalter) als auch fur altere Frauen ab 70 Jahren. Patientinnen in niedrigen Stadien erkranken in fruherem Alter als in hohen Stadien. In hohen Stadien wurde zudem ein Anstieg des medianen Alters beobachtet. Zugleich wird ein Ruckgang der Mortalitat der Brustkrebspatientinnen im Alter von 50 bis 69 Jahren beobachtet. Aktuell wird in Deutschland eine Erweiterung des Screenings auf Patientinnen von 45 bis 49 Jahren und von 70 bis 74 Jahren diskutiert, was zu einem weiteren Ruckgang der Mortalitat, aber auch zu einem Anstieg der Uberdiagnostik fuhren konnte. Die Erweiterung des Screenings auf die genannten Altersgruppen sollte intensiv wissenschaftlich evaluiert werden.

Der Beitrag zeigt Daten aus bevolkerungsbezogenen Krebsregistern zur Epidemiologie des Rektumkarzinoms in Deutschland. In Deutschland leben aktuell fast 120.000 Patienten, welche in den letzten 10 Jahren an einem Rektumkarzinom erkrankt sind. Ca. 11.000 Manner und 7000 Frauen erkranken jahrlich. Die Inzidenz und Mortalitat von Rektumkarzinomen ging in den letzten 10–15 Jahren zuruck. Fur die Altersgruppen unter 50 Jahren ist allerdings eine deutliche Zunahme zu beobachten. Zudem steigt in dieser Altersklasse der Anteil von Patienten mit neuroendokrinen Tumoren, insbesondere bei den 20- bis 39-Jahrigen. Diese Beobachtung kann den Anstieg der Inzidenz unter jungeren Patienten nur teilweise erklaren. Nur 30 % der Rektumkarzinome werden in UICC(Union internationale contre le cancer)-Stadien I und II entdeckt. Das relative Uberleben sinkt mit steigenden Stadien und steigendem Alter von 97 % (Frauen, unter 50 Jahren, Stadium I) auf 9 % (Frauen, uber 70 Jahre, Stadium IV). Aufgrund der schlechten Prognose in hohen Stadien spielt die Fruherkennung weiterhin eine wichtige Rolle. Eine Steigerung der Teilnahmerate im seit 2019 laufenden Darmkrebsscreening mit Einladungsmodell kann zu einem weiteren Ruckgang der Erkrankungsraten beitragen.

Background Differences in relative survival (RS) of melanoma between histologic subtypes were discussed to be mainly caused by tumor thickness. Objective To investigate RS of melanoma, stratified by tumor thickness for each histologic subtype, and identify survival trends. Methods With use of cancer registry data on melanoma cases (International Classification of Diseases, 10th Revision, codes C43.0–C43.9) diagnosed in Germany in 1997–2013, 5- and 10-year age-standardized RS stratified by histologic subtype and stratified or standardized by T stage was estimated by standard and modeled period analyses. We restricted 10-year RS analyses to patients younger than 75 years. Results We analyzed 82,901 cases. Overall, the 5- and 10-year RS rates were 91.7% and 90.8%, respectively. Prognosis worsened with increasing T stage for all histologic subtypes, but T-stage distribution varied substantially. Survival differences by histologic subtype were strongly alleviated after adjustment for T stage but remained significant. Overall, 5-year RS increased significantly (by 3.8 percentage points) between the periods 2002–2005 and 2010–2013. This increase was no longer seen after adjustment for T stage. Limitations Exclusion of cases on account of missing information on T stages, changes in the definition of T stages, and lack of information on screening and treatment limit our analyses. Conclusion Differences in RS between histologic subtypes were strongly mediated by tumor thickness. Over time, RS of melanoma increased as a result of changes in T-stage distribution.

Many countries have reported survival inequalities due to regional socioeconomic deprivation. To quantify the potential gain from eliminating cancer survival disadvantages associated with area-based deprivation in Germany, we calculated the number of avoidable excess deaths. We used population-based cancer registry data from 11 of 16 German federal states. Patients aged &ge, 15 years diagnosed with an invasive malignant tumor between 2008 and 2017 were included. Area-based socioeconomic deprivation was assessed using the quintiles of the German Index of Multiple Deprivation (GIMD) 2010 on a municipality level nationwide. Five-year age-standardized relative survival for 25 most common cancer sites and for total cancer were calculated using period analysis. Incidence and number of avoidable excess deaths in Germany in 2013&ndash, 2016 were estimated. Summed over the 25 cancer sites, 4100 annual excess deaths (3.0% of all excess deaths) could have been avoided each year in Germany during the period 2013&ndash, 2016 if relative survival were in all regions comparable with the least deprived regions. Colorectal, oral and pharynx, prostate, and bladder cancer contributed the largest numbers of avoidable excess deaths. Our results provide a good basis to estimate the potential of intervention programs for reducing socioeconomic inequalities in cancer burden in Germany.

Socioeconomic inequalities in cancer survival have been reported in various countries but it is uncertain to what extent they persist in countries with relatively comprehensive health insurance coverage such as Germany. We investigated the association between area-based socioeconomic deprivation on municipality level and cancer survival for 25 cancer sites in Germany. We used data from seven population-based cancer registries (covering 32 million inhabitants). Patients diagnosed in 1998 to 2014 with one of 25 most common cancer sites were included. Area-based socioeconomic deprivation was assessed using the categorized German Index of Multiple Deprivation (GIMD) on municipality level. We estimated 3-month, 1-year, 5-year and 5-year conditional on 1-year age-standardized relative survival using period approach for 2012 to 2014. Trend analyses were conducted for periods between 2003-2005 and 2012-2014. Model-based period analysis was used to calculate relative excess risks (RER) adjusted for age and stage. In total, 2 333 547 cases were included. For all cancers combined, 5-year survival rates by GIMD quintile were 61.6% in Q1 (least deprived), 61.2% in Q2, 60.4% in Q3, 59.9% in Q4 and 59.0% in Q5 (most deprived). For most cancer sites, the most deprived quintile had lower 5-year survival compared to the least deprived quintile even after adjusting for stage (all cancer sites combined, RER 1.16, 95% confidence interval 1.14-1.19). For some cancer sites, this association was stronger during short-term follow-up. Trend analyses showed improved survival from earlier to recent periods but persisting deprivation differences. The underlying reasons for these persisting survival inequalities and strategies to overcome them should be further investigated.

