Download Cancer in Germany 2005/2006 Incidence and Trends

 Cancer in Germany
2005/2006
Incidence and Trends
Published jointly by the Robert Koch Institute and
the Association of Population-based Cancer Registries in Germany
Seventh edition, 2010
Federal Health Reporting
Contributions to
Federal Health Reporting
Cancer in Germany
2005/2006
Incidence and Trends
Published jointly by the Robert Koch Institute and
the Association of Population-based Cancer Registries in Germany
Seventh edition
Robert Koch Institute, Berlin 2010
Bibliographic information from Deutsche Bibliothek
Die Deutsche Bibliothek records this publication in the
Deutsche Nationalbibliografie
Published by
Robert Koch-Institut
Nordufer 20, 13353 Berlin
Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V.
Ratzeburger Allee 160, Haus 50
23538 Lübeck
Authors
Gabriele Husmann (Rhineland-Palatinate Cancer Registry)
Dr Peter Kaatsch (German Childhood Cancer Registry)
Prof Dr Alexander Katalinic (GEKID)
Dr Joachim Bertz, Dr Jörg Haberland,
Dr Klaus Kraywinkel MSc, Dr Ute Wolf (RKI)
Special thanks to the Cancer Information Service (Krebsinformationsdienst) and the German
Cancer Research Centre (Deutsches Krebsforschungszentrum) for checking through and
updating the sections on cancer risk factors.
Translation
Bob Culverhouse, Berlin
Sources
www.rki.de/krebs
Email: [email protected]
www.gekid.de
and the cancer registries of Germany‘s Länder
(i.e. federal states, see address list in the appendix)
How to quote the title
Cancer in Germany 2005/2006. Incidence and Trends. Seventh edition. Robert Koch Institute (ed.)
and Association of Population-based Cancer Registries in Germany (ed.). Berlin, 2010
Graphics/typesetting
Gisela Winter
Robert Koch Institute
Printed by
Ruksal-Druck, Berlin
ISBN
978-3-89606-209-3
Cancer in Germany
Table of contents
1
1.1
1.2
1.3
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
About this booklet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Aims and tasks of population-based cancer registries . . . . . . . . . . . . . 5
Current development of cancer registration in Germany . . . . . . . . . . . . 7
2
2.1
2.2
2.3
Methodological aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Completeness of cancer registration . . . . . . . . . . . . . . . . . . . . . . . 9
Estimate and results for Germany in 2006 . . . . . . . . . . . . . . . . . . . 11
Indicators and presentation . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3 Results according to ICD-10 . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.1 All cancer sites . . . . . . . . . . . . C00 – 97 except C44 . . . . . . . . . . 19
3.2 Oral cavity and pharynx . . . . . . . . C00 – 14 . . . . . . . . . . . . . . . . 24
3.3 Oesophagus . . . . . . . . . . . . . . C15 . . . . . . . . . . . . . . . . . . . 28
3.4 Stomach . . . . . . . . . . . . . . . . C16 . . . . . . . . . . . . . . . . . . . 32
3.5 Colon and rectum . . . . . . . . . . . C18 – 21 . . . . . . . . . . . . . . . . 36
3.6 Pancreas . . . . . . . . . . . . . . . . C25 . . . . . . . . . . . . . . . . . . . 40
3.7 Larynx . . . . . . . . . . . . . . . . . C32 . . . . . . . . . . . . . . . . . . . 44
3.8 Lung . . . . . . . . . . . . . . . . . . C33, C34 . . . . . . . . . . . . . . . . 48
3.9 Malignant melanoma of the skin . . . C43 . . . . . . . . . . . . . . . . . . . 52
3.10 Breast (female) . . . . . . . . . . . . C50 . . . . . . . . . . . . . . . . . . . 56
3.11 Cervix . . . . . . . . . . . . . . . . . C53 . . . . . . . . . . . . . . . . . . . 60
3.12 Uterus (corpus uteri) . . . . . . . . . C54, C55 . . . . . . . . . . . . . . . . 64
3.13 Ovaries . . . . . . . . . . . . . . . . C56 . . . . . . . . . . . . . . . . . . . 68
3.14 Prostate . . . . . . . . . . . . . . . . C61 . . . . . . . . . . . . . . . . . . . 72
3.15 Testis . . . . . . . . . . . . . . . . . . C62 . . . . . . . . . . . . . . . . . . . 76
3.16 Kidney and efferent urinary tract . . . C64 – 66, C68 . . . . . . . . . . . . . 80
3.17 Bladder . . . . . . . . . . . . . . . . C67, D09.0, D41.4 . . . . . . . . . . . 84
3.18 Nervous system . . . . . . . . . . . . C70 – 72 . . . . . . . . . . . . . . . . 88
3.19 Thyroid gland . . . . . . . . . . . . . C73 . . . . . . . . . . . . . . . . . . . 92
3.20 Hodgkin‘s lymphoma . . . . . . . . . C81 . . . . . . . . . . . . . . . . . . . 96
3.21 Non-Hodgkin lymphomas . . . . . . C82 – 85 . . . . . . . . . . . . . . . 100
3.22 Leukaemias . . . . . . . . . . . . . . C91 – 95 . . . . . . . . . . . . . . . 104
4
Cancer in children . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . 108
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
German Centre for Cancer Registry Data at the Robert Koch Institute . . . 113
Association of Population-based Cancer Registries in Germany . . . . . . . 114
Addresses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Sources for comparing country-specific cancer incidence and
mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
3
4
Cancer in Germany
Cancer in Germany
1 Preface
1.1 About booklet
As in 2008 this edition of »Cancer in Germany«
is published as a contribution to health reporting by the Robert Koch Institute (RKI). It is published jointly every two years by the Association
of Population-based Cancer Registries (GEKID)
and the RKI.
This 7th edition covers cancer cases diagnosed
in Germany between 1980 and 2006. As a rule,
population-based cancer registries need about
three years from the end of the year of diagnosis to
the publication of the incidence figures. All cancer
cases occurring in a year must be reported to the
registry in full; all case reports must be matched
against each other, and all deaths in the region
against the data collected. Only in this way can reliable assessments on incidence and survival rates
be derived from the available data. For over 20
years a working group at the RKI called the Federal
Cancer Surveillance Unit has collected data every
year from the registries of currently 13 of 16 federal states (Länder) and one administrative district
(Münster, North Rhine-Westphalia), examined it
for consistency and completeness, and pooled it
for further analysis (see section 2.1). After the Federal Cancer Registry Data Act (BKRG) came into
force on 18 August 2009, the Unit was succeeded
by the newly formed German Centre for Cancer
Registry Data at the RKI (see appendix).
The data from all the population-based cancer registries in Germany with diagnoses up to
2006 were transferred to the RKI in the spring of
2009 with the exception of Baden-Württemberg
and Hesse. These data form the basis of the current edition of »Cancer in Germany«, with the
estimates of new cancer cases up to 2006 and
projections for 2010 (see section 2.2).
The booklet contains texts, charts and tables
with information on the incidence and mortality
of cancers in Germany according to age and gender, their development over time, and other epidemiological statistics on all cancer sites together
and 21 selected sites. Comparative data, e.g. from
the countries bordering on Germany, make it easier to put the results into context.
The text sections on the individual cancer
sites (including cancers of the nervous system
for the first time) describe the most important
risk factors. Information on incidence and mortality risks and the prevalence of cancers has been
included for the first time. Frequently used terms
are explained in the glossary at the end of the
booklet.
In future editions, the range of cancer sites
covered – as well as the evaluation methods and
analyses used – will be extended as the quality of
the data available improves further.
1.2 A
ims and tasks of population-based
cancer registries
Population-based (epidemiological) cancer registries are institutions for the collection, storage,
processing, analysis and interpretation of data on
the occurrence and frequency of cancers within
defined registration areas (e.g. the inhabitants of
a German federal state). The data from the population-based cancer registries are also indispensable as a basis for further research into the causes
of cancer and for efforts to improve the care of
tumour patients.
Examples of findings deduced from populationbased cancer registries include:
▶▶ The prostate, intestines and lungs are the most
common cancer sites among men.
The incidence of cancers (i.e. how frequently per
annum they occur in a certain population) can be
described with the data from population-based
cancer registries. The incidence is broken down
according to cancer type, the patient‘s age and
gender, and other characteristics. Reliable information on incidence is indispensable for describing the extent and type of the burden that cancer
places on a population.
▶▶ For some years now there have been just as
many cases of lung cancer in Germany among
women under the age of 40 as among men of
the same age.
5
6
Cancer in Germany
The development (trend) of incidence over time
can only be observed with the data from population-based cancer registries. The registries have a
key function for health reporting in this context.
▶▶ There are regional differences within Europe
and Germany regarding the incidence of malignant melanoma of the skin.
Population-based cancer registries can analyse
the regional distribution of cancer sites. They also
have the task of examining observed cancer clusters. More detailed analytical studies are usually
required to determine the causes of these clusters.
▶▶ The survival expectations of men with testicular
cancer have improved decisively over the last
25 years.
Population-based cancer registries conduct survival analyses of all cancer patients in their registration region. Population-based survival rates are
an important parameter for assessing the effectiveness of the diagnosis, therapy and aftercare
of cancers.
▶▶ Predicting the future number of new cancer
cases is an important aspect of requirements
planning for the health service. The populationbased cancer registries provide the underlying
data needed for this.
The data from population-based cancer registries
not only serve to describe the incidence of cancer
in the population, they are also used for scientific
research into the causes of cancer and for research
on healthcare effectiveness. Such studies (casecontrol studies, cohort studies, etc.) investigate
issues such as:
▶▶ What are the causes of childhood leukaemia?
▶▶ Do women who take hormone-replacement
therapy for menopausal problems have a higher
risk of developing breast cancer?
▶▶ Do people in certain occupational groups
develop lung cancer more frequently than others?
▶▶ Are diagnosis, therapy and aftercare being carried out according to the latest standards?
Population-based cancer registries make it possible for all cases of the disease that have occurred
in a defined population to be taken into account
in research projects. This ensures that the findings of such studies usually apply not only to a
specific hospital group of patients, but also to the
entire population. Population-based case-control
studies and cohort studies use data from population-based cancer registries for research into the
causes and risks of cancer.
▶▶ Does mammography screening lead to the discovery of tumours at more favourable stages,
thus improving survival prospects?
The data from population-based cancer registries
with complete coverage make it possible to objectively assess the effectiveness of preventive and
screening programmes. For example, a possible
decline in the number of advanced cases of cancer
in the population can be assessed on the basis of
data from population-based registries. The aim is
to show the desired reduction in mortality among
the participants of such a measure by linking the
registry data with the screening programme.
The degree of completeness of data capture
that has now been reached in many registries has
also led to an increase in the use of the registry
data. Here are some topical examples:
▶▶ a study of survival prospects after cancer,
▶▶ a study of the oncological care and long-term
quality of life of cancer patients,
▶▶ an evaluation of pilot projects on mammography screening, quality-assured breast cancer
diagnostics and skin-cancer screening,
▶▶ a study on the connection between social strata
and cancer incidence and mortality,
▶▶ a collaboration with the cancer centres, e.g.
in the assessment of the long-term survival of
treated patients,
▶▶ a study on the effectiveness of colonoscopy
screening.
(For a detailed list see: www.gekid.de).
Cancer in Germany
The evaluation of the screening measures introduced in Germany will be a special challenge
for the population-based cancer registries in the
coming years. Among other things, the focus is
on assessing mammography screening, which
has been introduced nationwide in Germany. The
population-based cancer registries have already
provided detailed basic data for the first evaluation report on mammography screening (www.
mammo-programm.de), and this is being used
for quality assurance and an initial assessment of
the programme. Skin cancer screening was introduced in 2008 by statutory health insurance as a
new early-detection measure; its effect can now
also be reviewed using the data from the cancer
registries.
A longer-term task of the population-based
cancer registries is examining the effectiveness
of the vaccination programme for girls aged
between 12 and 17 against human papillomavirus
(HPV) with the aim of significantly reducing the
number of new cases of cervical cancer.
In order to establish comprehensive health
monitoring – i.e. an ongoing comparative analysis of cancer in the population – it is not enough
to operate population-based cancer registries only
in selected regions of Germany. Rather, to achieve
this objective, comprehensive cancer registries
must be up and running in all federal states. The
first Federal Cancer Registry Act (1995 to 1999)
initiated the development of a network of state cancer registries. It also created a uniform framework
for the transfer of data to a central institution for
nationwide evaluation: the Federal Cancer Surveillance Unit at the RKI. Although the states made
full use of the broad freedoms provided by the law
in organizing the regional registries, the comparability of the collected data is guaranteed by national
and international rules, so that these data can be
pooled and used for statistical and epidemiological analyses. In 2009 the opportunities for pooling
and evaluating cancer-registry ¬data at a national
level were further strengthened after the Federal
Cancer Registry Data Act came into force with the
newly formed German Centre for Cancer Registry
Data at the RKI.
In order to be able to pool information about
an individual‘s cancer condition from different
sources, the data are collected in such a way that
multiple reports on the same person are recog-
nizable. For research purposes it should be possible to re-establish a link between the data and
the person. In order to safeguard patients‘ privacy
and their right to control what happens to their
data, extensive precautions are required to protect
and secure personal data; these are provided in all
population- based registries by state laws.
An undistorted evaluation of the data is only
possible if over 90% of all new cancer cases are
registered. The cooperation of all physicians and
dentists involved in diagnosis, treatment and
aftercare is therefore crucial to the informational
value of data from a population-based cancer registry. Patients are also requested to actively take
part in cancer registration. Ask your doctor to
report your case to the cancer registry! This way
you too can make a contribution to the assessment of cancer trends and to cancer research –
and thus to improving cancer detection, treatment and aftercare.
1.3 C
urrent development of cancer
registration in Germany
Population-based cancer registration has continued to develop positively in Germany over the
last two years.
In 2009, active efforts on population-based
cancer registration were resumed in BadenWürttemberg. Here, a state-wide cancer registry
is being built up step by step. The oncological networks and tumour centres are being linked with
the cancer registry as a first step. In the state of
Hesse, too, cancer registration has been extended
to cover the whole state after the state cancer registry law was amended.
An important milestone for population-based
cancer registration has thus been reached in Germany – the registration of cancer cases has now
been placed on a legal footing all over the country. Now the challenge is to quickly implement
complete registration in the new regions. This
objective was given a further boost at the national
level in 2009 with the Federal Cancer Registry
Data Act. The new law calls on all federal states
to report complete data to the newly formed German Centre for Cancer Registry Data at the Robert Koch Institute. In a few years the estimates
on the number of incident cancer cases in Ger-
7
8
Cancer in Germany
many, as made for this edition, can then be supplemented with the pooled data from all the state
registries.
