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.
What's new?
Certain cancer types that originate from the epithelial or mesothelial tissues of the thoracic cavity are exceedingly rare. As a consequence, little is known about their incidence and survival. Here, utilizing national databases, the authors estimated incidence and survival of malignant mesothelioma (MM) and other rare thoracic cancers in Germany and the United States. Analyses show that between 2000 and 2014, MM incidence declined in both countries, although only MM survival improved in Germany. No improvements were observed in either country for survival of epithelial tumors of the trachea and thymus, highlighting a need for preventive and therapeutic advances.
Common cancer monitoring practice is seldom prospective and rather driven by public requests. This study aims to assess the performance of a recently developed prospective cancer monitoring method ...and the statistical tools used, in particular the sequential probability ratio test in regard to specificity, sensitivity, observation time and heterogeneity of size of the geographical unit.
A simulation study based on a predefined selection of cancer types, geographical unit and time period was set up. Based on the population structure of Lower Saxony the mean number of cases of three diagnoses were randomly assigned to the geographical units during 2008-2012. A two-stage monitoring procedure was then executed considering the standardized incidence ratio and sequential probability ratio test. Scenarios were constructed differing by the simulation of clusters, significance level and test parameter indicating a risk to be elevated.
Performance strongly depended on the choice of the test parameter. If the expected numbers of cases were low, the significance level was not fully exhausted. Hence, the number of false positives was lower than the chosen significance level suggested, leading to a high specificity. Sensitivity increased with the expected number of cases and the amount of risk and decreased with the size of the geographical unit.
The procedure showed some desirable properties and is ready to use for a few settings but demands adjustments for others. Future work might consider refinements of the geographical structure. Inhomogeneous unit size could be addressed by a flexible choice of the test parameter related to the observation time.
Prostate cancer (PCa) is the most frequent cancer among men in Europe. Differences in PCa incidence around the world can be partly explained by variations in recommendations for prostate-specific ...antigen (PSA), particularly for early detection. For example, the PSA testing policy is more conservative in the Netherlands than in Germany. To better understand the relationship between PSA testing recommendations and PCa incidence, stage distribution, and mortality, we compared these variables over time between Lower Saxony in northwestern Germany and the neighboring province of Groningen in the Netherlands.
Population data, tumor stage- and age group-specific PCa incidence (ICD-10 C61) and mortality rates for Lower Saxony and Groningen were obtained from the Lower Saxony Epidemiological Cancer Registry, the Netherlands Comprehensive Cancer Organization, and Statistics Netherlands for 2003-2012. Incidence and mortality rates per 100,000 person-years were age-standardized (ASR, old European standard). Trends in age-standardized incidence rates (ASIR) and mortality rates (ASMR) for specific age groups were assessed using joinpoint regression.
The mean annual PCa ASIR between 2003 and 2012 was on average 19.9% higher in Lower Saxony than in Groningen (120.5 vs. 100.5 per 100,000), while the mean annual ASMR was on average 24.3% lower in Lower Saxony than in Groningen (21.5 vs. 28.4 per 100,000). Between 2003 and 2012, the average annual percentage change (AAPC) in PCa incidence rates did not change significantly in either Lower Saxony (-1.8%, 95% CI -3.5, 0.0) or Groningen (0.2%, 95% CI -5.0, 5.7). In contrast, the AAPC in mortality rate decreased significantly during the same time period in Lower Saxony (-2.5%, 95% CI -3.0, -2.0) but not in Groningen (0.1%, 95% CI -2.4, 2.6).
Higher PCa incidence and lower PCa-related mortality was detected in Lower Saxony than in Groningen. Although recommendations on PSA testing may play a role, the assessed data could not offer obvious explanations to the observed differences. Therefore, further investigations including data on the actual use of PSA testing, other influences (e.g., dietary and ethnic factors), and better data quality are needed to explain differences between the regions.