Hepatobiliary tract cancers (HBTCs) are a heterogeneous group of cancers with high mortality. Because most of these cancers, with the exception of hepatocellular carcinoma (HCC), are rare, few data are available concerning the population level survival expectations of patients with HBTC. Here, we describe survival of patients with HBTC in Germany with comparison to survival in the US. Therefore, data were extracted from 12 databases in Germany and the Surveillance, Epidemiology and End Results (SEER13) database in the US. Period analysis and modeled period analysis were used to calculate 5-year relative survival estimates for patients with HBTC diagnosed from 1997 to 2013. HCC was the most common HBTC in each database, accounting for over 1/3 of HBTC in Germany and about half of cases in the US. Overall age adjusted 5-year relative survival for HBTC in 2006-2013 was 19.1% in Germany and 20.6% in the US. Five-year relative survival increased by 3.8% units in Germany and 4.5% units in the US between 2002-2005 and 2010-2013. Five-year relative survival for individual types of HBTC ranged from 9.8% in Germany and 2.9% in the US for not otherwise specified biliary tract cancers to 44.4% and 50.1%, respectively, in Germany and the US for duodenal cancers. In conclusion, survival for HBTC remains poor in both Germany and the US, although a small increase in survival in the past decade was observed. Further work to find better treatment options for HBTC is needed to improve survival.

Background There are detailed reviews about different recruitment strategies, but not with regard to differences between recruitment of hospital-based versus office-based physicians. Within this study, the two different recruitment schemes are compared. Advantages and disadvantages of different ways of recruitment in registry-based studies are discussed. Methods In a cross-sectional cancer-registry-based study, long-term melanoma patients were contacted by dermatologists rather than directly by the registry on the basis of the legal situation. Logistic regression models and generalized estimating equations were used to assess effects of various patient and physician characteristics on participation and data quality. Especially differences between hospital-based versus office-based dermatologists are evaluated. Results Seventy two out of 112 contacted dermatologists took part in the study (64.3%). The cooperation proportion was 52.2% (689 participants/1320 contacted patients). Participants and non-participants differed regarding age and sex, but not regarding other social demographic factors and cancer stage. We did not observe a difference in patient participation between hospital-based versus office-based dermatologists (OR 1.08 [CI 0.84–1.39]; p = 0.57). However, medical data provided by the cancer registry were better for participants registered and recruited by hospitals. Conclusions In cohort studies with epidemiological cancer registries, recruitment via physicians has potential disadvantages and is more complex. If this indirect way of contact is mandatory, we recommend recruitment procedures including hospital-based rather than office-based physicians. However, physician characteristics were not associated with outcome.

Introduction Population-level survival has improved for common haematologic malignancies in the early 21st century. However, relatively few population-level data are available for rare haematologic malignancies. Methods Data were extracted from 12 cancer registries in Germany and the Surveillance, Epidemiology and End Results database in the United States (US). Cases of haematologic malignancies with an incidence of less than 1 per 100,000 were selected for analysis. Period analysis was used to determine 5-year relative survival (RS) for the years 2003–2012, and modelled period analysis was used to determine changes in survival between 2003–2007 and 2008–2012. Results Seven individual haematologic malignancies which met criteria were identified. Overall 5-year age-adjusted RS was 62.4% in Germany and 57.0% in the US in 2003–2012, with a good deal of variability by individual haematologic malignancy, ranging from less than 30% for chronic monomyeloid leukaemia to greater than 85% for hairy cell leukaemia and mycosis fungoides. Five-year RS increased significantly between 2003–2007 and 2008–2012 for patients with mantle cell lymphoma, Burkitt's lymphoma and hairy cell leukaemia in Germany and for patients with mantle cell lymphoma and anaplastic large-cell kinase+ anaplastic lymphoma in the US. Conclusions Survival for rare haematologic malignancies varied considerably by cancer entity. Overall 5-year RS was slightly higher in Germany compared to the US. Survival estimates increased for a minority of haematologic malignancies between 2003–2007 and 2008–2012. Further research into the best treatment options for rare malignancies is needed to further improve survival.

Dieser Artikel gibt einen Uberblick zu wichtigen Kenngrosen der Krebsregistrierung, welche vom Zentrum fur Krebsregisterdaten (ZfKD) und von Krebsregistern der Bundeslander regelmasig publiziert werden. Am Beispiel von Darmkrebs werden Inzidenz- und Mortalitatsraten, standardisierte Inzidenz- und Mortalitatsquotienten (SIR und SMR), Pravalenz, Erkrankungs- und Sterberisiken, Uberlebenswahrscheinlichkeiten und Vollzahligkeit definiert und interpretiert. Die dargestellten Methoden sollen den Leser bei der Interpretation von Routineberichten der Krebsregister unterstutzen.

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.

Background The proportion of cases notified by death certificate only (DCO) is a commonly used data quality indicator in studies comparing cancer survival across regions and over time. We aimed to assess dependence of DCO proportions on the age structure of cancer patients. Methods Using data from a national cancer survival study in Germany, we determined age specific and overall (crude) DCO proportions for 24 common forms of cancer. We then derived overall (crude) DCO proportions expected in case of shifts of the age distribution of the cancer populations by 5 and 10 years, respectively, assuming age specific DCO proportions to remain constant. Results Median DCO proportions across the 24 cancers were 2.4, 3.7, 5.5, 8.5 and 23.9% in age groups 15–44, 45–54, 55–64, 65–74, and 75+, respectively. A decrease of ages by 5 and 10 years resulted in decreases of cancer specific crude DCO proportions ranging from 0.4 to 4.8 and from 0.7 to 8.6 percent units, respectively. Conversely, an increase of ages by 5 and 10 years led to increases of cancer specific crude DCO proportions ranging from 0.8 to 4.8 and from 1.8 to 9.6 percent units, respectively. These changes were of similar magnitude (but in opposite direction) as changes in crude 5-year relative survival resulting from the same shifts in age distribution. Conclusions The age structure of cancer patient populations has a substantial impact on DCO proportions. DCO proportions should therefore be age adjusted in comparative studies on cancer survival across regions and over time.

We aimed at investigating the distribution and risk of all second discordant primary cancers (SDPCs) after a specific first primary cancer in Germany and Sweden to provide etiological understanding of SDPCs and insight into their incidence rates and recording practices. Among 1,537,004 survivors of first primary cancers in Germany and 588,103 in Sweden, overall 80,162 and 32,544 SDPCs were recorded, respectively. Standardized incidence ratios (SIRs) of all SDPCs were elevated at levels between 1.1 and 2.1 after 23 (out of overall 29) cancers in Germany and at levels between 1.1 and 1.6 after 24 cancers in Sweden, and among them, elevated SIRs were found after 19 cancers in both populations. Decreased SIRs at levels ranging from 0.5 to 0.9 were found for some cancers with poor prognosis in Germany only. We found elevated risk after 19 out of 29 cancers in both countries, suggesting common etiology of SDPCs after most of first cancers and registration similarity. Decreased risks after some fatal cancers were found only in Germany, which may be attributed to reporting practices or missed death data in Germany.