As a result of the considerable improvement
in cancer registration in Germany, the current
edition of »Cancer Incidence in Five Continents«
(volume IX), a series published by IARC (World
Health Organization‘s International Agency for
Research on Cancer, Lyon, France), has included
six further German cancer registries with diagnostic data from 1998 to 2002 in addition to the
data from the Saarland Cancer Registry.
The completeness of the data collected by the
cancer registries has further increased since the
publication of the 6th edition of »Cancer in Germany« in 2008. Progress with registration has
included, among other things, the introduction
of an obligation to report cancer cases in several
federal states, an increase in the exchange of data
between the population-based registries, and the
increased use of IT interfaces.
The »Association of Population-based Cancer
Registries in Germany« (Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V.,
abbreviated to GEKID), whose members include
not only all German population-based cancer registries, but also scientists working in the field of
cancer epidemiology, has been working intensively on harmonizing and standardizing cancer
registration in Germany over the past two years.
One result was the publication in 2008 of »The
Manual of Population-based Cancer Registration«, which lays down the coordinated methodological principles of cancer registration in Germany. Various IT interfaces were defined and
published for the transfer of data to the population-based cancer registries and the forwarding of
data between the cancer registries to standardize
the flow of data to the registries and the exchange
of data between them.
Further information on GEKID is available on
the Internet at www.gekid.de.
The public request for research proposals on
»cancer epidemiology« funded by the organization German Cancer Aid in 2007 was especially
important for population-based cancer registration in Germany and the scientific use of the collected data. The funding was made conditional
on the inclusion of population-based cancer registries. About 40 applications were made to Ger-
man Cancer Aid, and around half of these were
granted. The first projects began at the end of
2008, and initial results have already been presented at scientific congresses.
GEKID also represents the population-based
cancer registries in the context of Germany‘s
National Cancer Plan. GEKID is in charge of the
subtarget called »Evaluation of cancer screening
using the data of the state cancer registries« in
the »field of action« entitled »Further development of cancer screening«. GEKID is also very
much involved in the subtarget »Clinical cancer
registration«.
Coordination and cooperation between population-based and clinical cancer registries has
also developed very positively. For example, the
population-based cancer registries in Germany
and the clinical registries recently defined their
respective core competencies in two keynote
papers; they reaffirmed their intention to cooperate on improving the quality and usefulness of
the data from both forms of registry and avoiding
unnecessary burdens on those reporting caused
by their having to repeatedly report the same
information.
In order to further improve cancer registration, GEKID advocates reducing multiple documentations and raising efficiency by using electronic documentation systems. To achieve this,
GEKID has agreed with the clinical cancer registries (German Tumour Centres Work Group) to
use the same basic documentation (including an
electronic format description) to avoid any duplication of data capture by population-based and
clinical cancer registries. The association also
intends to continue promoting the use of cancer
registry data for quality assurance in oncology
and for helping hospitals and treatment centres
procure data for their quality reports.
Overall, the current development of registration and use of cancer data is positive and offers
good future prospects to the benefit of science,
medicine and, ultimately, cancer patients. If
the willingness of participating physicians and
patients to report does not decline, and the financial and political support for the cancer registries
continues, we will move one more step closer to
the aim of achieving a comprehensive, informative and usable population-based system of cancer registration.
Cancer in Germany
2
Methodological aspects
2.1 Completeness of cancer registration
The usefulness of population-based data on cancer
incidence depends primarily on how completely
all new cases of cancer are registered. The Robert
Koch Institute (RKI), therefore, regularly reviews
the completeness and reliability of the populationbased cancer registries in Germany – currently in
13 states and one administrative district. According to international experience, the following have
proved to be reliable indicators of the completeness of population-based cancer registries: (a) the
DCO (death-certificate-only) percentage, (b) the
percentage of diagnoses that are microscopically
confirmed by examinations of tissue or cell/blood
smears (histologically verified, HV), and (c) the
incidence/mortality ratio.
All cancer cases that are not reported to a cancer
registry until the death certificate has been issued
are initially listed as DCN (death-certificate-notification) cases. If the registry‘s inquiries produce
no further information on such cases, they are
referred to as DCO cases. Calculating the DCO
percentage is therefore a simple and reliable way
of determining how completely data on cases are
reported to – or collected by – a cancer registry. It is
done by the regular, case-by-case matching of registry records on cancer patients against the records
of the people who have died in the region. People
who have died of cancer, but were not covered by
the registry, and where no further information on
the disease is available, are added as DCO cases to
the incidence figures. The ‚younger‘ a cancer registry is, the more likely it is that DCO cases could
be a result of people dying who were diagnosed
with cancer before the registry was created and
who, therefore, could not be covered by the registry. Therefore, a high DCO percentage among case
reports in a cancer registry that has not existed
for long does not necessarily mean that the current incidence figures are incomplete. Older gaps
in cancer registration can also increase the current DCO percentage, which would understate the
completeness of cancer registration.
The HV percentage is essentially a validity indicator. A particularly low percentage can, however,
be the result of a high DCO percentage and therefore indicate a low level of completeness. On the
other hand, a particularly high HV percentage
can indicate underreporting in the cancer registry, since this can be a sign of an excessively high
percentage of reports by pathologists. Ultimately,
however, this indicator cannot quantify the degree
of completeness; it can only point to possible
underrepresentation.
In cooperation with the German cancer registries, the RKI estimates the degree of completeness using an indicator that is commonly used
internationally: the incidence/mortality ratio. In
this method, the expected incidence in a cancer
registry‘s catchment area is estimated on the basis
of data from a cancer registry in which registration is known to be complete; this figure is then
compared with the data actually collected there.
The registry used as the „reference registry“ is initially the Saarland Cancer Registry, the only population-based cancer registry in Germany that has
been working continuously for over 40 years. On
the assumption that diagnosis and therapy – and
hence the survival prospects – of cancer patients
do not vary substantially from one federal state
to another, and that different cancer risks can be
shown in the official cause-of-death statistics, cancer incidence in the respective region can be estimated using the quotients of incidence divided by
mortality in the reference registry and the regional
mortality figures. The development of the age-specific quotients over time is modelled in a log-linear
approach with polynomial trends. Further registries successively contribute to the data pool of the
reference registry, once the completeness of these
registries has been confirmed in a comparison
with the Saarland. The resulting virtual reference
registry is ultimately composed of the records of
all cancer registries in Germany in which registration is complete. Unlike the customary completeness indicators – such as the DCO percentage
or the histologically verified percentage – the RKI
estimate directly expresses the completeness of
cancer registration for each year since registration
began. Completeness is estimated according to
gender and cancer site. The percentage indicates
the degree of completeness of the regional population-based cancer registries compared to the vir-
9
10
Cancer in Germany
Figure 2.1.1
Development of the estimated completeness of the German population-based cancer registries, 2000 to 2002 and 2004 to 2006,
by federal state and/or region
(Mean value men and women)
2000 – 2002
2004 – 2006
Schleswig-Holstein
(1998)
Bremen
(1998)
Hamburg
(1926)
Mecklenburg-Western
Pomerania
(1953)
Lower Saxony
(2000)
Berlin
(1953/1995¹)
Saxony-Anhalt
(1953)
North RhineWestphalia
(1986/2005²)
Hesse
(2003/2007³)
Thuringia
(1953)
Brandenburg
(1953)
Saxony
(1953)
RhinelandPalatinate
(1997)
no data
<��%
��% – <��%
��% – <��%
≥��%
Saarland
(1967)
Baden-Württemberg
(2009)
Bavaria
(1998)
1 1953 East-Berlin, 1995 all of Berlin
2 1986 Münster administrative district, 2005 all of North Rhine-Westphalia
3 2003 Darmstadt administrative district, 2007 all of Hesse
tual reference registry. Following general international practice, a registry is regarded as complete
if at least 90% of all new cancer cases are registered. What counts here is the highest maximum
degree of completeness reached during the last
three years of observation, i.e. between 2004 and
2006 for the current analyses.
The degree of completeness of case reporting
to the cancer registries in Germany, as currently
estimated by the RKI, has further improved compared to the 6th edition of this booklet published
in 2008. More than half of the German cancer
registries examined can be regarded as complete
regarding all cancer sites combined for both
sexes; indeed, most of the other registries are
also close to reaching the desired level of 90%.
Only Saxony-Anhalt has figures below 80% for
all cancer sites combined (Figure 2.1.1). It should
also be mentioned that, according to provisional
estimates, the completeness of the cancer registry in North Rhine-Westphalia (NRW) for 2007
exceeded 90% not only in the administrative district of Münster, but also in the entire WestphaliaLippe region (the eastern part of NRW).
However, there are marked fluctuations in
the site-specific degrees of completeness within
the registries. Looking at the specific cancer sites
studied, breast cancer, cancer of the oral cavity
and pharynx, and cancer of the oesophagus are
the most completely covered by the registries.
The figures in Saxony-Anhalt are also above
90% in these cases. Despite the progress that
Cancer in Germany
has been made in cancer registration in Germany, there are still deficits in data acquisition
on some cancer sites. According to the RKI estimate, reporting is not yet sufficiently complete in
some cancer registries in the case of cancers of
the stomach, the colon and rectum, the ovaries,
the brain and the thyroid gland. As the degree of
completeness rises in the population-based cancer registries, the RKI‘s data pool that forms the
basis for the cancer-incidence figures published
in this booklet becomes larger. As a result, the
impact of regional peculiarities will decline and,
ultimately, the estimate for Germany as a whole
will become increasingly reliable.
2.2 E
stimate and results for Germany in
2006
Since the beginning of 2010, the German Centre for Cancer Registry Data at the RKI has been
continuing the many years of work done by the
Federal Cancer Surveillance Unit with a broader
remit. The Centre estimates the total number of
new cancer cases per year in Germany on the
basis of the data from the German populationbased cancer registries in which registration is
complete. The current estimate covers the entire
period from 1980 to 2006. Trends in morbidity
rates from 1980 form part of this estimate. They
are presented both for all cancer sites combined
and for selected individual cancer sites (broken
down by age and gender) in the corresponding
chapters.
In the case of all cancer sites combined and
some of the individual sites shown, the current estimate for the last year covered (2006) is
slightly lower than the figures for 2004 published
in the 6th issue of Cancer in Germany (426,800
compared to 436,500). However, this does not
mean that the number of cancer cases in Germany fell between 2004 and 2006; rather, it
reflects an improved estimate based on a broader
pool of data.
The estimate of the number of new cases of
cancer in Germany becomes more reliable as data
from more regional cancer registries are included
in the data pool. Since cancer registration in Germany is steadily improving, and more and more
registries are contributing sufficiently complete
data to the estimate, each new estimate is based
on a broader data pool than the one before. The
population-based cancer registries also contribute to this by conducting a subsequent ascertainment of cancer cases even for years in the more
distant past. The current estimates through 1990
are based almost exclusively on data from the
Saarland Population-based Cancer Registry.. For
the period after 1990, data from other populationbased cancer registries in Germany are also used
for estimating cancer incidence. The prerequisite for inclusion in the „data pool“ used for the
estimates is proof of at least 95% completeness
in the capture of cancer cases in three consecutive years.
In the last estimate for 2004, three cancer
registries contributed data to determine the total
number of men newly diagnosed with cancer. The
current estimate up to 2006, however, is based
on data from five cancer registries with a population four times as large. In the case of the total
number of women newly diagnosed with cancer,
two different registries contributed to the estimate in 2004; in the current estimate it was three
registries with a total population three times as
large. The results of the new RKI estimate for
the period from 1980 to 2006 can thus enable a
much more accurate and reliable description to
be made of the incidence of cancer in Germany.
For the years 2005 and 2006 this estimate is
on the one hand a continuation of the estimate
beyond 2004; on the other hand, it improves the
results of the old estimate for the preceding years.
The number of registries contributing to the
data pool for estimating the incidence of the different cancer sites varies considerably. Therefore,
the reliability of the results of the present estimate
of age-specific incidence is different for each of
the 21 selected cancer sites. The more years of
incidence data from the participating cancer registries are included in the estimate pool, the more
reliable the estimates become. For example, the
current estimates on cancer of the central nervous system, the stomach, the colon and rectum,
the cervix and the bladder in women are based on
data from no more than three cancer registries.
By contrast, nine to thirteen cancer registries contribute data to estimating the incidence of malignant melanoma of the skin, breast cancer, and
cancer of the larynx and oesophagus.