Investigating geographic variations in mammography screening participation and breast cancer incidence help improve prevention strategies to reduce the burden of breast cancer. This study examined ...the suitability of health insurance claims data for assessing and explaining geographic variations in mammography screening participation and breast cancer incidence at the district level. Based on screening unit data (1,181,212 mammography screening events), cancer registry data (13,241 incident breast cancer cases) and claims data (147,325 mammography screening events; 1,778 incident breast cancer cases), screening unit and claims-based standardized participation ratios (SPR) of mammography screening as well as cancer registry and claims-based standardized incidence ratios (SIR) of breast cancer between 2011 and 2014 were estimated for the 46 districts of the German federal state of Lower Saxony. Bland-Altman analyses were performed to benchmark claims-based SPR and SIR against screening unit and cancer registry data. Determinants of district-level variations were investigated at the individual and contextual level using claims-based multilevel logistic regression analysis. In claims and benchmark data, SPR showed considerable variations and SIR hardly any. Claims-based estimates were between 0.13 below and 0.14 above (SPR), and between 0.36 below and 0.36 above (SIR) the benchmark. Given the limited suitability of health insurance claims data for assessing geographic variations in breast cancer incidence, only mammography screening participation was investigated in the multilevel analysis. At the individual level, 10 of 31 Elixhauser comorbidities were negatively and 11 positively associated with mammography screening participation. Age and comorbidities did not contribute to the explanation of geographic variations. At the contextual level, unemployment rate was negatively and the proportion of employees with an academic degree positively associated with mammography screening participation. Unemployment, income, education, foreign population and type of district explained 58.5% of geographic variations. Future studies should combine health insurance claims data with individual data on socioeconomic characteristics, lifestyle factors, psychological factors, quality of life and health literacy as well as contextual data on socioeconomic characteristics and accessibility of mammography screening. This would allow a comprehensive investigation of geographic variations in mammography screening participation and help to further improve prevention strategies for reducing the burden of breast cancer.Investigating geographic variations in mammography screening participation and breast cancer incidence help improve prevention strategies to reduce the burden of breast cancer. This study examined the suitability of health insurance claims data for assessing and explaining geographic variations in mammography screening participation and breast cancer incidence at the district level. Based on screening unit data (1,181,212 mammography screening events), cancer registry data (13,241 incident breast cancer cases) and claims data (147,325 mammography screening events; 1,778 incident breast cancer cases), screening unit and claims-based standardized participation ratios (SPR) of mammography screening as well as cancer registry and claims-based standardized incidence ratios (SIR) of breast cancer between 2011 and 2014 were estimated for the 46 districts of the German federal state of Lower Saxony. Bland-Altman analyses were performed to benchmark claims-based SPR and SIR against screening unit and cancer registry data. Determinants of district-level variations were investigated at the individual and contextual level using claims-based multilevel logistic regression analysis. In claims and benchmark data, SPR showed considerable variations and SIR hardly any. Claims-based estimates were between 0.13 below and 0.14 above (SPR), and between 0.36 below and 0.36 above (SIR) the benchmark. Given the limited suitability of health insurance claims data for assessing geographic variations in breast cancer incidence, only mammography screening participation was investigated in the multilevel analysis. At the individual level, 10 of 31 Elixhauser comorbidities were negatively and 11 positively associated with mammography screening participation. Age and comorbidities did not contribute to the explanation of geographic variations. At the contextual level, unemployment rate was negatively and the proportion of employees with an academic degree positively associated with mammography screening participation. Unemployment, income, education, foreign population and type of district explained 58.5% of geographic variations. Future studies should combine health insurance claims data with individual data on socioeconomic characteristics, lifestyle factors, psychological factors, quality of life and health literacy as well as contextual data on socioeconomic characteristics and accessibility of mammography screening. This would allow a comprehensive investigation of geographic variations in mammography screening participation and help to further improve prevention strategies for reducing the burden of breast cancer.