Multiple myeloma is a chronic, incurable but highly treatable neoplasm. Recent population-based studies have shown improvements in survival for patients diagnosed in the early 21st century. Here, we examine trends in survival for patients diagnosed with multiple myeloma in Germany and the United States (US) between 2002 and 2010. Data were extracted from 11 population-based cancer registries in Germany and from the Surveillance, Epidemiology and End Results database in the US. Myeloma patients aged 15-74 years with diagnosis and follow-up between 1997 and 2010 from Germany and the US were included. Period analysis was employed to assess trends in 5-year relative survival in Germany and the US between 2002-04 and 2008-10. Age-adjusted 5-year relative survival increased from 47·3% to 53·8% in Germany and from 39·8% to 53·2% in the US between 2002-04 and 2008-10. There was a strong age gradient with lower survival among older patients, which persisted over time and was more pronounced in Germany than the US. Five-year relative survival estimates for patients diagnosed with multiple myeloma below 75 years of age steadily increased throughout the first decade of the 21st century and reached levels above 50% in both Germany and the US, probably reflecting the increased use of newer agents in myeloma treatment.

Background The population-based incidence of sarcoma and its histological subtypes in Germany is unknown. Up-to-date information on a disease with an incidence comparable to other cancer entities is of high public health relevance. The aim of this study was to determine this incidence and to detect significant changes in incidence trends using data from German epidemiological cancer registries. Methods Pooled data from the German Centre for Cancer Registry Data with a primary diagnosis occurring in 2013 were used. To date, this is the latest data on cancer incidence available for Germany. All German cancer registries with sufficient completeness were included (10 out of 11), covering a population of 70.0 million people, representing 87% of the German population. All malignant sarcomas according to the RARECARE Project and the WHO classification 2002 were considered for analysis and, above all, gastrointestinal stromal tumours (GIST) of uncertain behaviour. Sensitivity analysis was performed excluding certain histologies. Results The analysis included 3404 cases in men and 3442 cases in women diagnosed in 2013. The age adjusted sarcoma incidence (European standard) was 7.4 (men) and 6.6 (women) per 100,000 inhabitants. About 70% of sarcomas were soft tissue sarcomas, about 22% GIST, and about 9% bone sarcomas. The most common histological subtypes besides GIST were fibrosarcomas (14%) and liposarcomas (12%) in men and complex mixed and stromal neoplasms (22%), non-uterine leiomysarcomas (10%) and fibrosarcomas (9%) in women. Considering the trend for the years of diagnosis 2004 to 2013, there was a significant increase in incidence for GIST while the incidence of soft tissue sarcomas (only men) as well as of bone sarcoma stayed constant over time. As to soft tissue sarcoma in women, the incidence stayed constant up to the year 2009 and significantly decreased afterwards. Conclusion This study is the first detailed analysis of a German-wide population-based sarcoma incidence showing results comparable to the incidence detected in the RARECARE Project. Electronic supplementary material The online version of this article (10.1186/s12889-018-5131-4) contains supplementary material, which is available to authorized users.

Hepatobiliary tract cancers (HBTCs) are a heterogeneous group of cancers with high mortality. Because most of these cancers, with the exception of hepatocellular carcinoma (HCC), are rare, few data are available concerning the population level survival expectations of patients with HBTC. Here, we describe survival of patients with HBTC in Germany with comparison to survival in the US. Therefore, data were extracted from 12 databases in Germany and the Surveillance, Epidemiology and End Results (SEER13) database in the US. Period analysis and modeled period analysis were used to calculate 5-year relative survival estimates for patients with HBTC diagnosed from 1997 to 2013. HCC was the most common HBTC in each database, accounting for over 1/3 of HBTC in Germany and about half of cases in the US. Overall age adjusted 5-year relative survival for HBTC in 2006-2013 was 19.1% in Germany and 20.6% in the US. Five-year relative survival increased by 3.8% units in Germany and 4.5% units in the US between 2002-2005 and 2010-2013. Five-year relative survival for individual types of HBTC ranged from 9.8% in Germany and 2.9% in the US for not otherwise specified biliary tract cancers to 44.4% and 50.1%, respectively, in Germany and the US for duodenal cancers. In conclusion, survival for HBTC remains poor in both Germany and the US, although a small increase in survival in the past decade was observed. Further work to find better treatment options for HBTC is needed to improve survival.

Hintergrund: Epidemiologische Daten zu Kopf-Hals-Malignomen werden trotz ihrer anatomisch-histologischen Heterogenitat oft aggregiert berichtet. In Deutschland gibt es bisher nur wenige Studien, die Trends von Inzidenz und Mortalitat detailliert nach Tumorentitaten analysiert haben. Weiterhin ist wenig daruber bekannt, ob die Inzidenz von HPV-assoziierten Tumorentitaten der Kopf-Hals-Region zugenommen hat. Methoden: Anhand von Krebsregisterdaten aus Rheinland-Pfalz von 2000–2009 wurden altersstandardisierte Inzidenz- und Mortalitatsraten fur alle Kopf-Hals-Tumorentitaten einzeln und nach Lokalisationsgruppen, die HPV-assoziiert sein konnten, berechnet. Zeitliche Trends wurden mittels Joinpoint-Regression analysiert und als jahrliche prozentuale Veranderung (JPV) dargestellt. Ergebnisse: Im Studienzeitraum wurden 8055 Neuerkrankungs- und 3177 Sterbefalle registriert. Die Inzidenz von Kopf-Hals-Malignomen nahm bei Frauen zu (JPV:+2,2%), bei Mannern geringfugig ab (−0,9%). Die Inzidenz von Malignomen der Mundhohle (+2,7%) und des Oropharynx (+3,6%) nahm bei Frauen signifikant zu, wahrend bei Mannern Hypopharynx- (− 3,4%) und Larynxtumoren (− 2,7%) abnahmen. Manner und Frauen erkrankten zunehmend haufig an Malignomen, die aufgrund der Lokalisation wahrscheinlich mit HPV-assoziiert sind (Manner:+3,3%, Frauen:+4,3%). Bei beiden Geschlechtern zeigte sich ein Ruckgang der Mortalitat durch Larynxkarzinome (Manner:−5,8%, Frauen:−9,1%). Schlussfolgerung: Eine nach Lokalisationen detaillierte Analyse der Kopf-Hals-Malignome zeigte signifikante und oft gegenlaufige Trends bei Mannern und Frauen, sowohl bei Inzidenz als auch Mortalitat. Der Anstieg der Inzidenz von wahrscheinlich HPV-assoziierten Tumoren stellt ein wichtiges Argument fur die Einfuhrung einer routinemasigen Bestimmung des HPV-Status bei Kopf-Hals-Malignomen dar.