11
12
Cancer in Germany
Table 2.2.1
Estimated number of new cancer cases in Germany in 2006
Source: RKI estimate for Germany in 2006
Site
ICD-10
Men
Women
C00 – 14
7,930
2,930
Oesophagus
C15
4,100
1,090
Stomach
C16
10,620
7,230
C18 – 21
36,300
32,440
Pancreas
C25
6,380
6,980
Larynx
C32
3,430
460
C33, C34
32,500
14,600
Malignant melanoma of the skin
C43
7,360
Breast (female)
C50
Oral cavity and pharynx
Colon and rectum
Lung
Cervix
Uterus (corpus uteri)
8,470
57,970
C53
5,470
C54, C55
11,140
Ovaries
C56
Prostate
C61
Testis
9,670
60,120
C62
4,960
C64 – 66, C68
10,050
6,440
C67, D09.0, D41.4
19,360
8,090
C70 – 72
3,880
3,290
Thyroid gland
C73
1,620
3,660
Hodgkin's lymphoma
C81
1,130
890
C82 – 85
6,410
6,350
Kidney and efferent urinary tract
Bladder*
Nervous system
Non-Hodgkin lymphomas
Leukaemias
All malignant neoplasms, not incl. non-melanoma skin cancer
C91 – 95
5,080
4,220
C00­ – 97 except C44
229,200
197,600
* including malignant neoplasms in situ and neoplasms of uncertain behaviour
Figure 2.2.1
Selected tumour sites as a percentage of all new cancer cases excluding non-melanoma skin cancer in Germany in 2006
Source: estimate by Federal Cancer Surveillance Unit at the Robert Koch Institute
Men
Women
��,�
��,�
��,�
��,�
��,�
�,�
�,�
�,�
Stomach
�,�
�,�
Kidney and efferent urinary tract
�,�
�,�
Oral cavity and pharynx
�,�
�,�
Malignant melanoma of the skin
�,�
�,�
Non-Hodgkin lymphomas
�,�
�,�
Pancreas
Pancreas
�,�
�,�
Kidney and efferent urinary tract
Leukaemias
�,�
�,�
Non-Hodgkin lymphomas
Testis
�,�
�,�
Cervix
Prostate
Colon and rectum
Lung
Bladder*
Oesophagus �,�
Nervous system �,�
Larynx �,�
Thyroid gland
Breast (female)
Colon and rectum
Lung
Uterus (corpus uteri)
Ovaries
Malignant melanoma of the skin
Bladder*
Stomach
�,� Leukaemias
�,� Thyroid gland
�,� Nervous system
�,� Oral cavity and pharynx
Hodgkin's lymphoma
Oesophagus
Hodgkin's lymphoma
Larynx
30
25
20
15
10
5
0
0
5
* includes malignant neoplasms in situ and neoplasms of uncertain behaviour
10
15
20
25
30
Cancer in Germany
Table 2.2.2
Number of cancer-related deaths in Germany in 2006
Source: official cause-of-death statistics, Federal Statistical Office, Wiesbaden
Site
ICD-10
Men
Women
C00 – 14
3,623
1,111
Oesophagus
C15
3,642
1,074
Stomach
C16
5,986
4,937
C18 – 21
13,756
13,469
Pancreas
C25
6,729
7,213
Larynx
C32
1,351
226
C33, C34
28,898
11,873
Malignant melanoma of the skin
C43
1,266
Breast (female)
C50
17,286
C53
1,492
Oral cavity and pharynx
Colon and rectum
Lung
Cervix
Uterus (corpus uteri)
1,021
C54, C55
2,395
C56
5,636
Ovaries
Prostate
C61
Testis
C62
154
C64 – 66, C68
4,086
C67
3,549
1,893
C70 – 72
2,955
2,600
Thyroid gland
C73
258
502
Hodgkin's lymphoma
C81
180
162
C82 – 85
2,732
2,734
Kidney and efferent urinary tract
Bladder*
Nervous system
Non-Hodgkin lymphomas
Leukaemias
All malignant neoplasms, not incl. non-melanoma skin cancer
11,577
2,629
C91 – 95
3,720
3,387
C00 – 97 except C44
112,438
98,492
Figure 2.2.2
Selected tumour sites as a percentage of all cancer-related deaths in Germany in 2006
Source: official cause-of-death statistics, Federal Statistical Office, Wiesbaden
Men
Lung
Colon and rectum
Prostate
Women
��,�
��,�
��,�
��,�
��,�
��,�
�,�
�,�
Pancreas
Breast (female)
Colon and rectum
Lung
Pancreas
�,�
�,�
Ovaries
Kidney and efferent urinary tract
�,�
�,�
Stomach
Stomach
Leukaemias
�,�
�,�
Oesophagus
�,�
�,�
Non-Hodgkin lymphomas
Oral cavity and pharynx
�,�
�,�
Kidney and efferent urinary tract
Bladder
�,�
�,�
Nervous system
Nervous system
�,�
�,�
Uterus (corpus uteri)
Non-Hodgkin lymphomas
�,�
�,� Bladder
�,� Cervix
Larynx
Malignant melanoma of the skin
Leukaemias
Oral cavity and pharynx
Thyroid gland
Oesophagus
Hodgkin's lymphoma
Malignant melanoma of the skin
Testis
Thyroid gland
Larynx
Hodgkin's lymphoma
30
25
20
15
10
5
0
0
5
10
15
20
25
30
13
14
Cancer in Germany
Since the incidence of cancer is determined
from the age- and gender-specific ratio of incidence to mortality, the size of this ratio is also connected with the reliability of the estimate results.
For example, the tables on incidence and mortality in 2006 show that 30 times more men were
diagnosed with testicular cancer in Germany in
2006 than died of this condition in the same year.
The number of annual deaths caused by testicular
cancer was less than three in some of the smaller
federal states. The gratifying fact that very few
men die of testicular cancer leads to less reliable incidence estimates. The incidence figures on
Hodgkin lymphoma, malignant melanoma of the
skin and thyroid cancer are affected in a similar
way, but to a much lesser extent. Six to eight times
more of these cancers are diagnosed every year
than people die of them in the same year. However, the information gain from the RKI estimate,
compared to simple mortality statistics alone, is
particularly large if incidence and mortality vary
in size and furthermore develop in different directions – as in the examples mentioned.
As in 2004, prostate cancer was again the
most common cancer in men in 2006, accounting for 26% of all diagnoses and 10% of cancerrelated deaths. However, lung cancer was still by
far the most common cause of death due to cancer, accounting for almost 26%. In women, breast
cancer accounted for 29% of all new cancer cases
and caused nearly 18% of all cancer-related deaths.
Figure 2.2.1 shows various forms of cancer as
a percentage of all new cancer cases among men
and women; Figure 2.2.2 shows a corresponding
evaluation of cancer-related deaths. If we ignore
non-invasive neoplasms of the bladder, which are
included under bladder cancer, the individual cancer sites shown represent between 91% and 93%
of all cancers that occurred, but caused only 83%
to 84% of all cancer deaths. Most of the cancers
that have not been mentioned separately in the
estimate up to now (such as malignant tumours of
the liver, bone or soft tissues) are therefore associated with considerably poorer survival prospects
than those shown.
For the first time, the current estimate of
nationwide cancer incidence makes a projection
of the number of new cases in the year of the
report‘s publication – based on the last estimated
number of new cases for 2006. In this forecast,
higher incidence figures compared to 2006 are
thus exclusively a result of demographic changes
over the last four years. For example, according to
the latest forecasts of the Federal Statistical Office,
the number of 70-year-olds in Germany has risen
by 21% among men and 10% among women during this period. This leads to an estimate that
approximately 450,000 new cases of cancer can
be expected in Germany in 2010: 246,000 in men
and 204,000 in women. We can therefore expect
an increase in the number of cases between 2006
and 2010 of 17,000 among men and 6,000 among
women solely as a result of the demographic
development.
The projection of rates from 2006 to 2010 suggests that there will be 59,500 new cases of breast
cancer among women in Germany. However, it
should be taken into account that cancer registries in Germany are increasingly including early
stages of breast-cancer development, so-called in
situ carcinomas. Around 2005 these accounted
for about 10% of all malignant neoplasms of the
breast reported by the registries; however, they do
not form part of the present estimate, which only
included invasive cases. The number of new cases
of breast cancer will be considerably influenced in
the coming years by the now-established nationwide mammography screening programme. The
aim of the programme is to detect cases of breast
cancer at early – or at least less advanced – stages,
in order to reduce the mortality rate from breast
cancer by starting therapy earlier. In this context,
some of the malignant neoplasms detected early
will be classified under early stages, i.e. in situ
carcinomas, while others are likely, at least temporarily, to lead to higher numbers of invasive breast
cancer cases.
In the present report, malignant neoplasms
of the central nervous system – mainly brain
tumours – have been added to the twenty cancers
covered individually in the previous RKI estimate.
According to the 2010 projection, 7,500 newly
diagnosed malignant neoplasms of the nervous
system can be expected in Germany. Estimating
the total annual number of new cases of malignant neoplasms of the central nervous system in
Germany has been causing difficulties for a long
time. Too frequently, the statistics on the cause of
death referred to brain tumours, which account
for about 90% of these neoplasms, as neoplasms
Cancer in Germany
of uncertain behaviour or of unknown character,
instead of as benign or malignant neoplasms. The
percentage of cases and especially deaths reported
as such unspecified neoplasms of the nervous
system has recently fallen to about 10%. An estimate of the number of malignant neoplasms of
the nervous system now seems reasonable, therefore. However, the present estimate of malignant
neoplasms of the central nervous system is still
exclusively based on data from the Saarland Cancer Registry, which up to now has been the most
complete in its coverage of this cancer site.
2.3 Indicators and presentation
This section explains frequently used terms and
provides further methodological information.
Age-specific rate
The age-specific rate is determined by dividing the
number of cancer cases and/or deaths in a certain
age group by the corresponding number of men
or women in this age group in the population.
The age-specific incidence and mortality rates are
usually given as annual rates per 100,000 resident
members of the respective age group.
Age-standardized rate
Descriptive epidemiology compares the frequency
(incidence or mortality) of cancer at a certain site
either in different populations or within the same
region during different time periods. As shown
by the information provided in this booklet on
the age-specific incidence of cancer in men and
women, the incidence rate usually increases considerably with age. If, therefore, incidence or mortality is to be compared in different states and
regions, or within the same population at different
times, the possibility that these differences might
be caused exclusively by different age structures
of the populations being compared must first be
excluded by means of age standardization. As a
rule, age standardization is carried out by weighting the age-specific rates and subsequently adding
them together. Since the sum of the weights used
is one, the age-standardized rate can be regarded
as a weighted average of age-specific rates. It indicates how frequently a disease is contracted, or
causes death, in a total of 100,000 members of
a defined age structure. The European Standard (old European standard population) and the
World Standard (devised by Segi) are commonly
used as standard populations in cancer epidemiology; both have been used in this booklet. As a
rule, the rates based on the European Standard
are higher, because the corresponding standard
population includes a higher percentage of older
people than the World Standard. The European
standard was used to show trends over time in
Germany and for international comparisons.
DCO percentage
Cancer cases which are not reported to a population-based cancer registry during a person‘s lifetime and only find their way into statistics via a
death certificate are referred to as DCO (death
certificate only) cases and are added to the cancer
figures of the respective year of death. The DCO
percentage is a useful completeness indicator for
established cancer registries. However, in recently
established cancer registries the degree of completeness of data as calculated using the DCO percentage is understated. The DCO percentage can
be expected to be higher in ‚young‘ cancer registries, since it is possible that some of the people
who have died of cancer were diagnosed before
the registry was established, so that they could
not be registered. The German Centre for Cancer
Registry Data (formerly the Federal Cancer Surveillance Unit), therefore, also assesses the completeness of cancer reporting using a disease‘s
incidence/mortality ratio (see section 2.1).
Incidence rates and mortality rates
Age- and gender-specific incidence and mortality
rates can also be interpreted as measures of the
risk of developing (and/or dying of) cancer or a
particular malignant tumour within a year. To illustrate this form of risk communication more clearly,
we calculated the risk of 40-, 50-, 60- and 70-yearold women and men developing for the first time
(and/or dying of) a specific tumour over the next
10 years – as well as over the course of the expected
remaining lifetime. The information is given both
as the usual percentage and in natural variables,
i.e. in the form of one per N persons of the same
age and sex. So-called „competing risks“ were also
incorporated, i.e. the fact that, for example, there is
a certain probability that a 70-year-old man might
15
16
Cancer in Germany
die of some other disease within the next 10 years
was taken into consideration. The „lifetime risk“
– the risk of developing a tumour during one‘s
lifetime – was also calculated in a similar way.
However, only the respectively current rates (of
incidence, mortality and general life expectancy)
are included in the calculations. Thus no prediction was made regarding the future development
of these values. Furthermore, these risks reflect
population-level expectations (by age and gender);
individual risks can differ considerably due to the
presence or absence of various risk factors. ‚Devcan‘ – software developed by the US National Cancer Institute – was used for the calculations.
Graphical presentation
The age-specific incidence rates show the relation
between age and cancer risk. They make it possible to compare cancer incidence in the two sexes
and the development of the age-specific incidence
rates since 1980 and/or 1990.
The trend in age-standardized cancer mortality rates during the period from 1980 to 2006 is
based on data from the Federal Statistical Office‘s
official cause-of-death statistics, which were calculated retrospectively for a united Germany as
far back as 1980. The incidence figures for Germany estimated by the RKI are presented as agestandardized rates for the same period.
The currently (2005/2006) measured agestandardized incidence rates in 13 German states
and one administrative district (Münster, NRW)
are shown in comparison to the RKI estimate for
Germany (2005/2006). The only states where
population-based data on cancer cases are still
not available are Baden-Württemberg and Hesse,
whose cancer registries are under development
(see section 1.3).
The completeness of tumour registration by
the population-based cancer registries is shown
by different colours in the charts and figures. Registration of at least 90% of cancer cases between
2005 and 2006 is indicated by a darker colour on
the incidence bars. The incidence bar is lighter in
colour where the completeness of registration is
below 90%. The DCO proportion of age-standardized incidence is also a good indicator of completeness. In the charts, the DCO proportion is
shown at the end of each bar in a lighter colour
and can be distinguished in this way from the
incident cancer cases reported during the respective patient’s lifetime.
ICD
The ICD (International Classification of Diseases), which is occasionally revised, is used for
coding diseases and causes of death. The 9th and
10th revisions of the ICD were used in the period
from 1980 to 2004. Whereas recently established
cancer registries in Germany were able to use the
10th revision for coding cancer sites from the outset, there was some delay in implementing it in
the German cause-of-death statistics. For most of
the cancer sites dealt with here, the continuity of
mortality trends was hardly affected by the introduction (in 1998) of the 10th revision of the ICD
for coding the German cause-of-death statistics.
Compared to coding according to the 9th revision (ICD-9: 140–208), ICD-10 led to 0.1%-0.3%
higher death figures for all cancer sites (ICD-10:
C00–C97) and up to 2% lower death figures for
ovarian cancer and non-Hodgkin lymphomas.
Otherwise, the deviations were minimal. The
10th revision of the ICD was used in the present
booklet to designate cancer sites.
International comparison
To be able to internationally classify the level of
estimated cancer incidence and cancer mortality
in Germany, current age-standardized incidence
and mortality rates (European standard) from
the countries bordering on Germany, as well
as from the UK, the USA, Australia and Hong
Kong, were taken from the websites of the corresponding cancer registries or national umbrella
organizations, or else received from those institutions (see source references in the appendix). The
statistics available as of the end of January 2010
largely referred to 2006; otherwise, the comparison included the most recent results (2005 for
France and Australia, 2003 to 2006 for Switzerland, 2004 for mortality in Belgium). In the case
of some cancers (e.g. bladder cancer, kidney cancer) some countries group the diagnoses according to ICD-10 differently from the RKI, which
limits comparability in individual cases (see the
corresponding notes).
The results were used without verifying their
completeness or plausibility. The possibility cannot, therefore, be excluded that incidence in indi-
Cancer in Germany
vidual countries is underestimated (by underreporting new cases). As a rule, a marked deviation
in the incidence/mortality ratio from that of the
countries bordering on Germany can be regarded
as an indication of underestimation; similarly, an
incidence rate that is below the mortality rate for
certain types of cancer suggests underreporting.
Mortality
Cancer mortality is based on the number of
cancer-related deaths in a year according to the
official cause-of-death statistics. The deaths are
assigned to the underlying cause of death according to age and gender. The mortality rate is the
annual number of deaths relative to the size of
the population. The rates are usually expressed
per 100,000 people. This booklet reports both
the absolute number of deaths in 2006 and the
age-standardized mortality rates (European and
World Standards).
Relative survival rates
Population-based relative survival rates are calculated to assess survival after a cancer is diagnosed.
To do this, the patients‘ observed survival is related
to the life expectancy of the general population.
A relative survival rate of 100% means that the
mortality of the cancer patients is just as high as
that of the general population of the same age and
the same sex. Relative survival is therefore an estimator of cancer-specific survival irrespective of
whether the actual cause of death is known.
The German Cancer Research Centre (DKFZ)
and GEKID are currently working on a project
funded by German Cancer Aid to estimate the
current survival rates of cancer patients in Germany. Another GEKID project funded by the
Federal Ministry of Health is examining the data
quality of the German cancer registries in this
respect.