Zusammenfassung
Hintergrund
In den letzten Jahren wird verstärkt gefordert, Forschungsdaten gemäß den sog. FAIR-Prinzipien für eine Nachnutzung aufzubereiten. Dadurch könnten zukünftige Projekte auf ...einer breiteren Datengrundlage durchgeführt sowie durch Verknüpfung verschiedener Datenquellen neue Fragestellungen untersucht werden.
Fragestellung
Eruiert werden soll, inwieweit Abrechnungsdaten gesetzlicher Krankenversicherungen mit den Daten der Landeskrebsregister (LKR) überregional verknüpft werden können, um die in den Abrechnungsdaten fehlenden Informationen zu Krebserkrankungen ergänzen und die Validität der dortigen Angaben zur Tumordiagnose beurteilen zu können. Der Fokus liegt dabei auf der Beschreibung der länderspezifischen Anforderungen für einen solchen Datenabgleich.
Material und Methoden
Als Datenquellen wurden die Pharmakoepidemiologische Forschungsdatenbank GePaRD des Leibniz-Instituts für Präventionsforschung und Epidemiologie – BIPS und sechs Krebsregister herangezogen. Zur Verknüpfung wurden vergleichend das logistisch aufwendige direkte Linkage- und ein weniger aufwendiges indirektes Linkage-Verfahren angewandt. Dazu mussten für GePaRD und für jedes LKR die Genehmigungen der jeweils zuständigen Behörde eingeholt werden.
Ergebnisse
Hinsichtlich der Verknüpfung von LKR-Daten mit GePaRD zeigten sich gravierende Unterschiede in der Datenbereitstellung (vollständige Ablehnung bis hin zu einer unkomplizierten Umsetzung).
Diskussion
In Deutschland müssen einheitliche Rahmenbedingungen geschaffen werden, um eine angemessene Nachnutzung und eine Verknüpfung von personenbezogenen Gesundheitsdaten zu Forschungszwecken im Sinne der FAIR-Prinzipien zu ermöglichen. Bezüglich der Verknüpfung von LKR-Daten mit anderen Datenquellen könnte das neue Gesetz zur Zusammenführung von Krebsregisterdaten Abhilfe schaffen.
Background: Breast cancer treatment has changed tremendously over the last decades. In addition, the use of mammography screening for early detection has increased strongly. To evaluate the impact of ...these developments, long-term trends in incidence, mortality, stage distribution and survival were investigated for Germany and the United States (US). Methods: Using population-based cancer registry data, long-term incidence and mortality trends (1975–2015), shifts in stage distributions (1998–2015), and trends in five-year relative survival (1979–2015) were estimated. Additionally, trends in five-year relative survival after standardization for stage were explored (2004–2015). Results: Age-standardized breast cancer incidence rates were much higher in the US than in Germany in all periods, whereas age-standardized mortality began to lower in the US from the 1990s on. The largest and increasing differences were observed for patients aged 70+ years with a 19% lower incidence but 45% higher mortality in Germany in 2015. For this age group, large differences in stage distributions were observed, with 29% (Germany) compared to 15% (US) stage III and IV patients. Age-standardized five-year relative survival increased strongly between 1979–1983 and 2013–2015 in Germany (+17% units) and the US (+19% units) but was 9% units lower in German patients aged 70+ years in 2013–2015. This difference was entirely explained by differences in stage distributions. Conclusions: Overall, our results are in line with a later uptake and less extensive utilization of mammography screening in Germany. Further studies and efforts are highly needed to further explore and overcome the increased breast cancer mortality among elderly women in Germany.
Background
We investigated the association between residential proximity to oil and gas production sites and hematologic malignancies, due to a cancer cluster in the German state of Lower Saxony.
...Methods
A registry‐based case‐control study was conducted including 3978 cases of hematologic malignancies diagnosed within 2013–2016 and 15,912 frequency‐matched controls randomly drawn by population registries. Residential proximity to 5333 oil and gas production sites at the time of diagnosis was calculated. Unconditional logistic regression models were used to estimate the association between living within 1 km of any exposure site and developing a hematologic malignancy. Models were adjusted for matching variables sex, age group, district, and year of diagnosis as well as for proximity to main streets and to agricultural land.