The monitoring of cancer survival by population-based cancer registries is a prerequisite to evaluate the current quality of cancer care. Our study provides 1-, 5- and 10-year relative survival as well as 5-year relative survival conditional on 1-year survival estimates and recent survival trends for Germany using data from 11 population-based cancer registries, covering around one-third of the German population. Period analysis was used to estimate relative survival for 24 common and 11 less common cancer sites for the period 2007-2010. The German and the United States survival estimates were compared using the Surveillance, Epidemiology and End Results 13 database. Trends in cancer survival in Germany between 2002-2004 and 2008-2010 were described. Five-year relative survival increased in Germany from 2002-2004 to 2008-2010 for most cancer sites. Among the 24 most common cancers, largest improvements were seen for multiple myeloma (8.0% units), non-Hodgkin lymphoma (6.2% units), prostate cancer (5.2% units) and colorectal cancer (4.6% units). In 2007-2010, the survival disadvantage in Germany compared to the United States was largest for cancers of the mouth/pharynx (-11.0% units), thyroid (-6.8% units) and prostate (-7.5% units). Although survival estimates were much lower for elderly patients in both countries, differences in age patterns were observed for some cancer sites. The reported improvements in cancer survival might reflect advances in the quality of cancer care on the population level as well as increased use of screening in Germany. The survival differences across countries and the survival disadvantage in the elderly require further investigation.

Although socioeconomic inequalities in cancer survival have been demonstrated both within and between countries, evidence on the variation of the inequalities over time past diagnosis is sparse. Furthermore, no comprehensive analysis of socioeconomic differences in cancer survival in Germany has been conducted. Therefore, we analyzed variations in cancer survival for patients diagnosed with one of the 25 most common cancer sites in 1997-2006 in ten population-based cancer registries in Germany (covering 32 million inhabitants). Patients were assigned a socioeconomic status according to the district of residence at diagnosis. Period analysis was used to derive 3-month, 5-year and conditional 1-year and 5-year age-standardized relative survival for 2002-2006 for each deprivation quintile in Germany. Relative survival of patients living in the most deprived district was compared to survival of patients living in all other districts by model-based period analysis. For 21 of 25 cancer sites, 5-year relative survival was lower in the most deprived districts than in all other districts combined. The median relative excess risk of death over the 25 cancer sites decreased from 1.24 in the first 3 months to 1.16 in the following 9 months to 1.08 in the following 4 years. Inequalities persisted after adjustment for stage. These major regional socioeconomic inequalities indicate a potential for improving cancer care and survival in Germany. Studies on individual-level patient data with access to treatment information should be conducted to examine the reasons for these socioeconomic inequalities in cancer survival in more detail.

Second primary cancer (SPC) has become an increasing concern in cancer survivorship. Patterns of SPCs in different populations may offer clinical implications and research priorities into SPCs. This study is devoted to compare the occurrences and rank correlations of SPCs between Germany and Sweden. Patients diagnosed with 10 common first primaries between 1997 and 2006 from the Swedish Family-Cancer Database and 10 German cancer registries were included in this population-based study. Spearman's rank correlation coefficients were used to evaluate the strength of the relationship of SPCs between the German and Swedish datasets. Spearman's rank correlation coefficients suggested a strong positive correlation between the German and Swedish datasets based on the ranks of thirty possible SPCs after all selected first cancers. This was also true when we compared the rankings and proportions of the five most common SPCs after site-specific first primaries between the two populations. For kidney cancer, non-Hodgkin's lymphoma, and leukemia the components of the five most common SPCs was exactly the same. Also, the ranking and the proportions for the three most common SPCs (i.e., colorectal, bladder, and lung cancers) after prostate cancer were identical in the two populations, as were those after most other primary cancers. The strikingly consistent patterns of SPCs in the two populations provide excellent opportunities for joint studies and they also suggest that many underlying reasons for SPC may have universal and tangible causes that await mechanistic dissection. The strikingly consistent patterns of second primary cancers (SPCs) in German and Swedish populations provide excellent opportunities for joint studies and they also suggest that many underlying reasons for SPC may have universal and tangible causes that await mechanistic dissection.

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.

Introduction : The aim of this study was to provide detailed age-specific (5-year age groups) and histology-specific (histologic subtypes of seminoma and nonseminoma) relative survival estimates of testicular germ cell cancer patients in Germany and the United States (U.S.) for the years 2002–2006 and to compare these estimates between countries. Methods : We pooled data from 11 cancer registries of Germany and used data from the U.S. (SEER-13 database) including 11,508 and 10,774 newly diagnosed cases (1997–2006) in Germany and the U.S., respectively. We estimated 5-year relative survival (5-year-RS) by histology and age based on period analysis. Results : 5-year-RS for testicular germ cell tumors was 96.7% and 96.3% in Germany and the U.S., respectively. 5-Year-RS for spermatocytic seminoma was close to 100% in both countries. 5-Year-RS for nonseminoma was lower than for classical seminoma in Germany (93.3% versus 97.6%) and the U.S. (91.0% versus 98.2%). Among nonseminomas, choriocarcinomas provided the lowest 5-year-RS in both countries (Germany 80.1%, U.S. 79.6%). Age-specific 5-year-RS for seminoma showed only little variation by age. 5-Year-RS for nonseminomas tended to be lower at higher ages, especially for malignant teratoma. Discussion : This is the first study that provides up-to-date survival estimates for testicular cancer by histology and age in Germany and the U.S. Survival after a diagnosis of testicular cancer is very comparable between Germany and the U.S. 5-Year-RS for spermatocytic seminoma was close to 100% and the lowest 5-year-RS occurred among choriocarcinoma. Higher age at diagnosis is associated with a poorer prognosis among nonseminoma patients.

Background The objective of this study was to analyse the incidence of lip malignancies in Germany. Methods Data from population-based cancer registries covering a population of 39 million inhabitants from 14 federal states were pooled. Lip malignancies were classified according to the International Classification of Diseases (ICD-10). Age-standardised incidence rates and annual percentage changes in the incidence trends of lip cancer (C00), melanoma of the lip (C43.0), and non-melanoma skin cancer of the lip (C44.0) were calculated. Results Lip cancer (C00) incidence rate was 0.57/0.15 per 100 000 (men/women) in 2003 and 0.52/0.18 in 2012. In women, the change was statistically significant. Melanoma lip cancer (C43.0) incidence rates both in men and women were 0.02 in 2003 and 0.01 in 2012. Incidence rates of non-melanoma skin cancer of the lip (C44.0) significantly increased from 1.6 in 2003 to 2.1 in 2012 in men and from 1.5 in 2003 to 2.4 in 2012 in women. In lip cancer (C00), the vast majority (98% in men/93% in women) were squamous cell carcinomas and 2%/7% were basal cell carcinoma. In men, 56% of non-melanoma skin cancers (C44.0) were squamous cell carcinoma, whereas these were only 27% in women. Conclusions The incidences of non-melanoma skin cancer of the lip increased over time in Germany in both sexes. Lip cancer incidence increased in women, while it stayed stable in men. Melanoma of the lip did not change in incidence. The distribution of histology in non-melanoma skin cancer of the lip differed by sex.