The relative 5-year survival rates from the
current annual reports of the cancer registries
in Bremen, Hamburg, NRW (for the administrative district of Münster), the Saarland and
the Joint Cancer Registry or GKR (with pooled
results from Brandenburg, Mecklenburg-Western Pomerania and Saxony) available at the beginning of 2010 were used for this booklet. No population-based survival rates from the other federal
states had been published at that time. Although
the above-mentioned registries used the same
inclusion factors for their calculations (age > 15
years, exclusion of DCO cases), their methodological approaches and reference years differed
slightly (the GKR used a cohort analysis from
1999 to 2001, the other registries a period analysis from 2002 to 2004 and from 2004 to 2006).
The results are therefore not directly comparable, so that this booklet only reports value ranges
quoting the lowest and highest published values
respectively (usually by gender).
The survival prospects of cancer patients are
influenced not only by the cancer site, but also
by the stage of the disease when diagnosed, the
patient‘s age and a number of other factors.
An individual prognosis cannot, therefore, be
deduced from the data presented here. It can only
serve as an orientation for patients, family members and the interested public.
Crude rates
A crude rate (of incidence or mortality) for a certain cancer site and population is calculated by
dividing the number of new cancer cases in a
given period (incidence), or the total number of
deaths caused by a cancer (mortality), by the total
number of people in the respective population (in
this case the resident population of Germany).
The result is usually given as a rate per 100,000
residents per year. Unlike the age-standardized
rate, it is highly dependent on the population‘s
age structure, particularly in the case of cancers.
5-year prevalence
The 5-year prevalence refers to the number of
people living at a given time (in this case on 31
December 2006) who have been newly diagnosed with cancer within the previous five years,
i.e. from 2002 through 2006.
The prevalences of all the individual sites discussed here (except for CNS tumours) were calculated for a separate RKI publication for the period
1990 to 2004 (using the Pisani method) from
the estimated incidence rates for Germany and
the survival rates observed in the Saarland since
1980.
The figures for 2006 reported here were
extrapolated from the population development
in 2005/2006, assuming unchanged incidence
and survival rates since 2004.
17
18
Cancer in Germany
All cancer sites | Cancer in Germany
3 Results according to ICD-10
3.1 All cancer sites
Occurrence
Incidence in 2006
Projection for 2010
Risk factors and screening
Men
Women
229,200
197,600
246,200
204,000
Crude incidence rate*
568.6
469.9
Standardized incidence rate (Europe)*
432.9
318.3
Standardized incidence rate (World)*
300.6
230.7
112,438
98,492
Standardized mortality rate (Europe)*
210.3
131.6
Standardized mortality rate (World)*
136.9
87.4
Deaths 2006
* per 100,000
The category ‚all cancer sites‘ is defined as all
malignant neoplasms, including lymphomas
and leukaemias. In line with international practice, non-melanoma skin cancer is not included.
The median age at diagnosis is 68 years among
women and 69 years among men. The median
age of death as a result of cancer is 76 years
among women and 72 years among men. The risk
of a woman developing cancer in the course of her
life is 38%, compared to 47% among men.
The Robert Koch Institute‘s current estimate
indicates a total of 426,800 new cases of cancer in Germany in 2006. This figure is slightly
lower than the estimate for 2004 (approximately
436,500) published in the 6th edition of this
booklet (2008). This change is not due to a decrease in the number of new cancer cases in Germany, but rather to the fact that far more registries
(with a reference population that is three to four
times larger) have contributed their data to the
current estimate. The current RKI estimate therefore describes the cancer situation in Germany
much more reliably than previous estimates (see
also section 2.2). As in the previous estimates, the
most common form of the disease among women
was breast cancer with approx. 58,000 new cases
in 2006 (2004: approx. 57,000) Prostate cancer
remained the most common cancer among men
with approx. 60,100 diagnoses (2004: approx.
58,100).
The aetiology has not been conclusively established for all known cancers. Present knowledge
therefore only provides a sufficiently reliable
basis for prevention in a few of the more common
types of tumour. The specific cause of a tumour
can only rarely be unequivocally clarified in an
individual case.
Tobacco consumption, especially cigarette
smoking, is by far the most significant of the avoidable cancer risk factors, causing between a quarter and a third of all cancer-related deaths. A less
precisely quantifiable proportion of deaths can
probably be attributed to obesity and lack of exercise. Other nutrition-related factors include too
little fruit and vegetables in the diet and regular
alcohol consumption; these seem to play a much
more important role today than, say, harmful substances or contaminants in food.
Chronic infections – e.g. with human papilloma virus (HPV) or Helicobacter pylori – are
regarded as major risk factors for, respectively,
cervical and stomach cancer, so that great hopes
are being placed in preventive vaccinations and
antibiotic therapy. The overall risk posed by natural or anthropogenic environmental influences
– such as solar radiation, indoor pollution from
radon or tobacco smoke – and by harmful ambient substances at the workplace is often overestimated. In individual cases, however, they can
exert a major influence on the development of
cancers. The same applies to iatrogenic (medically caused) risk factors. They include diagnostic-imaging procedures that involve exposure
to radiation, many cancer-treatment methods
themselves, and hormone-replacement therapy
for menopausal women, which was only recently
identified as a definite risk factor. The risk factors
that are relevant for specific cancers are described
in detail in the individual chapters.
Early-detection or screening programmes
have been developed and introduced to prevent
the formation of invasive malignant neoplasms,
or to prevent death from certain cancers. The aim
is to detect tumour precursors and/or developing
19
20
Cancer in Germany | All cancer sites
stages of cancers early enough for them to be successfully treated. The screening programme provided by statutory health insurance in Germany
targets cancers of the skin, colon, uterus and
breast among women and the prostate among
men. These screening measures are described in
the individual chapters.
Incidence and mortality trends
According to the current RKI estimate, the
annual number of new cancer cases in Germany
has risen by 35% among women and more than
80% among men since 1980; the age-standardized incidence rates have gone up 15% and
23% respectively. One cause can be found in the
change in the population‘s age structure, especially among men (demographic change). Only
the incidence rates of men between the ages of
55 and 80 years and women aged 45 to 70 years
have increased since 1990, while the incidence
rates among younger and older age groups have
fallen. The increase among men is probably
largely due to the fact that prostate-cancer cases
are being diagnosed in higher numbers and at
younger ages (with the increased use of PSA
blood tests as a preliminary screening examination). In 1980, prostate cancer only accounted for
16% of all cancer cases; in 2006, it accounted for
26%. Breast cancer as a proportion of all cancers among women rose less markedly from 24%
to 29%. In contrast to the incidence rates, agestandardized cancer mortality rates fell by more
than 20% among women and men alike.
Survival and prevalence
The relative 5-year cancer survival rates vary
greatly – from very favourable rates of 90% for
lip cancer, malignant melanoma of the skin and
testicular cancer (and, meanwhile, prostate cancer), to unfavourable rates of under 20% for lung
and oesophageal cancer and below 10% for pancreatic cancer. The overall survival rates of cancer
patients in Germany have improved considerably
compared to the corresponding rates in the 1980s
of between 50% and 53% for women and 38% to
40% for men in Saarland (a cancer registry with
many years of good coverage). The most recent
relative 5-year survival rates published by the
state epidemiological cancer registries were 61%
to 62% for women and 54% to 57% for men. By
comparison, data from Finland points to survival
rates of 67% for women and 61% for men. Shifts
in the spectrum of sites – e.g. fewer cases of stomach cancer (which has a poor survival rate) and
more cases of colorectal cancer and breast cancer
among women and prostate cancer among men
(with better survival rates) – have also contributed
to the improved cancer-survival rates.
Out of a population of about 82 million people
in Germany in 2006, a total of nearly 1.4 million
cancer patients were living who had been diagnosed no more than five years previously (5-year
prevalence); they included 700,000 women and
680,000 men. 2.1 million people (of whom 1.1
million were women) had been diagnosed up
to 10 years beforehand. Compared to 1990, this
represents an increase of approximately 90%
among men and almost 40% among women.
Contributory factors here included higher incidence rates (of some cancers), improved survival
prospects (for most types of cancer) and, especially among men, demographic changes.
ICD-10 C00 – 97 except C44 | Cancer in Germany
Figure 3.1.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C00 – 97 except C44
per 100,000
3,500
Men
3,000
2,500
2,000
1,500
1,000
500
0–14
1980
15–34
1990
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
3,500
Women
3,000
2,500
2,000
1,500
1,000
500
0–14
1980
15–34
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
21
22
Cancer in Germany | All cancer sites
Figure 3.1.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C00 – 97 except C44
Incidence per 100,000 (European Standard)
500
450
400
350
300
250
200
150
100
50
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.1.1
Cancer incidence and mortality risks for all cancer sites (ICD-10 C00 – 97 except C44) in Germany, by age and gender
Data basis 2006
Risk of developing the disease
Men
aged
40
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
1.8%
(1 in 57)
47.5%
(1 in 2)
0.7%
(1 in 150)
26.2%
(1 in 4)
50
6.1%
(1 in 16)
47.5%
(1 in 2)
2.5%
(1 in 40)
26.2%
(1 in 4)
60
15.5%
(1 in 6)
46.2%
(1 in 2)
5.9%
(1 in 17)
25.5%
(1 in 4)
70
25.0%
(1 in 4)
40.4%
(1 in 2)
11.0%
(1 in 9)
23.0%
(1 in 4)
47.3%
(1 in 2)
25.8%
(1 in 4)
Lifetime risk
Risk of developing the disease
Women
aged
40
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
2.9%
(1 in 34)
37.3%
(1 in 3)
0.7%
(1 in 150)
20.3%
(1 in 5)
50
6.1%
(1 in 16)
35.7%
(1 in 3)
1.8%
(1 in 54)
19.9%
(1 in 5)
60
10.0%
(1 in 10)
32.1%
(1 in 3)
3.7%
(1 in 27)
18.7%
(1 in 5)
70
13.5%
(1 in 7)
25.6%
(1 in 4)
6.6%
(1 in 15)
16.3%
(1 in 6)
38.2%
(1 in 3)
20.3%
(1 in 5)
Lifetime risk
ICD-10 C00 – 97 except C44 | Cancer in Germany
Figure 3.1.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C00 – 97 except C44
New cases per 100,000 (European Standard)
Women
Men
Schleswig-Holstein
Meckl.-Western Pom.
Lower Saxony
Brandenburg
Lower Saxony
Bremen
Schleswig-Holstein
Saarland
NRW (Münster dist.)
Saarland
Bavaria
Bremen
Hamburg
NRW (Münster dist.)
Bavaria
Rhineland-Palatinate
Saxony
Germany, estimated
Germany, estimated
Berlin
Meckl.-Western Pom.
Hamburg
Brandenburg
Saxony-Anhalt
Saxony
Rhineland-Palatinate
Thuringia
Thuringia
Saxony-Anhalt
Berlin
600
500
400
300
at least 90% registration:
200
100
cases
0
0
100
200
less than 90% registration rate:
300
400
cases
500
600
DCO cases
Figure 3.1.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C00 – 97 except C44
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100.000 (European Standard), *incl. some other tumours, e.g. benign neoplasms of the brain
Data sources, see appendix, page 117
Men
Women
Denmark*
Australia
USA
France
Belgium
Norway*
Czech Republic
Australia
Netherlands
USA
Belgium
Denmark*
England
Norway*
Czech Republic
Switzerland
France
Netherlands
Germany
Sweden*
Austria
Finland*
Finland*
Switzerland
Sweden*
Germany
Austria
England
Incidence
Mortality
600
Hong Kong
Hong Kong
500
400
Incidence
Mortality
Poland
Poland
300
200
100
0
0
100
200
300
400
500
600
23
24
Cancer in Germany | Oral cavity and pharynx
3.2 Oral cavity and pharynx
the pharynx, although their influence cannot be
precisely quantified at present.
Occurrence
Men
Women
7,930
2,930
Projection for 2010
8,360
3,040
Crude incidence rate*
19.7
7.0
Standardized incidence rate (Europe)*
16.4
5.2
Standardized incidence rate (World)*
12.0
3.8
Incidence in 2006
Deaths 2006
3,623
1,111
Standardized mortality rate (Europe)*
7.4
1.7
Standardized mortality rate (World)*
5.2
1.2
* per 100,000
Cancers of the oral cavity and the pharynx include
malignant neoplasms that differ in terms of site,
histology and prognosis. Men develop cancer
of the lip, the tongue, the floor and roof of the
mouth, the salivary glands and the pharynx more
frequently than women. This category represents
the seventh most common cancer among men
(3.5%); among women (1.5%), it is 16th. On average, women develop cancer of the oral cavity and
the pharynx at the age of about 64 years; among
men, the onset age tends to be earlier at around
60 years. The risk of developing this cancer over
the next ten years is highest among men and
women aged between 50 and 70 years; the lifetime risk is 0.6% for women and 1.4% for men.
Risk factors
The main triggers for cancers of the oral cavity
and the pharynx are tobacco and alcohol consumption, especially in combination. Not eating enough fruit and vegetables, insufficient oral
hygiene, and mechanical irritation (e.g. from illfitting dentures) are regarded as further risk factors for malignant neoplasms of the oral cavity
and the pharynx. Exposure to the sun contributes to the development of carcinomas of the lip.
Contact with wood dust and certain chemicals
(usually in an occupational context) can aggravate the risk of tumours, particularly those of
the nasopharynx. There is also discussion on the
involvement of viruses (especially the human
papilloma virus and the Epstein-Barr virus) in
the development of cancer of the oral cavity and
Incidence and mortality trends
Incidence and mortality among women with cancer of the oral cavity and the pharynx rose markedly up to the late 1990s and have remained
almost unchanged since then. among men, the
upward trend in incidence and mortality rates
continued until the early 1990s; since then, incidence rates in western Germany have fallen by
25%, while both mortality and incidence rates
among men in the east of the country have risen.
The decline in mortality and incidence rates
among men in western Germany since 1990
affected the same age groups (35- to 69-yearolds) as the increase prior to 1990. The increase
in mortality and incidence rates among men in
eastern Germany after 1990 particularly affected
40- to 64-year-old age group.
Survival and prevalence
The relative 5-year survival rates for people with
cancer of the oral cavity and the pharynx are 36%
to 45% for men and 50% to 63% for women. It
is possible that differences in the composition
of this group of cancers contribute to the more
favourable rates among women. The most favourable 5-year survival rates are associated with lip
cancer, followed by cancer of the salivary glands.
Cancers of the floor of the mouth, the tongue and
the pharynx have less favourable survival prospects. In 2006, 10,000 women and 25,000 men
living in Germany had been diagnosed with a
cancer of the oral cavity or the pharynx within
the previous five years (5-year prevalence).