Results
We found no association between the development of hematologic malignancies and the proximity to all oil and gas production sites (odds ratio: 0.97; 95% confidence interval: 0.85, 1.11). Focusing on gas production sites increased the odds of developing hematologic cancer (odds ratio: 1.19; 95% confidence interval: 0.97, 1.45). In stratified analyses, associations were stronger in women and for acute myeloblastic leukemia. We also found an association in the district where the initial cluster occurred.
Conclusions
Our results suggest that residential proximity to oil and gas production is not a risk factor for all hematologic malignancies in general. Sporadic and past exposures are the most likely scenarios for mechanisms involving oil and gas production, leading to increased risk for certain subtypes of cancer in certain populations.
Summary
Background
Germany‐wide skin cancer screening was introduced in 2008 to reduce skin cancer mortality and morbidity. However, the effectiveness of the program is still unclear. We explore the ...relationship between early‐stage melanoma incidence and melanoma mortality in subsequent years, using early‐stage melanoma incidence as surrogate for screening participation and early detection.
Patients and Methods
Data on melanoma incidence for 2005–2016 and melanoma mortality for 2005–2018 were obtained for 244 German counties. We investigated the correlation between several measures of incidence and mortality with correlation analyses and linear regressions.
Results
Melanoma incidence of early stages (in situ and T1) rose by 69% between pre‐screening (2005–2007) and screening period (2008–2010). In contrast, there was no temporal trend in mortality over time. Correlation coefficients between incidence and mortality variables ranged between –0.14 and 0.10 (not significant). Linear regression indicated that mortality 6 years after screening introduction decreases with increasing change in early‐stage incidence (b = –0.0029, 95% confidence interval –0.0066, 0.0007).
Conclusions
The estimated population‐based effects of skin cancer screening on melanoma mortality were minimal and not significant. A potential effectiveness cannot be demonstrated.
Zusammenfassung
Hintergrund
In Deutschland wurde 2008 ein flächendeckendes Hautkrebsscreening eingeführt, um die Hautkrebsmortalität und ‐morbidität zu senken. Noch unklar ist jedoch die Wirksamkeit ...des Programms. Wir untersuchen den Zusammenhang zwischen der Inzidenz von Melanom‐Frühstadien und Melanom‐Mortalität in den Folgejahren, wobei die Inzidenz von Melanom‐Frühstadien als Surrogatparameter für Screening‐Teilnahme und Früherkennung verwendet wird.
Methodik
Für 244 deutsche Landkreise wurden Daten zur Melanom‐Inzidenz von 2005–2016 und zur Melanom‐Mortalität von 2005–2018 erhoben. Die Zusammenhänge zwischen verschiedenen Maßen der Inzidenz und Mortalität wurden mit Korrelationsanalysen und linearen Regressionen untersucht.
Ergebnisse
Die Melanom‐Inzidenz früher Stadien (in situ und T1) stieg nach Einführung des Screenings (2005–2007 vs. 2008–2010) um 69%. Im Gegensatz dazu gab es bei der Mortalität keinen zeitlichen Trend. Die Korrelationen zwischen Inzidenz‐ und Mortalitätsvariablen lagen zwischen –0,14 und 0,10 (nicht signifikant). Die linearen Regressionsanalysen ergaben, dass die Mortalität sechs Jahre nach Einführung des Screenings mit zunehmendem Anstieg der Inzidenz früher Stadien abnimmt (b = –0,0029, 95%‐Konfidenzintervall –0,0066; 0,0007).
Schlussfolgerungen
Die geschätzten bevölkerungsbezogenen Auswirkungen des Hautkrebsscreenings auf die Melanom‐Mortalität waren minimal und nicht signifikant. Eine mögliche Wirksamkeit kann daher nicht nachgewiesen werden.
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.
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.
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.
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.
PDF
