Long-term Incidence and Mortality Trends for Breast Cancer in GermanyArticle in several languages: English | deutsch
Introduction Changes in risk factors and the introduction of mammography screening in 2005 have led to dramatic changes in the breast cancer-associated burden of disease in Germany. This study aimed to investigate long-term disease-related incidence and mortality trends in women from East and West Germany since the reunification of Germany.
Methods Total and stage-specific incidence rates were evaluated based on data obtained from selected cancer registries. Sufficiently complete data going back to 1995 were available for 4 East German and 3 West German regions. The figures were weighted for population size, and rates were calculated for the whole of Germany based on the rates for East and West Germany. The study particularly focused on 3 different age groups: women eligible for mammography screening (50 – 69 years), younger women (30 – 49 years) and older women (70+ years). All rates were standardised for age. The mortality rates obtained from the official statistics on cause of death since 1990 were processed accordingly.
Results Incidence rates in the observation period increased, as they were affected by the increasing number of cases with early-stage cancers being diagnosed in the screening age group. The total incidence for this group, which included the incidence of non-invasive breast cancers, increased by 14.5% between 2005 and 2016. Early-stage cancers (UICC stages 0 and I) increased by 48.1% while late-stage diagnoses (UICC stages III and IV) decreased by 31.6%. Qualitatively similar changes were noted for the other age groups, although they were less pronounced. The decrease in breast cancer mortality observed since the mid-1990s ended around 2008 for the group of younger women but continued in the screening age group. After 2008, an increase in mortality was observed in the group of older women. The differences in disease burden between East and West Germany (in favour of East Germany) decreased in younger women during the observation period but tended to increase in the group of older women.
Conclusion The analysis suggests that the introduction of mammography screening contributed to a decrease in the incidence of advanced-stage breast cancers and in breast cancer-related mortality rates but also resulted in a substantial number of overdiagnoses. The relatively unfavourable incidence trend in the group of younger women, particularly in East Germany, should be interpreted in the context of lifestyle changes. The slight increase in mortality observed in the group of older women after 2008 requires further analysis.
Received: 07 January 2020
Received: 15 April 2020
Accepted: 17 April 2020
17 June 2020 (online)
Georg Thieme Verlag KG
Stuttgart · New York
- 1 Robert Koch Institute, Association of Population-based Cancer Registries in Germany (GEKID), eds. Cancer in Germany 2013/2014. 11th ed. Berlin; 2018
- 2 GBD Global Health Data Exchange (GHDx) platform. Online (last access: 28.11.2019): http://ghdx.healthdata.org/gbd-results-tool
- 3 German Centre for Cancer Registry Data, Robert Koch Institute. Online (last access: 28.11.2019): https://www.krebsdaten.de/database
- 4 Association of Population-based Cancer Registries in Germany in collaboration of with the Robert Koch Institute. eds. Cancer in Germany. Frequencies and trends. 3th ed. Saarbrücken; 2002
- 5 Federal Statistical Office. GENESIS-Online. Online (last access: 12.12.2019): https://www-genesis.destatis.de/genesis/online
- 6 Waldmann A, Eberle A, Hentschel S. et al. [Population-based incidence rates of colorectal neoplasms (2000–2006) – has systematic colonoscopy screening an impact on incidence? A combined analysis of cancer registry data of the Federal States of Bremen, Hamburg, Saarland and Schleswig-Holstein]. Z Gastroenterol 2010; 48: 1358-1366 doi:10.1055/s-0029-1245602
- 7 Malek D, Kaab-Sanyal V. Implementation of the German Mammography Screening Program (German MSP) and First Results for Initial Examinations, 2005–2009. Breast Care 2016; 11: 183-187 doi:10.1159/000446359
- 8 Carter JL, Coletti RJ, Harris RP. Quantifying and monitoring overdiagnosis in cancer screening: a systematic review of methods. BMJ 2015; 350: g7773 doi:10.1136/bmj.g7773
- 9 Katalinic A, Lemmer A, Zawinell A. et al. Trends in hormone therapy and breast cancer incidence – Results from the German Network of Cancer Registries. Pathobiology 2009; 76: 90-97 doi:10.1159/000201677
- 10 Holleczek B, Brenner H. Trends of population-based breast cancer survival in Germany and the US: decreasing discrepancies, but persistent survival gap of elderly patients in Germany. BMC Cancer 2012; 12: 317 doi:10.1186/1471-2407-12-317
- 11 Broeders MJM, Allgood P, Duffy SW. et al. The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review. BMC Cancer 2018; 18: 860 doi:10.1186/s12885-018-4666-1
- 12 Castro Habedank AC. Klinischer und pathologischer Lymphknotenstatus bei Mammakarzinom unter Berücksichtigung der alten und neuen TNM-Klassifikation [Abstract of a medical dissertation]. Heidelberg: Heidelberg University; 2004 Online (last access: 28.11.2019): http://www.ub.uni-heidelberg.de/archiv/9590
- 13 Bleyer A, Baines C, Miller AB. Impact of screening mammography on breast cancer mortality. Int J Cancer 2016; 138: 2003-2012 doi:10.1002/ijc.29925
- 14 Autier P, Hery C, Haukka J. et al. Advanced breast cancer and breast cancer mortality in randomized controlled trials on mammography screening. J Clin Oncol 2009; 27: 5919-5923 doi:10.1200/JCO.2009.22.704
- 15 Mandrik O, Zielonke N, Meheus F. et al. Systematic reviews as a ‘lens of evidence’: Determinants of benefits and harms of breast cancer screening. Int J Cancer 2019; 145: 994-1006 doi:10.1002/ijc.32211
- 16 Peters E, Anzeneder T, Jackisch C. et al. The Treatment of Primary Breast Cancer in Older Women With Adjuvant Therapy: A Retrospective Analysis of Data From Over 3000 Patients From the PATH Biobank, With Two-Year Follow-up. Dtsch Arztebl Int 2015; 112: 577-584 doi:10.3238/arztebl.2015.0577
- 17 Tamimi RM, Spiegelman D, Smith-Warner SA. et al. Population Attributable Risk of Modifiable and Nonmodifiable Breast Cancer Risk Factors in Postmenopausal Breast Cancer. Am J Epidemiol 2016; 184: 884-893 doi:10.1093/aje/kww145
- 18 Bujard M, Diabaté S. Wie stark nehmen Kinderlosigkeit und späte Geburten zu?. Gynäkologe 2016; 49: 393-404 doi:10.1007/s00129-016-3875-4
- 19 Mensink GB, Lampert T, Bergmann E. [Overweight and obesity in Germany 1984–2003]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2005; 48: 1348-1356 doi:10.1007/s00103-005-1163-x