ICD-10 C00 – 14 | Cancer in Germany
Figure 3.2.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C00 – 14
per 100,000
70
Men
60
50
40
30
20
10
15–34
1980
1990
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
70
Women
60
50
40
30
20
10
15–34
1980
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
25
Cancer in Germany 26
| Oral cavity and pharynx
Figure 3.2.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C00 – 14
Incidence per 100,000 (European Standard)
��
��
��
��
��
��
��
�
�
�
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.2.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C00 – 14
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
40
0.2%
(1 in 540)
1.4%
50
0.5%
(1 in 220)
60
0.5%
(1 in 210)
70
0.3%
(1 in 300)
Lifetime risk
ever
(1 in 69)
0.1%
(1 in 1,700)
0.7%
(1 in 140)
1.3%
(1 in 77)
0.2%
(1 in 520)
0.7%
(1 in 150)
0.9%
(1 in 110)
0.2%
(1 in 420)
0.5%
(1 in 200)
0.5%
(1 in 210)
0.2%
(1 in 520)
0.3%
(1 in 320)
1.4%
(1 in 69)
0.7%
(1 in 140)
Risk of developing the disease
Women
aged
Risk of dying of the disease
in the next 10 years
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.1%
(1 in 1,800)
0.5%
(1 in 190)
<0.1%
(1 in 7,500)
0.2%
(1 in 450)
50
0.1%
(1 in 720)
0.5%
(1 in 200)
<0.1%
(1 in 2,700)
0.2%
(1 in 470)
60
0.1%
(1 in 670)
0.4%
(1 in 270)
0.1%
(1 in 1,900)
0.2%
(1 in 550)
70
0.1%
(1 in 800)
0.2%
(1 in 420)
0.1%
(1 in 1,800)
0.1%
(1 in 710)
0.6%
(1 in 180)
0.2%
(1 in 450)
Lifetime risk
ICD-10 C00 – 14 | Cancer in Germany
Figure 3.2.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C00 – 14
New cases per 100,000 (European Standard)
Men
Women
Hamburg
.-Western Pom.
Bremen
Saarland
Berlin
Bremen
NRW (Münster dist.)
Hamburg
Saarland
Brandenburg
Schleswig-Holstein
Berlin
Lower Saxony
Saxony
Bavaria
Germany, estimated
Schleswig-Holstein
Rhineland-Palatinate
Meckl.-Western Pom.
Saxony-Anhalt
Bavaria
Thuringia
Saxony
NRW (Münster dist.)
Germany, estimated
Saxony-Anhalt
Brandenburg
Lower Saxony
Thuringia
Rhineland-Palatinate
30
25
20
15
10
at least 90% registration:
cases
5
0
0
5
10
less than 90% registration rate:
15
20
cases
25
30
DCO cases
Figure 3.2.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C00 – 14
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Men
Women
Hong Kong
France
Denmark
Hong Kong
Netherlands
Belgium
France
Australia
Australia
Switzerland
Norway
Denmark
Switzerland
Austria
Belgium
Czech Republic
USA
Germany
USA
Finland
Poland
Germany
England
Netherlands
Sweden
England
Czech Republic
Norway
30
Austria
Finland
Incidence
Mortality
25
20
15
10
Incidence
Mortality
Poland
Sweden
5
0
0
5
10
15
20
25
30
27
28
Cancer in Germany | Oesophagus
3.3 Oesophagus
Occurrence
Incidence and mortality trends
Men
Women
4,100
1,090
Projection for 2010
4,340
1,140
Crude incidence rate*
10.2
2.6
8.0
1.7
Incidence in 2006
Standardized incidence rate (Europe)*
Standardized incidence rate (World)*
5.7
1.2
3,642
1,074
Standardized mortality rate (Europe)*
7.0
1.5
Standardized mortality rate (World)*
4.8
1.0
Deaths 2006
* per 100,000
About 4,100 men and 1,090 women are diagnosed
with oesophageal cancer each year in Germany.
This corresponds to 1.8% of all malignant neoplasms among men and 0.6% among women.
Oesophageal cancer is responsible for a higher
percentage of cancer-related deaths (3.1% among
men, 1.1% among women) than diagnoses. Men
in Germany currently develop oesophageal cancer about three times more frequently, and on
average 4 years earlier (at 66 years), than women.
Squamous cell carcinomas account for 50% to
60% of oesophageal cancer cases. Adenocarcinomas, which occur mainly in the lower third of
the oesophagus, have considerably increased in
number; they now make up 40% to 50% of cases.
Risk factors
Alcohol and tobacco consumption are among the
most important risk factors in the development
of squamous cell carcinomas in the oesophagus,
and a combination of both factors further aggravates the effect. Adenocarcinomas tend to develop
from a gastroesophageal reflux disease. Barrett’s
oesophagus and Barrett’s ulcer, a lesion of the
mucous membrane caused by frequent reflux
with heartburn (due to the backing up of stomach contents into the oesophagus), are regarded
as cancer precursors. Diet-related risk factors and
overweight, therefore, also play a role, at least
indirectly. Familial clustering of cases has been
observed.
The age-standardized incidence rates and mortality rates are almost identical due to the unfavourable prognosis for oesophageal cancer. among
men, both incidence and mortality rates rose
slightly up to the mid-1990s, primarily in the 55to 69-year-old age group; both rates have tended
to fall slightly since then. Among women, both
incidence and mortality rates have risen since the
early 1980s. The increase in incidence rates has
particularly affected 50- to 64-year-old women.
Survival and prevalence
The survival rates of patients with an oesophageal carcinoma are among the most unfavourable
of all cancers. The relative 5-year survival rates
in Germany are between 11% and 22% for men
and 15% to 20% for women. The prospects of
survival with oesophageal cancer have improved
overall in recent years, especially for men: in the
early 1980s these rates were still under 10%. At
the end of 2006, about 6,000 men and 1,400
women living in Germany had been diagnosed
with oesophageal cancer within the previous five
years (5-year prevalence).
ICD-10 C15 | Cancer in Germany
Figure 3.3.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C15
per 100,000
40
Men
35
30
25
20
15
10
5
15–34
1980
1990
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
40
Women
35
30
25
20
15
10
5
40–44
1980
1990
2006
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
29
Cancer in Germany 30
| Oesophagus
Figure 3.3.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C15
Incidence per 100,000 (European Standard)
��
�
�
�
�
�
�
�
�
�
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.3.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C15
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
<0.1%
(1 in 2,100)
0.8%
(1 in 130)
<0.1%
(1 in 2,800)
0.8%
(1 in 130)
50
0.2%
(1 in 570)
0.8%
(1 in 130)
0.1%
(1 in 750)
0.7%
(1 in 140)
60
0.3%
(1 in 330)
0.6%
(1 in 160)
0.2%
(1 in 410)
0.6%
(1 in 160)
70
0.3%
(1 in 360)
0.4%
(1 in 260)
0.3%
(1 in 360)
0.5%
(1 in 210)
0.8%
(1 in 130)
0.7%
(1 in 140)
Lifetime risk
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
<0.1%
(1 in 11,000)
0.2%
(1 in 460)
<0.1%
(1 in 15,000)
0.2%
(1 in 450)
50
<0.1%
(1 in 2,700)
0.2%
(1 in 480)
<0.1%
(1 in 3,800)
0.2%
(1 in 460)
60
0.1%
(1 in 1,700)
0.2%
(1 in 560)
<0.1%
(1 in 2,100)
0.2%
(1 in 510)
70
0.1%
(1 in 1,500)
0.1%
(1 in 770)
0.1%
(1 in 1,500)
0.2%
(1 in 620)
0.2%
(1 in 470)
0.2%
(1 in 460)
Lifetime risk
ICD-10 C15 | Cancer in Germany
Figure 3.3.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C15
New cases per 100,000 (European Standard)
Men
Women
Meckl.-Western Pom.
Bremen
Bremen
Hamburg
Hamburg
Berlin
Brandenburg
Schleswig-Holstein
Lower Saxony
NRW (Münster dist.)
NRW (Münster dist.)
Lower Saxony
Berlin
Saarland
Schleswig-Holstein
Brandenburg
Saxony-Anhalt
Germany, estimated
Bavaria
Meckl.-Western Pom.
Saxony
Rhineland-Palatinate
Saarland
Bavaria
Germany, estimated
Saxony-Anhalt
Thuringia
Saxony
Rhineland-Palatinate
12
10
Thuringia
8
6
4
at least 90% registration:
2
cases
0
0
2
4
less than 90% registration rate:
6
8
cases
10
12
DCO cases
Figure 3.3.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C00 – 15
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Men
Women
England
England
Netherlands
Netherlands
Denmark
Belgium
Belgium
France
Australia
Hong Kong
Switzerland
Hong Kong
Denmark
Switzerland
France
Germany
USA
Czech Republic
Finland
Australia
USA
Germany
Austria
Austria
Sweden
Norway
Norway
Poland
Incidence
Mortality
18
15
12
9
Finland
Czech Republic
Sweden
Poland
6
3
0
0
3
6
Incidence
Mortality
9
12
15
18
31
32
Cancer in Germany | Stomach
3.4 Stomach
Occurrence
Men
Women
10,620
7,230
11,640
7,590
Crude incidence rate*
26.3
17.2
Standardized incidence rate (Europe)*
19.9
9.7
Standardized incidence rate (World)*
13.2
6.4
Incidence in 2006
Projection for 2010
Deaths 2006
5,986
4,937
Standardized mortality rate (Europe)*
11.2
6.0
Standardized mortality rate (World)*
7.2
3.9
* per 100,000
Histologically, adenocarcinomas are the most
common carcinomas in the stomach. The less
common (mucosa-associated) MALT lymphomas, which originate in the stomach lining,
are a special case; they are usually classified
as low-grade malignant non-Hodgkin lymphomas. Stomach cancer is the eighth most common cancer among women and the fifth among
men. It accounts for 4% to 5% of all cancer cases
in Germany and causes 5% of all cancer-related
deaths. The median age at which stomach cancer is diagnosed is 71 years among men and 75
years among women. The highest risk of developing stomach cancer in the next ten years is found
among 70-year-old women (0.5%) and men (1%).
Currently, one in 68 women and one in 43 men
will develop stomach cancer in the course of their
lives. More than 1% die of this disease.
Risk factors
Eating habits, especially a lack of fresh fruit and
vegetables and frequent consumption of highly
salted, grilled, pickled or smoked foods, appear
to be of relevance to the development of stomach cancer. Smoking is considered a risk factor.
Excessive consumption of alcohol also increases
the risk of developing the disease by promoting
chronic inflammations and lesions of the gastric
mucosa. A bacterial infection of the stomach with
Helicobacter pylori is the most important of the
lifestyle-related risk factors. Hereditary genetic
defects, pernicious anaemia, Ménétrier’s disease
and other rare pre-existing diseases only lead to a
small relative increase in the risk. Among stomach polyps, which are virtually always benign,
only the rare adenomas are regarded as precancerous (i.e. the preliminary stage of a carcinoma).
Incidence and mortality trends
As in other industrialized nations, stomach cancer incidence and mortality rates in Germany
have been falling continuously for over 30 years.
The age-specific incidence and mortality rates in
Germany declined by 20%-50% between 1980
and 2006, the annual mortality and incidence
figures by as much as 45%-65%.
Survival and prevalence
Although the relative 5-year survival rates for people with stomach cancer have improved in recent
years, they are still quite unfavourable (at around
30%) compared to other cancers. By comparison,
slightly lower survival rates are reported from the
USA (23%) and Finland (27%).
In 2006, 22,000 men and 15,000 women living in Germany had been diagnosed with stomach cancer within the previous five years (5-year
prevalence).
ICD-10 C16 | Cancer in Germany
Figure 3.4.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C16
per 100,000
350
Men
300
250
200
150
100
50
15–34
1980
1990
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
350
Women
300
250
200
150
100
50
15–34
1980
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
33
Cancer in Germany 34
| Stomach
Figure 3.4.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C16
Incidence per 100,000 (European Standard)
50
45
40
35
30
25
20
15
10
5
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.4.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C16
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.1%
(1 in 910)
2.4%
(1 in 42)
<0.1%
(1 in 2,300)
1.4%
(1 in 69)
50
0.3%
(1 in 380)
2.3%
(1 in 43)
0.1%
(1 in 780)
1.4%
(1 in 70)
60
0.5%
(1 in 180)
2.2%
(1 in 45)
0.3%
(1 in 360)
1.4%
(1 in 71)
70
1.0%
(1 in 98)
2.0%
(1 in 51)
0.6%
(1 in 170)
1.3%
(1 in 76)
2.3%
(1 in 43)
1.4%
(1 in 70)
Lifetime risk
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
<0.1%
(1 in 2,000)
1.5%
(1 in 68)
<0.1%
(1 in 3,800)
1.1%
(1 in 95)
50
0.1%
(1 in 760)
1.4%
(1 in 69)
0.1%
(1 in 1,500)
1.0%
(1 in 96)
60
0.3%
(1 in 380)
1.4%
(1 in 74)
0.1%
(1 in 720)
1.0%
(1 in 99)
70
0.5%
(1 in 190)
1.2%
(1 in 84)
0.3%
(1 in 320)
0.9%
(1 in 110)
1.5%
(1 in 68)
1.1%
(1 in 95)
Lifetime risk
ICD-10 C16 | Cancer in Germany
Figure 3.4.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C16
New cases per 100,000 (European Standard)
Men
Women
Meckl.-Western Pom.
Meckl.-Western Pom.
Saxony
Saxony
Brandenburg
Bavaria
Saxony-Anhalt
Thuringia
Germany, estimated
Saxony-Anhalt
Brandenburg
Thuringia
Germany, estimated
Bavaria
Schleswig-Holstein
Saarland
Rhineland-Palatinate
NRW (Münster dist.)
NRW (Münster dist.)
Schleswig-Holstein
Bremen
Lower Saxony
Saarland
Bremen
Lower Saxony
Rhineland-Palatinate
Berlin
Berlin
Hamburg
Hamburg
30
25
20
15
at least 90% registration:
10
5
cases
0
0
5
10
less than 90% registration rate:
15
20
25
cases
30
DCO cases
Figure 3.4.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C00 – 16
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Men
Women
Germany
Germany
Austria
Poland
Hong Kong
Czech Republic
Czech Republic
Hong Kong
Finland
Austria
Poland
Netherlands
Belgium
Norway
England
Netherlands
Belgium
Finland
Switzerland
France
Denmark
Denmark
Australia
Australia
England
Switzerland
USA
Norway
Incidence
Mortality
30
Sweden
USA
25
20
15
10
Incidence
Mortality
France
Sweden
5
0
0
5
10
15
20
25
30
35
36
Cancer in Germany | Colon and rectum
3.5 Colon and rectum
Occurrence
Incidence in 2006
Projection for 2010
Men
Women
36,300
32,440
39,410
33,620
Crude incidence rate*
90.0
77.1
Standardized incidence rate (Europe)*
67.0
44.5
Standardized incidence rate (World)*
44.8
29.8
Deaths 2006
13,756
13,469
Standardized mortality rate (Europe)*
25.4
15.8
Standardized mortality rate (World)*
16.2
9.8
* per 100,000
Colorectal cancer is used here as a collective term
to cover cancers of the colon, the rectum and rarer
cancers of the anus. Histologically, most cases
involve adenocarcinomas. Squamous cell carcinomas only occur in the anus. Making up 16% of
cancer diagnoses, colorectal cancer is the second
most common form of cancer among both men
and women and the second most frequent cause
of death from cancer.