The increased risk of subsequent primary malignancies (SPM) in survivors of adult-onset Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) remains a challenging clinical problem worldwide. The German cancer registry database, pooled from 14 federal states, was used to calculate the standardized incidence ratio (SIR) and excess absolute risk (EAR) of SPM in 128 587 patients registered with first primary HL/NHL between 1990 and 2012. Conversely, SIRs were also calculated for a subsequent HL/NHL following other first cancers. The risk of developing SPM was significantly increased over twofold for HL survivors (SIR = 2.14, EAR = 51.87 cases/10 000 person-years) and 1.5-fold for NHL survivors (SIR = 1.48, EAR = 55.23) compared with the general German population. For solid cancers, SIRs were significantly elevated (1.6- and 1.4-fold; respectively) and were highest (threefold) in patients below 30 years of age upon initial diagnosis. Overall, SIRs were consistently elevated for lip/oral cavity, colon/rectum, lung, skin melanoma, breast, kidney and thyroid. Significantly increased SIRs for oesophagus, stomach, liver, pancreas, testis, prostate, and brain/central nervous system were observed following NHL only. For certain SPM, SIRs remained significantly elevated more than 10 years following HL/NHL diagnosis. Positive reciprocal associations were demonstrated between HL/NHL and several solid cancers mentioned above; for some, common aetiological mechanisms seem plausible.

Objectives 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). Patients and methods Incidence and mortality rates for Germany and the USA for the period 1999-2010 were obtained from the Centre for Cancer Registry Data at the Robert Koch Institute and the USA Surveillance Epidemiology and End Results (SEER) database. For analyses on stage and survival, data from 12 population-based cancer registries in Germany and from the SEER-13 database were analysed. Patients (aged ≥ 15 years) diagnosed with prostate cancer (1997-2010) and mortality follow-up to December 2010 were included. The 5- and 10-year RS and survival trends (2002-2010) were calculated using standard and model-based period analysis. Results Between 1999 and 2010, prostate cancer incidence decreased in the USA but increased in Germany. Nevertheless, incidence remained higher in the USA throughout the study period (99.8 vs 76.0 per 100,000 in 2010). The proportion of localised disease significantly increased from 51.9% (1998-2000) to 69.6% (2007-2010) in Germany and from 80.5% (1998-2000) to 82.6% (2007-2010) in the USA. Mortality slightly decreased in both countries (1999-2010). Overall, 5- and 10-year RS was lower in Germany (93.3%; 90.7%) than in the USA (99.4%; 99.6%) but comparable after adjustment for stage. The same patterns were seen in age-specific analyses. Improvements seen in prostate cancer survival between 2002-2004 and 2008-2010 (5-year RS: 87.4% and 91.2%; +3.8% units) in Germany disappeared after adjustment for stage (P = 0.8). Conclusion The survival increase in Germany and the survival advantage in the USA might be explained by differences in incidence and stage distributions over time and across countries. Effects of early detection or a lead-time bias due to the more widespread utilisation and earlier introduction of PSA testing in the USA are likely to explain the observed patterns.

Background: Population-based studies on endometrial cancer providing survival estimates by age, histology, and stage have been sparse. We aimed to derive most up-to-date and detailed survival estimates for endometrial cancer patients in Germany. Methods: We used a pooled German national dataset including data from 11 cancer registries covering a population of 33 million people. 30,906 patients diagnosed with endometrial cancer in 1997-2006 were included. Period analysis was performed to calculate 5-year relative survival (RS) in 2002-2006. Trends in survival between 2002 and 2006 were examined using model-based period analysis. Age-adjustment was performed using five age groups (15-44, 45-54, 55-64, 65-74, and 75+ years). Results: Overall, age-adjusted 5-year relative survival in 2002-2006 was 81%. A moderate age gradient was observed, with 5-year RS decreasing from 90% in the age group 15-49 years to 75% in the age group 70+ years. Furthermore prognosis varied strongly by histologic subtypes and stage, with age-adjusted 5-year RS ranging from 43% (for sarcoma) to 94% (for squamous metaplasia), and reaching 91% for localized, 51% for regional, and 20% for distant stage. Except for age group 65-74 years, no significant improvement in survival was seen during the recent 5-year period under investigation. Conclusion: In this comprehensive population-based survival analysis of patients with endometrial cancer from Germany, prognosis of endometrial cancer moderately varied by age, and strongly varied by histology and stage. While prognosis is rather good overall, further improvement in 5-year relative survival of endometrial cancer patients has been stagnating in the early 21 st century.

Summary Background Prior analyses of survival of patients with primary cutaneous malignant melanoma from Germany were based only on small populations and need to be updated. Objectives We give a detailed overview of relative 5-year survival by sex, age group, histology, tumour stage and body site, and of time trends in a population of 33 million (40% of Germany), and compare survival in the federal states. Methods Conventional and model-based period analysis using the Ederer II method was applied to patients with melanoma diagnosed during 1997–2006 in Germany to assess 5-year relative survival (RS) rates and time trends. Results In total, 37 155 melanoma cases were included. Overall age-adjusted 5-year RS for the time period 2002–2006 was 91·9% for women and 87·0% for men. Survival differences by age group, histology, tumour stage and body site were found. No significant overall trend (2002–2006) was seen either in women or in men. Differences in survival between federal states were small; no clear pattern was seen. Conclusions Based on the most recent and high-quality data from population-based cancer registries a comprehensive picture on melanoma survival in Germany was given. Survival from cutaneous malignant melanoma was high compared with other cancer sites and did not change during the analysed period 2002–2006. Patterns in melanoma survival by sex, age, tumour stage, histology and body site were in good agreement with previously published findings. No relevant differences between federal states were found.

Die Ergebnisse bevolkerungsbasierter Uberlebenszeitanalysen von Krebspatienten sind zentrale Bewertungskriterien fur die onkologische Versorgung. Ihre Nutzung und Interpretation als solche erfordert Kenntnis und Transparenz der Datengrundlage, um falsche Schlussfolgerungen zu vermeiden. Die Arbeitsgruppe „Uberlebenszeitanalyse“ der Gesellschaft der Epidemiologischen Krebsregister in Deutschland e. V. (GEKID) hat Faktoren im Bereich der Krebsregistrierung und Datenauswertung identifiziert, die bevolkerungsbezogene Uberlebensraten in relevantem Ausmas verzerren konnen. Im Rahmen empirischer Untersuchungen und Diskussionen der GEKID wurden einvernehmliche Empfehlungen im Sinne von Berichtsstandards fur ein harmonisiertes Vorgehen entwickelt. Wir legen eine Liste von 17 Indikatoren vor, die im Rahmen von bevolkerungsbezogenen Uberlebenszeitanalysen berucksichtigt und dargestellt werden sollten. Mit den hier von der GEKID vorgestellten „Berichtsstandards fur bevolkerungsbezogene Uberlebenszeitanalysen bei Krebspatienten“ wird ein Vorschlag zur Datentransparenz gemacht, der wesentlich zur Bewertbarkeit der Ergebnisqualitat von onkologischer Versorgung beitragen kann.

