Colorectal cancer incidence in Germany: stage-shift 6 years after implementation of a colonoscopy screening program.
BACKGROUND
In 2002, colonoscopy was introduced as a tool for colorectal cancer screening in Germany. The long-term objective was to reduce the incidence in colorectal cancer (CRC) by detection and removal of advanced adenomas. Currently, the effect of colonoscopy screening on the population-based incidence of CRC in Germany is unknown.


METHODS
We provide data on stage-specific (age-standardized) incidence rates in three federal states in Germany, 6 years after the implementation of colonoscopy.


RESULTS
Between 2002 and 2008 a statistically significant decrease in CRC incidence could be observed (annually 3.0%, 95% confidence interval [CI]: -3.8; -2.2). The decline could be observed in all advanced tumor categories (T2, T3, and T4), whereas the incidence of in situ carcinomas (Tis) increased annually by 51.6% (95% CI: 28.0; 79.4) until 2004, and remained stable until 2008.


CONCLUSIONS
The observed changes cannot be attributed definitively to the screening activities, but the presented data support a possible causal association.
Institute of Clinical Epidemiology, University Hospital Schleswig-Holstein, Campus Luebeck, RatzeburgerAllee 160, 23562 Luebeck, Germany. maike.schnoor@uksh.de
M
M
Schnoor
A
A
Waldmann
A
A
Eberle
B
B
Holleczek
A
A
Katalinic
D017677:Age Distribution; D000368:Aged; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology* / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006284:Health Plan Implementation / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000458:organization & administration* / Q000706:statistics & numerical data*; D009367:Neoplasm Staging; D017678:Sex Distribution