Risk factors and screening
The risk of developing colorectal cancer is
increased by overweight, lack of exercise and dietrelated factors such as low-fibre, high-fat foods,
a high proportion of red (iron-containing) meat
and processed sausages, and a low proportion
of vegetables. Regular alcohol and tobacco consumption also contribute to increased risk. An
above-average number of first-degree relatives
of patients with colorectal cancer are themselves
affected; this points to a link involving similar
lifestyle and/or hereditary factors, but the connection has not yet been definitively clarified.
To a lesser extent, pre-existing diseases such as
chronic-inflammatory intestinal diseases, e.g.
colitis ulcerosa, also increase the cancer risk.
People aged between 50 and 54 years who are
covered by statutory health insurance are entitled to an annual test for hidden blood in the faeces (stool guaiac test, faecal occult blood test) as
part of cancer screening. The physician also palpates the rectum to check for changes. Everyone
aged 55 years or above is entitled to a colonoscopy.
If there are no pathological findings, they can
have a repeat examination after ten years. Alternatively, insured people aged 55 years or over can
have a stool test every two years.
Incidence and mortality trends
Between 1980 and 2006, the age-standardized
incidence of colorectal cancer rose by 34% among
men and 26% among women, while the agestandardized mortality rates fell by 38% among
women and 24% among men. Among women,
this development even led to a decrease in the
absolute number of deaths; among men this
was only prevented by an even larger increase in
the number of people aged over 65 years in the
population. Since 1990, the incidence rates have
essentially increased among women over 75 years
and men aged between 60 and 84 years. By contrast, the mortality rates of both women and men
declined in all age groups. At present, up to twice
as many cases of colorectal cancer are diagnosed
per annum as in the early 1980s, while mortality
rates are much lower.
Survival and prevalence
The 5-year relative survival rates for people with
colon cancer were 50% in the 1980s. Currently,
German population-based cancer registries
report rates between 53% and 63%. In comparison, rates for Finnish and US patients lie between
60% and 65%.
In 2006, about 235,000 people (115,000
women and 120,000 men) living in Germany had
been diagnosed with colon cancer within the previous five years (5-year prevalence).
ICD-10 C18 – 21 | Cancer in Germany
Figure 3.5.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C18 – 21
per 100,000
700
Men
600
500
400
300
200
100
15–34
1980
1990
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
700
Women
600
500
400
300
200
100
15–34
1980
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
37
38
Cancer in Germany | Colon and rectum
Figure 3.5.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C18 – 21
Incidence per 100,000 (European Standard)
100
90
80
70
60
50
40
30
20
10
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.5.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C18 – 21
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.2%
(1 in 480)
7.8%
(1 in 13)
0.1%
(1 in 1,800)
3.3%
(1 in 30)
50
0.9%
(1 in 120)
7.8%
(1 in 13)
0.3%
(1 in 390)
3.4%
(1 in 30)
60
2.3%
(1 in 44)
7.5%
(1 in 13)
0.7%
(1 in 140)
3.3%
(1 in 30)
70
3.7%
(1 in 27)
6.3%
(1 in 16)
1.4%
(1 in 70)
3.1%
(1 in 32)
7.7%
(1 in 13)
3.3%
(1 in 31)
Lifetime risk
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.2%
(1 in 560)
6.5%
(1 in 15)
<0.1%
(1 in 2,300)
2.9%
(1 in 34)
50
0.6%
(1 in 160)
6.4%
(1 in 16)
0.2%
(1 in 650)
2.9%
(1 in 34)
60
1.5%
(1 in 67)
6.0%
(1 in 17)
0.4%
(1 in 260)
2.9%
(1 in 35)
70
2.4%
(1 in 42)
5.0%
(1 in 20)
0.9%
(1 in 110)
2.7%
(1 in 37)
6.5%
(1 in 15)
2.9%
(1 in 34)
Lifetime risk
ICD-10 C18 – 21 | Cancer in Germany
Figure 3.5.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C18 – 21
New cases per 100,000 (European Standard)
Men
Women
Saarland
Schleswig-Holstein
NRW (Münster dist.)
Bavaria
Lower Saxony
NRW (Münster dist.)
Germany, estimated
Lower Saxony
Germany, estimated
Saarland
Rhineland-Palatinate
Brandenburg
Bremen
Rhineland-Palatinate
Bavaria
Schleswig-Holstein
Brandenburg
Meckl.-Western Pom.
Thuringia
Thuringia
Saxony
Hamburg
Saxony
Bremen
Meckl.-Western Pom.
Saxony-Anhalt
Berlin
Berlin
Saxony-Anhalt
Hamburg
120
100
80
60
at least 90% registration:
40
cases
20
0
0
20
40
60
less than 90% registration rate:
80
cases
100
120
DCO cases
Figure 3.5.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C18 – 21
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Men
Women
Norway
Czech Republic
Denmark
Australia
Germany
Australia
Denmark
Netherlands
Germany
Belgium
Belgium
Netherlands
Czech Republic
Norway
Hong Kong
Hong Kong
Austria
USA
France
France
England
Sweden
England
Switzerland
Switzerland
USA
Austria
Sweden
120
Finland
Poland
Incidence
Mortality
100
80
60
40
Incidence
Mortality
Poland
Finland
20
0
0
20
40
60
80
100
120
39
40
Cancer in Germany | Pancreas
3.6 Pancreas
Occurrence
Men
Women
6,380
6,980
Projection for 2010
6,910
7,320
Crude incidence rate*
15.8
16.6
Standardized incidence rate (Europe)*
12.1
9.0
Standardized incidence rate (World)*
8.1
5.8
6,729
7,213
Standardized mortality rate (Europe)*
12.6
9.0
Standardized mortality rate (World)*
8.3
5.8
Incidence in 2006
Deaths 2006
* per 100,000
In Germany, the annual number of new cases of
pancreatic cancer is estimated at approx. 6,380
among men and 6,980 among women. Among
men, pancreatic cancer accounts for 2.8% of all
cancers; among women the figure is 3.5%. Due
to the poor prognosis, the condition is responsible for 6% of all cancer-related deaths among
men and 7.3% among women, making it the
fourth most common cause of death from cancer in both men and women. The median age at
onset is around 69 years for men and 76 years for
women. The lifetime risk of developing pancreatic cancer is about 1.4% for both sexes.
95% of pancreatic tumours begin in the exocrine cells of the pancreas Histologically, ductal
adenocarcinomas are the most common.
Risk factors
Tobacco consumption is regarded as a confirmed
risk factor for pancreatic cancer. Overweight also
has a disadvantageous effect. Alcohol consumption has long been controversially discussed as
a contributory factor in tumour formation; its
influence is now considered probable. However,
the effects of other lifestyle-related risk factors in
general – and a person’s choice of foods in particular – have not been unequivocally confirmed.
The risk of developing pancreatic cancer is higher
for patients with type 2 diabetes mellitus, and
first-degree relatives of a patient are slightly
more likely to develop the disease than the rest
of the population. Some of these patients seem
to be affected by an inheritable increase in risk,
although only some of the genes that might be
involved are known. The risk of pancreatic cancer can also be considerable higher in families
with certain rare, genetically determined cancer
syndromes. The role of environmental or occupational stress factors has not been conclusively
clarified.
Incidence and mortality trends
The age-standardized incidence rates and mortality rates are similarly high for men and women
due to the unfavourable prognosis for pancreatic
cancer. Both the estimated incidence rates and
the mortality rates have remained approximately
constant among men in Germany since the late
1980s. Among women, both the incidence rates
and the mortality rates have risen slightly from
the early 1980s to today.
Survival and prevalence
Malignant neoplasms of the pancreas belong
to those cancers with rare and uncharacteristic early symptoms. Pancreatic carcinomas are
therefore frequently not diagnosed until they are
at an advanced stage. The chances of a cure are
still very poor for the overwhelming majority of
patients. The relative 5-year survival rate for people with pancreatic cancer is decidedly unfavourable. It lies between about 5% and 7% for men,
and 3% to 8% for women. The 5-year prevalence
at the end of 2006 was approx. 5,300 women and
about 5,800 men.
ICD-10 C25 | Cancer in Germany
Figure 3.6.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C25
per 100,000
140
Men
120
100
80
60
40
20
15–34
1980
1990
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
140
Women
120
100
80
60
40
20
35–39
1980
1990
40–44
2006
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
41
Cancer in Germany 42
| Pancreas
Figure 3.6.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C25
Incidence per 100,000 (European Standard)
20
18
16
14
12
10
8
6
4
2
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.6.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C25
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
<0.1%
(1 in 2,400)
1.4%
(1 in 72)
<0.1%
(1 in 2,600)
1.5%
(1 in 66)
50
0.2%
(1 in 530)
1.4%
(1 in 72)
0.2%
(1 in 600)
1.5%
(1 in 66)
60
0.4%
(1 in 250)
1.3%
(1 in 78)
0.4%
(1 in 250)
1.4%
(1 in 70)
70
0.6%
(1 in 180)
1.0%
(1 in 97)
0.6%
(1 in 160)
1.2%
(1 in 83)
1.4%
(1 in 73)
1.5%
(1 in 68)
Lifetime risk
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
<0.1%
(1 in 3,400)
1.5%
(1 in 69)
<0.1%
(1 in 4,200)
1.5%
(1 in 66)
50
0.1%
(1 in 970)
1.4%
(1 in 69)
0.1%
(1 in 990)
1.5%
(1 in 66)
60
0.3%
(1 in 360)
1.4%
(1 in 72)
0.3%
(1 in 380)
1.5%
(1 in 68)
70
0.5%
(1 in 190)
1.2%
(1 in 83)
0.5%
(1 in 180)
1.3%
(1 in 77)
1.4%
(1 in 70)
1.5%
(1 in 67)
Lifetime risk
| Cancer in Germany
ICD-10 C25 Figure 3.6.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C25
New cases per 100,000 (European Standard)
Men
Women
Thuringia
Schleswig-Holstein
Brandenburg
Saarland
Meckl.-Western Pom.
Hamburg
Saxony
Meckl.-Western Pom.
Bavaria
Bavaria
Schleswig-Holstein
Brandenburg
Bremen
Saxony
Hamburg
Bremen
Saxony-Anhalt
Lower Saxony
Berlin
Berlin
Saarland
Thuringia
Germany, estimated
Germany, estimated
Lower Saxony
Saxony-Anhalt
Rhineland-Palatinate
Rhineland-Palatinate
NRW (Münster dist.)
18
15
12
NRW (Münster dist.)
9
at least 90% registration:
6
cases
3
0
0
3
6
less than 90% registration rate:
9
12
cases
15
18
DCO cases
Figure 3.6.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C25
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Men
Women
Czech Republic
Czech Republic
Denmark
Austria
Finland
Finland
Norway
Denmark
Austria
Germany
USA
USA
Switzerland
Norway
Germany
France
England
Switzerland
Australia
Australia
Netherlands
England
Belgium
Belgium
Poland
France
Sweden
Netherlands
Incidence
Mortality
18
Poland
Sweden
15
12
9
Incidence
Mortality
Hong Kong
Hong Kong
6
3
0
0
3
6
9
12
15
18
43
44
Cancer in Germany | Larynx
3.7 Larynx
Occurrence
Incidence in 2006
Projection for 2010
Men
Women
3,430
460
3,630
480
Crude incidence rate*
8.5
1.1
Standardized incidence rate (Europe)*
6.8
0.8
Standardized incidence rate (World)*
4.8
0.6
1,351
226
Standardized mortality rate (Europe)*
2.6
0.4
Standardized mortality rate (World)*
1.8
0.2
Deaths 2006
* per 100,000
Men are diagnosed with laryngeal cancer much
more frequently than women, as becomes apparent when laryngeal cancer cases are shown as
a percentage of all cancer cases: they account
for 1.5% of all cancers among men, compared to
only 0.2% among women. One in 150 men will
develop this form of cancer in Germany over a
lifetime, compared to only one in 1,200 women.
The median age at onset is about 64 years among
both men and women, about five years earlier
than the average of all cancer sites.
Risk factors
Tobacco smoking is the most important risk factor in the development of laryngeal cancer. Alcohol consumption definitely enhances risk, and
the combination of both factors is particularly
harmful. The influence of lifestyle, nutrition or
the environment, beyond the major role played
by tobacco and alcohol, has not been conclusively
clarified. However, there are indications that vegetables and fruit have a protective effect. There is
also a known association between tumours of the
larynx and occupational exposure to e.g. asbestos,
nickel or polycyclic aromatic hydrocarbons.
Incidence and mortality trends
Incidence and mortality rates vary considerably
between women and men in terms of both magnitude and trends. The lower rates among women
compared to men have risen overall by about
50% since 1980, while the much higher mortality rates among men have fallen by a quarter and
incidence rates by a third over the same period.
Although declining incidence rates among men
were observed in all age groups, the fall was especially sharp among the under-50-year-olds. Overall, the number of deaths and new cases among
men has remained almost unchanged, while the
number of women developing – and dying of –
laryngeal cancer has risen by about 70%.
Survival and prevalence
The current survival rates among men reported
by the state cancer registries are between 58% and
76%, and these findings are approximately comparable to the figures from Finland and the USA.
In 2006, about 1,100 men and 1,400 women living in Germany had been diagnosed with laryngeal cancer within the previous five years.
ICD-10 C32 | Cancer in Germany
Figure 3.7.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C32
per 100,000
40
Men
35
30
25
20
15
10
5
35–39
1980
1990
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
40
Women
35
30
25
20
15
10
5
35–39
1980
1990
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
45
Cancer in Germany 46
| Larynx
Figure 3.7.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C32
Incidence per 100,000 (European Standard)
��
��
��
��
��
��
�
�
�
�
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.7.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C32
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
<0.1%
(1 in 2,100)
0.7%
(1 in 150)
<0.1%
(1 in 8,400)
0.3%
(1 in 350)
50
0.2%
(1 in 610)
0.6%
(1 in 160)
0.1%
(1 in 2,000)
0.3%
(1 in 350)
60
0.2%
(1 in 430)
0.5%
(1 in 200)
0.1%
(1 in 1,200)
0.2%
(1 in 400)
70
0.2%
(1 in 460)
0.3%
(1 in 320)
0.1%
(1 in 960)
0.2%
(1 in 520)
0.6%
(1 in 150)
0.3%
(1 in 360)
Lifetime risk
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
<0.1%
(1 in 12,000)
0.1%
(1 in 1,200)
<0.1%
(1 in 36,000)
<0.1%
(1 in 2,200)
50
<0.1%
(1 in 3,900)
0.1%
(1 in 1,300)
<0.1%
(1 in 13,000)
<0.1%
(1 in 2,300)
60
<0.1%
(1 in 3,900)
0.1%
(1 in 1,800)
<0.1%
(1 in 9,000)
<0.1%
(1 in 2,800)
70
<0.1%
(1 in 4,800) <0.1%
(1 in 3,100)
<0.1%
(1 in 7,900)
<0.1%
(1 in 3,700)
0.1%
(1 in 1,200)
<0.1%
(1 in 2,300)
Lifetime risk
ICD-10 C32 | Cancer in Germany
Figure 3.7.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C32
New cases per 100,000 (European Standard)
Men
Women
Saarland
Hamburg
Bremen
Bremen
Meckl.-Western Pom.