Esophagus and stomach cancers are associated with poor prognosis. But most published population-based cancer survival estimates for stomach and esophagus cancer refer to survival experience of patients diagnosed in the 1990s or earlier years. The aim of this study was to provide up-to-date survival estimates and trends for patients with stomach and esophagus cancer in Germany.Our analysis is based on data from 11 population-based cancer registries, covering 33 million inhabitants. Patients diagnosed with stomach and esophagus cancer in 1997-2006 were included. Period analysis was used to derive five-year relative survival estimates and trends by age, sex, cancer subsite, and stage for the time period of 2002-2006. German and US survival estimates were compared utilizing the SEER 13 database.Overall age-standardized five-year relative survival was 31.8% and 18.3% for stomach and esophagus cancer, respectively, compared to 27.2% and 17.4% in the US. Survival was somewhat higher among female than among male patients for both cancer sites (33.6% vs. 30.6% and 21.5% vs. 17.5%, respectively) and much higher for non-cardia stomach cancer (40.4%) than for cardia cancer (23.4%). From 2002 to 2006, a moderate increase in five-year relative survival by 2.7 percent units was observed for non-cardia stomach cancer patients in Germany (p0.001).Five-year relative cancer survival has reached levels around 40% for patients with non-cardia stomach cancer in Germany in the early 21st century, whereas it remained at lower levels around 20% for patients with esophagus and cardia cancer.

We aimed at investigating the distribution and risk of second primary cancers (SPCs) in multiple myeloma (MM) survivors in Germany and Sweden to provide etiological understanding of SPCs and insight into their incidence rates and recording practices. MM patients diagnosed in 1997–2010 at age ≥15 years were selected from the Swedish (nationwide) and 12 German cancer registries. Standardized incidence ratios (SIRs) were used to assess risk of a specific SPC compared to risk of the same first cancer in the corresponding background population. Among 18,735 survivors of first MM in Germany and 7,560 in Sweden, overall 752 and 349 SPCs were recorded, respectively. Significantly elevated SIRs of specific SPCs were observed for acute myeloid leukemia (AML; SIR = 4.9) in Germany and for kidney cancer (2.3), AML (2.3) and nervous system cancer (1.9) in Sweden. Elevated risk for AML was more pronounced in the earlier diagnosis period compared to the later, i.e., 9.7 (4.2–19) for 1997–2003 period versus 3.5 (1.5–6.9) for 2004–2010 in Germany; 3.8 (1.4–8.3) for 1997–2003 versus 2.2 (0.3–7.8) for 2004–2010 in Sweden. We found elevated risk for AML for overall, early diagnosis periods and longer follow-up times in both populations, suggesting possible side effects of treatment for MM patients.

In 2007 the International Agency for Research on Cancer (IARC) classified shift work involving circadian disruption as a probable human carcinogen (1). Most of the evidence for this is based on animal experiment models and only a few reliable epidemiological studies. The cancer best described to date is breast cancer; this has mainly been investigated in female nurses and flight attendants (2, 3). Shift work can also increase the incidence of prostate cancer, as plausibly described in a review article published in 2012 (4). Mechanistically, it is possible that nocturnal light exposure and disrupted circadian rhythms cause cancer, or that tumor growth is favored by hormonal mediation. Nocturnal light exposure suppresses melatonin secretion in the pineal gland. In vitro and in vivo experiments have shown that melatonin prevents or inhibits tumor growth, particularly that of prostate cancer, and that there is a dose–effect relationship (1, 5). The epidemiological evidence on prostate cancer comes from only a few studies involving individual data on shift work (6– 8) (Table 1). In studies of flight personnel, duration of employment or number of flight hours was used as a proxy measure (9– 11). In one large Scandinavian study, the probability of exposure was estimated using a job exposure matrix (12). Table 1 Review of earlier studies on shift work and on prostate cancer Earlier research of a cohort of 31 143 male production workers in the chemical industry, 45% of whom worked shifts, showed no overall increase in deaths from cancer or individual tumors (13, 14). This article investigates the incidence of prostate cancer in this cohort and examines earlier findings on overall tumor incidence in more detail (15). The complete scientific report is available online (16).

Patients who have survived malignant melanoma for more than five years may lack the opportunity to talk about their burden. As a consequence their psychosocial care needs remain undetected and available supportive interventions may not be utilised. Therefore, the psychosocial burden of this patient group needs to be assessed using specific screening instruments. The aim of this study was to investigate the psychosocial burden of long-term melanoma survivors, their psychosocial care needs and the determinants of these needs. We wanted to find out if the use of professional support corresponds to the care needs defined by experts. Using the cancer registry of Rhineland-Palatinate, melanoma patients diagnosed at least 5 years before the survey were contacted by physicians. N = 689 former patients completed the Hornheide Questionnaire (short form HQ-S) to identify psychosocial support need (scale cut off ≥ 16 or item-based cut-off score) and the potential psychosocial determinants of these needs. Additionally, they were asked about their utilisation of the professional support system. More than one third (36%) of them was in need for professional psychosocial support. The highest burden scores concerned worry about tumour progression. Younger age (< 50), higher general fatigue, higher symptom burden, lower general health, negative social interactions and unfulfilled information needs were significant predictors of the need for psychosocial intervention. Related to the percentage of survivors identified as ‘in need’, the professional support system was underused. Further studies should investigate whether using the HQ-S to routinely identify burdened melanoma patients could lead to better fulfilment of their intervention needs, ultimately enhancing health-related quality of life.

Lung cancer is the most common cancer-related death worldwide. In Germany it accounts for 25% of cancer deaths in men, and 14% in women. The aim of this study is to provide an overview of 5-year relative survival by sex, age, histology, and tumour stage in Germany representing a population of 26.7 million people.The study is based on a pooled German dataset including data from 12 population-based cancer registries covering around one third of the German population. A total of 132,612 patients diagnosed with lung cancer from 2002 to 2010 were included in the analysis. Survival estimates for the time period 2007-2010 were calculated using period analysis. Differences in survival between sexes were tested for statistical significance by model-based period analysis (poisson regression model). The relative excess risk (RER) of death (women vs. men) was extracted from the model with the p value for the difference in RER.The overall age adjusted 5-year relative survival was 15.5% (standard error (SE) 0.2) for men and 20.3% (SE 0.3) in women. Survival differed markedly according to age (men:60 years 18.5% vs. 80+ years 8.4% and women 23.7% vs. 10.6%, respectively), histology (largest difference between histological groups: men 25.7 and women 44.4% points) and stage (men: UICC Ia 62.9%, vs. UICC IV 4.6% and women 75.2% vs. 7.0%, respectively). Our study showed survival advantages for women compared to men, most notably in younger aged patients (RER 0.83, p0.0001), patients with adenocarcinoma (RER 0.80, p0.0001), and patients with lower stage cancer (RER 0.62, p0.0001).This study presents up-to-date survival estimates for lung cancer in Germany. Compared to other European countries survival was relatively high. Women showed higher survival than men independent of age, histology and stage. The reasons for the survival differences require further clarification.

