Report on trends of incidence (1970-2002) of and mortality (1952-2002) from cancer in Germany.
OBJECTIVE
The paper presents the statistical analysis of current and past trends of cancer mortality rates in Germany in terms of annual percent change, overall and for the major sites, and contrasts them with trends in incidence of the Cancer Registry of the Saarland, the only registry in this country with long-term completeness. It addresses also the issue of a cross-over of cancer mortality and mortality from cardiovascular diseases (CVD) in the near future, as suggested by various authors.


METHODS
Analyses are based on the mortality data of the official mortality statistics as published by the Federal Statistical Office and reported annually to the WHO, and the regularly reported incidence data of the Cancer Registry of the Saarland. The data was age-standardised and analysed by piecewise regression using a freely available dedicated software package.


RESULTS
The report shows a downward trend of mortality rates for all cancers combined based on declining rates for many individual sites with only few exceptions affecting mainly females (e.g. lung cancer). Recently, the long-term increase of cancer incidence also flattened out with rather heterogeneous underlying site-specific trends increasing for some sites (e.g. cancers of the intestine, breast, prostate, or some lymphoma) and decreasing for others (e.g. cancers of the stomach, gall bladder in females, larynx, and lung in males). A crossover of cancer mortality and mortality from CVD might occur-if at all-after 2,020 in males and 2,030 in females.


CONCLUSIONS
Depending on cancer site, primary prevention (e.g. lung cancer among males), early detection (cervical cancer), and treatment (e.g. breast and testicular cancer, lymphoma) contributed to the current decline of mortality rates. Absence of a turnaround (e.g. lung cancer among females), slower decline than in other countries (e.g. cervical cancer), or later turnaround (e.g. breast cancer) may be related to failures in promoting prevention (lung cancer among females), early detection programmes (cervical cancer), or delays in the translation of modern treatment into routine health care (breast cancer) and indicate major challenges for current and future health policy.
Becker
Nikolaus
N
German Cancer Research Center, Division of Clinical Epidemiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany. n.becker@dkfz.de
Altenburg
Hans-Peter
HP
Stegmaier
Christa
C
Ziegler
Hartwig
H
D002318:Cardiovascular Diseases / Q000453:epidemiology; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D009026:Mortality / Q000639:trends; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D012042:Registries; D017678:Sex Distribution