NRW (Münster dist.)
NRW (Münster dist.)
Saarland
Berlin
Meckl.-Western Pom.
Rhineland-Palatinate
Rhineland-Palatinate
Schleswig-Holstein
Berlin
Germany, estimated
Lower Saxony
Brandenburg
Saxony-Anhalt
Germany, estimated
Lower Saxony
Hamburg
Schleswig-Holstein
Saxony-Anhalt
Bavaria
Bavaria
Saxony
Saxony
Brandenburg
Thuringia
12
10
8
Thuringia
6
4
at least 90% registration:
cases
2
0
0
2
4
less than 90% registration rate:
6
8
cases
10
12
DCO cases
Figure 3.7.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C32
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Men
Women
Denmark
Poland
France
France
USA
Belgium
Poland
Czech Republic
Belgium
Germany
Netherlands
Netherlands
England
Denmark
Germany
Austria
Austria
USA
Czech Republic
Schwitzerland
Schwitzerland
Hong Kong
Australia
Australia
Finland
England
Sweden
Norway
12
Norway
Finland
Incidence
Mortality
10
8
6
4
Incidence
Mortality
Hong Kong
Sweden
2
0
0
2
4
6
8
10
12
47
48
Cancer in Germany | Lung
3.8 Lung
Occurrence
Incidence in 2006
Projection for 2010
Men
Women
32,500
14,600
35,150
15,180
Crude incidence rate*
80.6
34.7
Standardized incidence rate (Europe)*
60.8
23.7
Standardized incidence rate (World)*
41.1
16.6
Deaths 2006
28,898
11,873
Standardized mortality rate (Europe)*
53.7
18.1
Standardized mortality rate (World)*
35.6
12.4
* per 100,000
Lung cancer is now the third most common cancer site among both men and women in Germany. It accounts for about 14% of all new cancer cases among men and 7% of all malignant
neoplasms among women. The unfavourable
prognosis means that lung cancer causes 26%
of all cancer-related deaths among men and
12% among women. The median age at onset is
approx. 69 years.
smoking. Environmental pollutants (fine particulate matter, other harmful substances) probably
have an influence, although the extent is still the
subject of research. The same applies to the influence of genetic factors.
Incidence and mortality trends
As in the case of laryngeal cancer, the trends of
incidence and mortality rates among women
run contrary to those among men. While overall
incidence and mortality rates from lung cancer
among men have fallen by about a quarter, since
1980 the mortality rates among women have
risen by over 100%, the incidence rates by almost
200% in all age groups. The same trends can be
observed in other European industrialized countries. The differences in incidence and mortality
trends between men and women are attributed to
changes in smoking habits.
Survival and prevalence
Risk factors
Tobacco smoking has been recognized as the
main risk factor for lung cancer for a long time.
Nine out of ten lung-cancer cases among men
and currently at least six out of ten cases of lung
cancer among women can probably be attributed
to active smoking – especially cigarette smoking. Exposure to second-hand smoke in enclosed
spaces increases the risk of lung cancer. Other
risk factors can be regarded as relatively unimportant. The risk of developing lung cancer is
higher in areas where buildings are affected by
high natural levels of radon (e.g. in poorly ventilated cellars). A small proportion of all lungcancer cases are attributable to occupational
exposure to various carcinogenic substances
(including asbestos, ionizing radiation/radon,
types of quartz dust and the silicosis it causes).
Cigarette smoking aggravates the effects of these
harmful substances
Eating a lot of vegetables and above all fruit
possibly has a protective effect, although it certainly cannot offset the risk caused by cigarette
Current survival rates reported by the state cancer
registries are between 13% and 17% for men and
between 13% and 19% for women, and are thus
comparable to findings in the USA. In 2006, a
total of 63,000 people (of whom 20,000 were
women) living in Germany had been diagnosed
with lung cancer within the previous five years
(5-year prevalence).
ICD-10 C33, C34 | Cancer in Germany
Figure 3.8.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C33, C34
per 100,000
���
Men
450
400
350
300
250
200
150
100
50
15–34
1980
1990
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
400
Women
350
300
250
200
150
100
50
15–34
1980
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
49
50
Cancer in Germany | Lung
Figure 3.8.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C33, C34
Incidence per 100,000 (European Standard)
100
90
80
70
60
50
40
30
20
10
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.8.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C33, C34
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.2%
(1 in 460)
6.8%
(1 in 15)
0.2%
(1 in 610)
6.3%
(1 in 16)
50
1.0%
(1 in 100)
6.8%
(1 in 15)
0.8%
(1 in 130)
6.3%
(1 in 16)
60
2.1%
(1 in 48)
6.2%
(1 in 16)
1.8%
(1 in 57)
5.9%
(1 in 17)
70
3.1%
(1 in 32)
4.9%
(1 in 20)
2.9%
(1 in 35)
4.9%
(1 in 20)
6.7%
(1 in 15)
6.2%
(1 in 16)
Lifetime risk
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.2%
(1 in 580)
2.8%
(1 in 36)
0.1%
(1 in 920)
2.3%
(1 in 43)
50
0.5%
(1 in 190)
2.7%
(1 in 37)
0.4%
(1 in 280)
2.3%
(1 in 44)
60
0.8%
(1 in 130)
2.2%
(1 in 45)
0.6%
(1 in 170)
2.0%
(1 in 51)
70
0.9%
(1 in 110)
1.6%
(1 in 64)
0.8%
(1 in 130)
1.5%
(1 in 66)
2.8%
(1 in 36)
2.3%
(1 in 43)
Lifetime risk
| Cancer in Germany
ICD-10 C33, C34 Figure 3.8.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C33, C34
New cases per 100,000 (European Standard)
Men
Women
Bremen
Hamburg
Hamburg
Bremen
Saarland
Berlin
Saxony-Anhalt
Schleswig-Holstein
Saarland
NRW (Münster dist.)
Brandenburg
NRW (Münster dist.)
Berlin
Lower Saxony
Germany, estimated
Meckl.-Western Pom.
Schleswig-Holstein
Rhineland-Palatinate
Lower Saxony
Brandenburg
Thuringia
Meckl.-Western Pom.
Germany, estimated
Saxony-Anhalt
Saxony
Bavaria
Rhineland-Palatinate
Thuringia
Bavaria
90
75
60
Saxony
45
at least 90% registration:
30
15
cases
0
0
15
30
45
less than 90% registration rate:
60
cases
75
90
DCO cases
Figure 3.8.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C33, C34
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Men
Women
Denmark
Poland
USA
Belgium
Netherlands
Czech Republic
England
Hong Kong
Norway
Netherlands
Hong Kong
France
Australia
USA
Switzerland
Denmark
Sweden
Germany
Belgium
England
Germany
Switzerland
Czech Republic
Austria
Austria
Norway
Poland
Australia
120
France
Finland
Incidence
Mortality
100
80
60
40
Incidence
Mortality
Finland
Sweden
20
0
0
20
40
60
80
100
120
51
52
Cancer in Germany | Malignant melanoma of the skin
3.9 Malignant melanoma of the skin
Occurrence
Men
Women
7,360
8,470
Projection for 2010
7,690
8,540
Crude incidence rate*
18.3
20.1
Standardized incidence rate (Europe)*
14.6
16.2
Incidence in 2006
Standardized incidence rate (World)*
10.8
13.1
1,266
1,021
Standardized mortality rate (Europe)*
2.4
1.5
Standardized mortality rate (World)*
1.7
1.0
Deaths 2006
* per 100,000
In 2006, malignant melanomas of the skin
accounted for 4.3% of all new cases of malignant
neoplasms among women and 3.2% among men;
they caused about 1% of all cancer-related deaths.
The median age at onset was comparatively low
among women at 58 years; it was 64 years among
men. Especially striking is the relatively high risk
of young women developing the disease.
Most malignant melanomas of the skin
develop as malignant neoplasms of the pigment
cells (melanocytes). Although basal cell carcinomas and squamous epithelial carcinomas of
the skin, which do not metastasize as a rule,
are much more common, they cause considerably fewer cancer-related deaths than malignant
melanomas of the skin; they are ignored here in
line with international practice.
Risk factors
People with a large number of pigmentation
marks (birth marks, moles, dysplastic naevi) and
a light skin type are at higher risk of melanoma.
Ultraviolet exposure from sun or solariums,
especially during childhood and adolescence, is
regarded as the most important exogenous risk
factor. Exposure to ultraviolet radiation at the
workplace, e.g. during welding work, is also considered a-cancer risk factor.
In mid-2008, the statutory cancer screening
programme in Germany began measures for
the early detection of all forms of skin cancer.
People of both sexes with state health insurance
are now entitled to a medical examination of the
skin every two years from the age of 35; they are
referred to a dermatologist for clarification if
there are any potentially pathological findings.
It is not clear as yet what impact this screening
programme will have on incidence and mortality
rates relating to malignant melanoma of the skin.
Incidence and mortality trends
The age-standardized incidence rates of women
and men have more than tripled since 1980.
By contrast, the mortality rates among women
have fallen by about 10% since then, while the
mortality rates of men have increased by the
same degree. Women as a whole, and especially
younger women, have lower mortality rates and
higher incidence rates than men. However, the
incidence rates among men over the age of 60
years are higher than those of women of the same
age.
Survival and prevalence
The relative 5-year survival rates for women with
malignant melanoma of the skin in Germany are
currently 90% and higher. The survival rates for
men are somewhat less favourable, however, with
figures around 85% in all registries. Due to the
increase in incidence and much improved survival rates in Germany, 63,000 people (of whom
37,000 were women) living in 2006 had been
diagnosed with a malignant melanoma of the
skin within the previous 5 years (5-year prevalence).
ICD-10 C43 | Cancer in Germany
Figure 3.9.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C43
per 100,000
70
Men
60
50
40
30
20
10
15–34
1980
1990
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
70
Women
60
50
40
30
20
10
15–34
1980
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
53
Cancer in Germany 54
| Malignant melanoma of the skin
Figure 3.9.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C43
Incidence per 100,000 (European Standard)
20
18
16
14
12
10
8
6
4
2
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.9.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C43
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.1%
(1 in 750)
1.3%
(1 in 75)
<0.1%
(1 in 5,800)
0.3%
(1 in 370)
50
0.2%
(1 in 430)
1.2%
(1 in 81)
<0.1%
(1 in 3,000)
0.3%
(1 in 380)
60
0.4%
(1 in 240)
1.1%
(1 in 92)
0.1%
(1 in 1,500)
0.2%
(1 in 410)
70
0.5%
(1 in 220)
0.8%
(1 in 130)
0.1%
(1 in 960)
0.2%
(1 in 480)
1.5%
(1 in 69)
0.3%
(1 in 360)
Lifetime risk
Risk of developing the disease
Women
aged
in the next 10 years
ever
40
0.2%
(1 in 470)
1.3%
50
0.3%
(1 in 380)
60
0.3%
(1 in 330)
70
0.3%
(1 in 320)
Lifetime risk
Risk of dying of the disease
in the next 10 years
ever
(1 in 79)
<0.1%
(1 in 6,900)
0.2%
(1 in 500)
1.1%
(1 in 93)
<0.1%
(1 in 4,200)
0.2%
(1 in 530)
0.8%
(1 in 120)
<0.1%
(1 in 2,900)
0.2%
(1 in 580)
0.6%
(1 in 170)
0.1%
(1 in 1,800)
0.1%
(1 in 680)
1.6%
(1 in 63)
0.2%
(1 in 480)
ICD-10 C43 | Cancer in Germany
Figure 3.9.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C43
New cases per 100,000 (European Standard)
Men
Women
Rhineland-Palatinate
Rhineland-Palatinate
Schleswig-Holstein
Lower Saxony
Germany, estimated
Lower Saxony
Bavaria
Schleswig-Holstein
Germany, estimated
Bavaria
Bremen
NRW (Münster dist.)
Thuringia
Hamburg
NRW (Münster dist.)
Saarland
Hamburg
Thuringia
Berlin
Meckl.-Western Pom.
Meckl.-Western Pom.
Saxony-Anhalt
Saxony-Anhalt
Bremen
Saxony
Brandenburg
Saarland
Saxony
Brandenburg
24
20
16
Berlin
12
8
at least 90% registration:
4
cases
0
0
4
8
12
less than 90% registration rate:
16
20
cases
24
DCO cases
Figure 3.9.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C43
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Men
Women
Australia
Australia
Norway
USA
Switzerland
Denmark
Norway
Netherlands
Switzerland
Denmark
Sweden
Sweden
Germany
Netherlands
USA
Czech Republic
England
Finland
Belgium
Germany
Czech Republic
England
Finland
Austria
France
Belgium
Austria
France
Incidence
Mortality
60
Poland
Poland
50
40
30
20
10
Incidence
Mortality
Hong Kong
Hong Kong
0
0
10
20
30
40
50
60
55
56
Cancer in Germany | Breast (female)
3.10 Breast (female)
Occurrence
Women
Incidence in 2006
57,970
Projection for 2010
59,510
Crude incidence rate*
137.9
Standardized incidence rate (Europe)*
102.1
Standardized incidence rate (World)*
Deaths 2006
75.3
17,286
Standardized mortality rate (Europe)*
25.5
Standardized mortality rate (World)*
17.5
* per 100,000
Approximately 58,000 women were diagnosed
with breast cancer in Germany in 2006. Breast
cancer is the most commonly diagnosed form of
cancer among women, accounting for 29%; the
median age at onset is 64 years.
but is now recognized. The same applies to the
unfavourable influence of alcohol.
Female close relatives of women with breast
cancer have a comparatively high risk. Breastcancer-related genes known today to significantly
increase risk (e.g. (BRCA1 and BRCA2) can only
be detected in a small percentage of affected
patients; it is assumed that further genes might
be involved in the development of breast cancer.