The monitoring of cancer survival by population-based cancer registries is a prerequisite to evaluate the current quality of cancer care. Our study provides 1-, 5- and 10-year relative survival as well as 5-year relative survival conditional on 1-year survival estimates and recent survival trends for Germany using data from 11 population-based cancer registries, covering around one-third of the German population. Period analysis was used to estimate relative survival for 24 common and 11 less common cancer sites for the period 2007-2010. The German and the United States survival estimates were compared using the Surveillance, Epidemiology and End Results 13 database. Trends in cancer survival in Germany between 2002-2004 and 2008-2010 were described. Five-year relative survival increased in Germany from 2002-2004 to 2008-2010 for most cancer sites. Among the 24 most common cancers, largest improvements were seen for multiple myeloma (8.0% units), non-Hodgkin lymphoma (6.2% units), prostate cancer (5.2% units) and colorectal cancer (4.6% units). In 2007-2010, the survival disadvantage in Germany compared to the United States was largest for cancers of the mouth/pharynx (-11.0% units), thyroid (-6.8% units) and prostate (-7.5% units). Although survival estimates were much lower for elderly patients in both countries, differences in age patterns were observed for some cancer sites. The reported improvements in cancer survival might reflect advances in the quality of cancer care on the population level as well as increased use of screening in Germany. The survival differences across countries and the survival disadvantage in the elderly require further investigation.

Summary Treatment for Hodgkin lymphoma (HL) is more aggressive in Germany than in the United States (US) and differences in treatment may lead to differences in population level survival. Patients diagnosed with HL in 11 German states in 1997–2006 were included in the analyses and were compared to similar analyses from patients in the Surveillance, Epidemiology, and End Results database in the US. Period analysis was used to calculate 5-year relative survival for the time period of 2002–2006 overall and by gender, age and histology. Overall 5-year relative survival for patients with HL in Germany was 84·3%, compared to 80·6% for the US. Survival was highest in patients aged 15–29 years at 97·9% and decreased with age to 57·5% at age 60 + Survival for men and women, respectively, was 84·7% and 84·1% in Germany and 78·2% and 83·6% in the US. 5-year relative survival for patients diagnosed with HL in Germany was close to 100% for younger patients. Survival of HL patients in the US was lower than in Germany overall, but was comparable in older patients and in women. Population-based studies with longer follow-up are still needed to examine effects of late toxicity on long term survival.

This study provides up-to-date and detailed cancer survival estimates of German patients with non-Hodgkin lymphoma (NHL, International Statistical Classification of Diseases 10th Revision [ICD-10] codes C82-C85) based on data from 11 cancer registries. Period analysis was used to calculate 5-year relative survival in 2002-2006, overall and by gender, age and histology. Comparison was made with patients with NHL in the United States (US) Surveillance, Epidemiology and End Results database in the same time period. Overall 5-year relative survival for patients with NHL in Germany in 2002-2006 was 62.8% and in the US was 65.1%. Survival decreased with age from 81.7% at age 15-49 to 46.5% at age 75+. Survival in the US was 75.3% at age 15-49 and 52% at age 75+. Survival was higher for women than for men, at 65.2% for women and 60.7% for men. Survivals for diffuse B-cell lymphoma and follicular lymphoma, the two most common subtypes of NHL, were 57.3% and 77.5%, respectively. Between 2002 and 2006, overall 5-year relative survival increased by 5.3 percentage points. We conclude that survival for NHL is increasing in Germany in recent years. Survival was higher in Germany than in the US for patients aged 15-49 but lower for older patients.

In unsparing efforts to find the hidden primaries, second primary cancers (SPCs) unrelated to cancer of unknown primary (CUP) are found. The detection rates of SPCs after CUP can be considered as measures for the effectiveness of modern diagnostic techniques in finding tumors. We aimed to compare the rates of specific SPCs found after the work-up of CUP and the more sign/symptom-directed diagnostic approaches applied after any other cancer. The number of CUP patients identified in the nationwide Swedish database and nine German cancer registries was 24 641 from 1997 through 2006, and rate ratios (RRs) for SPCs were recorded in two follow-up periods. The detection rate of SPCs immediately after any other cancer was about two times higher in Germany than in Sweden, but the rate immediately after CUP was almost the same for the two datasets. In the joint analyses after CUP, the RRs of liver, lung, breast, and kidney cancers were higher than after any other cancer, whereas the RRs of prostate, urinary bladder, and connective tissue cancers as well as non-Hodgkin's lymphoma were not significantly different; the RR of cancers of upper aerodigestive tract was lower after CUP than after any other cancer. The joint data indicate that the work-up is efficient in detecting tumors in the thoracoabdominal organs that are screened by computed tomography. For some other organ sites, the more sign/symptom-directed diagnostic approaches may be equally efficient. However, none of the applied techniques could detect all tumors immediately after the first diagnosis.

Population-based studies on ovarian cancer providing survival estimates by age, histology, laterality, and stage have been sparse. We aimed to derive the most up-to-date and detailed survival estimates for ovarian cancer patients in Germany. We used a pooled German national dataset including data from 11 cancer registries covering 33 million populations. A total of 21 651 patients diagnosed with ovarian cancer in 1997-2006 were included. Period analysis was carried out to calculate the 5-year relative survival (RS) for the years 2002-2006. Trends in survival between 2002 and 2006 were examined using model-based period analysis. Age adjustment was performed using five age groups (15-44, 45-54, 55-64, 65-74, and 75+ years). Overall, the age-adjusted 5-year RS in 2002-2006 was 41%. A strong age gradient was observed, with a decrease in the 5-year RS from 67% in the age group 15-49 years to 28% in the age group 70+ years. Furthermore, the prognosis varied markedly by histology, laterality, and stage, with the age-adjusted 5-year RS ranging from 25% (for carcinoma not otherwise specified) to 81% (for stromal cell carcinoma), reaching 46% for unilateral and 32% for bilateral carcinoma and reaching 82% for Federation of Gynecology and Obstetrics (FIGO) stages I and II, 36% for FIGO stage III, and 18% for FIGO stage IV. No improvement in survival could be observed for any of the subgroups in the period between 2002 and 2006. Our analyses suggest that an improvement in the 5-year RS for ovarian cancer may have stagnated in the early 21st century and underline the need for a more effective translation of therapeutic innovation into clinical practice.

Prior to the German reunification, cancer survival was much lower in East than in West Germany. We compare cancer survival between Eastern and Western Germany in the early twenty-first century, i.e. the second decade after the German reunification. Using data from 11 population-based cancer registries covering a population of 33 million people, 5-year age-standardized relative survival for the time period 2002–2006 was estimated for the 25 most common cancers using model-based period analysis. In 2002–2006, 5-year relative survival was very similar for most cancers, with differences below 3 % units for 20 of 25 cancer sites. Larger, statistically significant survival advantages were seen for oral cavity, oesophagus, and gallbladder cancer and skin melanoma in the West and for leukemia in the East. Our study shows that within two decades after the assimilation of political and health care systems, the former major survival gap of cancer patients in Eastern Germany has been essentially overcome. This result is encouraging as it suggests that, even though economic conditions have remained difficult in Eastern Germany, comparable health care provision may nevertheless enable comparable levels of cancer survival within a relatively short period of time.

Background: Colorectal cancer is the most common cancer in Germany and the second most common cause of cancer-related deaths in both men and women. The aim of this study is to provide detailed analysis of recent developments in survival of colorectal cancer patients using newly available data on a national basis. Methods: We included data from 11 German cancer registries covering a population of 33 million inhabitants. Period analysis and modelled period analysis were used to provide most up-to-date estimates of 5-year relative survival in 2002–2006. Results: The analysis was based on records of 164 996 colorectal cancer patients. Five-year relative survival was 63.0% overall, decreased with age and was significantly higher among women than among men in patients under 75 years. Overall age-adjusted 5-year relative survival increased from 60.6 to 65.0% over the period 2002–2006. Significant increase in survival was only observed in patients with localised or regional disease. Highest subsite-specific survival was observed in patients with cancer in descending (67.7%) and ascending (66.5%) colon. Conclusion: Survival of patients with colorectal cancer continued to increase in the early 21st century in Germany, with 5-year relative survival reaching 65% in 2006. However, lack of progress still persisted in patients with advanced disease.

Abstract 759 Background: Chronic myeloid leukemia (CML) is a rare but highly treatable form of leukemia. Recent advances in the treatment of CML have dramatically improved survival in clinical trials. Prior work using the Surveillance, Epidemiology, and End Results (SEER) database in the United States (US) suggest that survival on the population level has increased, but still lags behind that seen in clinical trials1. In the past, evaluation of population level survival in other countries has been hampered by the lack of high quality data from a large enough population to evaluate trends in survival in this rare disease. Recently, a collaborative effort between the German Cancer Research Center and several German cancer registries has provided the chance to evaluate population level survival for rare cancers. Here, we examine survival for patients with CML in Germany in the early 21st century, comparing it to survival in the US. Methods: Data was extracted from the SEER13 database in the US and 13 epidemiologic cancer registries in Germany. Patients diagnosed with CML between 1997 and 2006 were included in the analysis. Data quality analysis showed an excessive level of cases diagnosed by death certificate only in older patients (age 70+) so analysis was restricted to patients age 15–69. Patients diagnosed by death certificate only were excluded from the analysis. Period analysis was used to provide the most up-to-date possible estimates of five year relative survival. Results: 1848 cases of CML were identified in the German database and 2910 cases in the SEER database. More cases were seen in younger patients in the US, whereas each age group was roughly equal in size in Germany (see table). Five year relative survival was 68.7% overall in Germany and 72.7% in the US. Survival was higher in the US for all age groups except for age 15–39, but the difference was only significant for ages 50–59, where a difference of 10.2 percentage units was seen (see table). Survival decreased with age, ranging from 83.1% and 81.9%, respectively, in Germany and the US for patients age 15–39 to 54.2% and 54.5%, respectively, in patients age 65–69. Conclusions: Estimated five year survival increased in the US compared to previous estimates of survival in the 2000–2004 period1. Five year survival estimates were higher in the US than in Germany overall, but the difference was only significant for age 50–59. These results are the first detailing survival in CML on the population level in Germany and providing an international comparison. Survival did not equal that seen in clinical trials of tyrosine kinase inhibitors2 for either country, but comparison with previous estimates in earlier time periods suggests that improvement in survival is ongoing. Greater concentration on treatment of CML in older patients may help improve survival for this population, for which survival lags. Table: . Five year relative survival of patients diagnosed with CML in Germany and the US by age. Germany US Germany - US Age N RS SE N RS SE Diff P (Model) 15-39 324 83.1 3.0 818 81.9 2.0 +1.2 0.9403 40-49 328 78.0 3.4 680 82.8 2.2 −4.8 0.1777 50-59 423 67.5 3.5 697 77.7 2.6 −10.2 0.0018 60-64 361 65.3 3.8 340 70.3 4.1 −5.0 0.2065 65-69 412 54.2 4.0 375 54.5 4.2 −0.3 0.5093 Overall a 1848 68.7 1.6 2910 72.7 1.5 −4.0 0.0036 a=age adjusted using the percentage of cases in each age group in Germany N=Number of cases RS=Relative Survival SE=Standard Error Diff=Difference between survival in Germany and the US Disclosures: No relevant conflicts of interest to declare.

Introduction: The advent of tyrosine kinase inhibitors has produced 5-year survival of 90 + % for chronic myelocytic leukemia (CML) patients in clinical trials. However, population level survival has been lower, especially in older patients. Here, we examine survival of patients with CML in Germany and compare it to survival of patients in the United States (US). Methods: Data were extracted from the Surveillance, Epidemiology, and End Results database in the US and 11 cancer registries in Germany. Patients 15–69 years old diagnosed with CML were included in the analysis. Period analysis for 2002–2006 was used to provide the most up-to-date possible estimates of five-year relative survival. Results: Five-year relative survival was 68.7% overall in Germany and 72.7% in the US. Survival was higher in the US for all age groups except for ages 15–39 years, but the difference was only statistically significant for ages 50– 59 years (at 67.5% vs 77.7% in Germany and the US, respectively). Survival decreased with age, ranging from 83.1% and 81.9%, respectively, in Germany and the US for patients 15–39 years old to 54.2% and 54.5%, respectively, in patients 65–69 years old. Survival increased between 2002 and 2006 by 12.0% points in Germany and 17.1% points in the US. Conclusions: Five-year survival estimates were higher in the US than in Germany overall, but the difference was only significant for ages 50–59 years. Survival did not equal that seen in clinical trials for either country, but strong improvement in survival was seen between 2002 and 2006.