Comprehensive mammography screening
programmes were introduced all over Germany
between 2005 and 2008. Since then, all women
between the ages of 50 and 69 years are invited
to attend mammography screening in specialized
centres; participation up to now has been around
54%
Incidence and mortality trends
Risk factors and screening
An early first menstruation (menarche), childlessness, a late first birth and a late menopause
(climacteric) are associated with an increased
risk of breast cancer. On the other hand, giving
birth at a young age, several births and longer
lactation periods seem to reduce breast cancer
risk. Ovulation inhibitors containing oestrogen
and progesterone (the “Pill”) slightly increase
the risk of breast cancer, an effect that disappears ten years after the woman stops using the
Pill. However, they have a favourable effect on
the risk of ovarian cancer and cancer originating
in the lining of the uterus (endometrial carcinoma). Hormone-replacement therapy with
oestrogens during and after menopause – and
especially with a combination of oestrogens and
gestagens – increases the risk of developing
breast cancer.
Many studies have observed an increase
in risk due to overweight and lack of exercise,
especially after the menopause, whereas regular
physical activity and sport have a favourable influence. The choice of foodstuffs, e.g. consumption
of fruit or vegetables, does not seem to affect the
risk. The risk-enhancing influence of tobacco
consumption was controversial for a long time,
Age-standardized breast-cancer incidence in Germany rose continuously from 1980 until about
2000; since then it has remained approximately
stable. An increase in the number of new cases
must be expected with the introduction of mammography screening; this effect can already be
observed for 2006 in regions where screening
began early (e.g. the administrative district of
Münster). In countries such as the Netherlands
and the UK, where screening programmes have
been established since the 1990s, incidence is
much higher than in Germany, even though mortality rates are comparable. The latter have been
falling in Germany since the mid-1990s
Survival and prevalence
The relative 5-year survival rates of female breast
cancer patients in Germany are currently between
83% and 87%. At the end of 2006, about 242,000
women living in Germany had been diagnosed
with breast cancer within the previous five years
(5-year prevalence).
ICD-10 C50 | Cancer in Germany
Figure 3.10.1
Age-standardized incidence rates in Germany for 1980, 1990 and 2006, ICD-10 C50
per 100,000
350
Women
300
250
200
150
100
50
15–34
1980
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
57
58
Cancer in Germany | Breast (female)
Figure 3.10.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C50
Incidence per 100,000 (European Standard)
150
135
120
105
90
75
60
45
30
15
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.10.1
Cancer incidence and mortality risks in Germany by age, ICD-10 C50
Data basis 2006
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
1.3%
(1 in 76)
10.4%
(1 in 10)
0.2%
(1 in 540)
3.4%
(1 in 29)
50
2.3%
(1 in 43)
9.3%
(1 in 11)
0.5%
(1 in 220)
3.3%
(1 in 30)
60
3.0%
(1 in 33)
7.4%
(1 in 13)
0.8%
(1 in 130)
2.9%
(1 in 34)
70
2.8%
(1 in 35)
4.9%
(1 in 20)
1.0%
(1 in 99)
2.4%
(1 in 42)
10.9%
(1 in 9)
3.5%
(1 in 29)
Lifetime risk
ICD-10 C50 | Cancer in Germany
Figure 3.10.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C50
New cases per 100,000 (European Standard)
Women
Schleswig-Holstein
NRW (Münster dist.)
Lower Saxony
Bavaria
Bremen
Hamburg
Saarland
Rhineland-Palatinate
Germany, estimated
Berlin
Meckl.-Western Pom.
Brandenburg
Thuringia
Saxony
Saxony-Anhalt
0
at least 90% registration:
cases
30
60
less than 90% registration rate:
90
120
150
cases
180
DCO cases
Figure 3.10.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C50
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Women
Belgium
France
Netherlands
England
USA
Denmark
Finland
Switzerland
Australia
Sweden
Germany
Norway
Austria
Czech Republic
Hong Kong
Incidence
Mortality
Poland
0
30
60
90
120
150
180
59
60
Cancer in Germany | Cervix
3.11 Cervix
Occurrence
Women
Incidence in 2006
5,470
Projection for 2010
5,500
Crude incidence rate*
13.0
Standardized incidence rate (Europe)*
11.0
Standardized incidence rate (World)*
Deaths 2006
8.9
1,492
Standardized mortality rate (Europe)*
2.5
Standardized mortality rate (World)*
1.8
* per 100,000
About 5,470 women developed cervical cancer in
2006, continuing a trend of decreasing incidence.
Currently, the highest incidence rates are in the 40to 59-year-old age group, which is much earlier than
in 1980. The median age at onset of invasive cervical cancer is 52 years; for in situ carcinomas it is
36 years.
Histologically, about 80% of invasive cervical
tumours are squamous cell carcinomas; adenocarcinomas make up approx. 11%.
Risk factors and screening
Cervical cancer develops from an infection with
human papillomavirus (HPV). The HPV infection, not the cancer, can be sexually transmitted.
Most women are infected with HPV in the course
of their lives; however, the infection only persists in
a small percentage of those affected. Several concomitant factors are known to be associated with an
enhanced risk of developing the disease:
– smoking and passive smoking;
– additional genital infections with other sexually
transmitted pathogens such as herpes simplex
viruses or chlamydia;
– a large number of births;
– a greatly weakened immune system; and
– the use of oral contraceptives (the “Pill”).
Since the 1970s, women above the age of 20 years
in Germany have been offered an annual cervical examination (Pap smear) as part of statutory
cancer screening. Since then, a decrease in cervical carcinoma incidence and mortality has been
observed. Since March 2007, the Standing Vacci-
nation Commission (STIKO) in Germany has recommended inoculating girls aged between 12 and
17 years against two high-risk types of HPV which
are responsible for about 70 percent of all cases of
cervical carcinomas. Based on pilot studies, it is
hoped that such measures will reduce not only the
number of infections, but also the rate of preliminary stages of cancer and, in the long term, also the
rate of invasive cervical carcinomas. However, at the
present time regular screening by Pap smears cannot be replaced either by vaccinations or by tests for
human papillomavirus.
Incidence and mortality trends
The incidence rate of cervical cancer in Germany fell
markedly up to the 1990s. Since then, the number
of new cases has been falling less rapidly. The mortality rate from cervical cancer has been decreasing
continuously since the 1980s. The general view is
that much of this decline has been due to the statutory cancer screening programme, since preliminary stages of cervical cancer can now be diagnosed
and the development of the invasive carcinoma prevented by timely treatment. In 2006, the incidence
rates of in situ carcinomas were up to four times
higher than those of invasive carcinomas.
Survival and prevalence
The relative 5-year survival rate for invasive cancers
of the cervix in Germany is between 63% and 71%.
At the end of 2006, about 23,700 women living in
Germany had been diagnosed with cervical cancer
within the previous five years (5-year prevalence).
ICD-10 C53 | Cancer in Germany
Figure 3.11.1
Age-standardized incidence rates in Germany for 1980, 1990 and 2006, ICD-10 C53
per 100,000
70
Women
60
50
40
30
20
10
15–34
1980
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
61
Cancer in Germany 62
| Cervix
Figure 3.11.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C53
Incidence per 100,000 (European Standard)
50
45
40
35
30
25
20
15
10
5
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.11.1
Cancer incidence and mortality risks in Germany by age, ICD-10 C53
Data basis 2006
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.2%
(1 in 460)
0.8%
(1 in 130)
<0.1%
(1 in 2,800)
0.3%
(1 in 370)
50
0.2%
(1 in 460)
0.6%
(1 in 170)
<0.1%
(1 in 2,100)
0.2%
(1 in 410)
60
0.1%
(1 in 700)
0.4%
(1 in 260)
0.1%
(1 in 2,000)
0.2%
(1 in 500)
70
0.1%
(1 in 720)
0.3%
(1 in 390)
0.1%
(1 in 1,300)
0.2%
(1 in 620)
1.0%
(1 in 100)
0.3%
(1 in 350)
Lifetime risk
ICD-10 C53 | Cancer in Germany
Figure 3.11.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C53
New cases per 100,000 (European Standard)
Women
Thuringia
Berlin
Meckl.-Western Pom.
Germany, estimated
Saarland
Saxony
Brandenburg
Schleswig-Holstein
Bremen
Saxony-Anhalt
NRW (Münster dist.)
Rhineland-Palatinate
Hamburg
Bavaria
Lower Saxony
0
at least 90% registration:
cases
3
6
9
less than 90% registration rate:
12
cases
15
18
DCO cases
Figure 3.11.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C53
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Women
Czech Republic
Poland
Denmark
Norway
Hong Kong
Germany
Belgium
Austria
France
Sweden
England
USA
Netherlands
Australia
Switzerland
Incidence
Mortality
Finland
0
5
10
15
20
25
30
63
64
Cancer in Germany | Uterus (corpus uteri)
3.12 Uterus (corpus uteri)
Occurrence
Women
Incidence in 2006
Projection for 2010
11,140
11,460
Crude incidence rate*
26.5
Standardized incidence rate (Europe)*
17.9
Standardized incidence rate (World)*
Deaths 2006
oestrogen/gestagen combinations are used; however, they increase the breast cancer risk at least
slightly. Women with confirmed genetic defects
leading to hereditary nonpolyposis colorectal
carcinoma (HNPCC syndrome) are affected by a
high risk not only of colorectal cancer, but also of
cancer of the corpus uteri.
12.6
2,395
Standardized mortality rate (Europe)*
3.0
Standardized mortality rate (World)*
2.0
* per 100,000
With about 11,140 new cases per year, cancer
of the corpus uteri represents the fourth most
common cancer among women and the most
common cancer of the female genital organs. It
accounts for 5.6% of all malignant neoplasms
among women. Thanks to a good prognosis, it
causes a much lower percentage of all cancerrelated deaths: 2.6%. The median age at onset is
69 years. These days, the highest incidence rates
are in the 75- to 79-year-old age group, i.e. significantly later than in the 1980s. One in 47 women
will develop uterine cancer in the course of their
lives; one in 200 dies of this disease. Most cancers of the corpus uteri are endometrial carcinomas, i.e. they develop in the lining of the uterus.
Risk factors
Hormonal influences over many years are
regarded as the primary risk factor for endometrial corpus uteri carcinomas. These influences
can be caused by an early first menstruation
(menarche), a late onset of menopause, childlessness or diseases of the ovaries. As far as lifestyle
factors are concerned, overweight and lack of
exercise have an effect, possibly also by influencing hormone levels. The administration of oestrogens as a monotherapy for climacteric complaints
increases the risk not only of breast cancer, but
also of endometrial carcinoma, which can be prevented by the additional administration of progesterone. On the other hand, oral contraceptives
(the “Pill”) provide protection against the development of corpus uteri carcinomas, especially when
Incidence and mortality trends
The age-standardized incidence rates in Germany have been falling again following a slight
increase up to the late 1980s; only in the higher
(70- to 84-year-old) age groups have the incidence
rates risen again. As in the case of cervical cancer, mortality due to cancer of the corpus uteri is
also decreasing.
Survival and prevalence
The relative 5-year survival rates are between
75% and 83% in Germany. Corpus uteri carcinomas can be ranked among the cancer sites with a
favourable prognosis. At the end of 2006, about
48,000 women living in Germany had been diagnosed with a cancer of the corpus uteri within the
previous five years (5-year prevalence).
ICD-10 C54, C55 | Cancer in Germany
Figure 3.12.1
Age-standardized incidence rates in Germany for 1980, 1990 and 2006, ICD-10 C54, C55
per 100,000
���
Women
90
80
70
60
50
40
30
20
10
15–34
1980
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
65
Cancer in Germany 66
| Uterus (corpus uteri)
Figure 3.12.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C54, C55
Incidence per 100,000 (European Standard)
30
27
24
21
18
15
12
9
6
3
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.12.1
Cancer incidence and mortality risks in Germany by age, ICD-10 C54, C55
Data basis 2006
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.1%
(1 in 1,200)
2.1%
(1 in 48)
<0.1%
(1 in 11,000)
0.5%
(1 in 200)
50
0.4%
(1 in 280)
2.0%
(1 in 49)
<0.1%
(1 in 2,600)
0.5%
(1 in 200)
60
0.6%
(1 in 160)
1.7%
(1 in 57)
0.1%
(1 in 1,100)
0.5%
(1 in 210)
70
0.8%
(1 in 130)
1.2%
(1 in 83)
0.2%
(1 in 620)
0.4%
(1 in 240)
2.1%
(1 in 47)
0.5%
(1 in 200)
Lifetime risk
ICD-10 C54, C55 | Cancer in Germany
Figure 3.12.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C54, C55
New cases per 100,000 (European Standard)
Women
Bremen
Saxony
Saarland
Bavaria
Thuringia
Lower Saxony
Schleswig-Holstein
Germany, estimated
Brandenburg
Saxony-Anhalt
Meckl.-Western Pom.
Rhineland-Palatinate
NRW (Münster dist.)
Hamburg
Berlin
0
at least 90% registration:
cases
5
10
less than 90% registration rate:
15
20
25
cases
30
DCO cases
Figure 3.12.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C54, C55
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Women
Czech Republic
USA
Norway
Sweden
Finland
Poland
Denmark
Belgium
England
Switzerland
Germany
Austria
Netherlands
Australia
Hong Kong
Incidence
Mortality
France
0
5
10
15
20
25
30
67
68
Cancer in Germany | Ovaries
3.13 Ovaries
Occurrence
Incidence and mortality trends
Women
Incidence in 2006
9,670
Projection for 2010
9,960
Crude incidence rate*
23.0
Standardized incidence rate (Europe)*
15.8
Standardized incidence rate (World)*
Deaths 2006
11.4
5,636
Standardized mortality rate (Europe)*
8.0
Standardized mortality rate (World)*
5.3
* per 100,000
Most malignant tumours of the ovaries (ovarian
cancer) are carcinomas. Otherwise, cancers of
the ovaries can also be tumours of the connective
tissue, mixed tumours or tumours composed of
immature germ cells or embryonic cells. Ovarian cancer accounts for 4.9% of all malignant
neoplasms among women and causes 5.7% of
all cancer-related deaths. About 5% to 10% of all
ovarian cancer cases affect women under the age
of 45 years. These are mostly germ-cell tumours.
The median age at diagnosis is 68 years.
Risk factors
The risk of developing epithelial ovarian cancer
seems to be associated with hormonal influences
over many years. An early first menstruation
(menarche) and a late onset of menopause, childlessness or no lactation periods have an unfavourable effect. Hormone-replacement therapy – of
any type or duration – represents a risk factor.
On the other hand, hormonal ovulation inhibitors (the “Pill”) provide protection against ovarian
cancer. Women whose first-degree relatives have
developed breast or ovarian cancer, or who have
themselves already had breast, corpus uteri, or
colorectal cancer, are at greater risk of developing
ovarian cancer. Genetic defects in the BRCA1 and
BRCA2 genes are known today to raise the risk
of developing the disease, but are only relevant
to a small percentage of women affected. Other
genetic factors are the subject of research.
The incidence rates of ovarian cancer gradually
increased from 1980 until the mid-1990s, since
when they have been declining. Overall, ageadjusted rates rose by 10% between 1980 and
2006; the number of new cases rose by 40%.
Incidence rates have increased almost exclusively
among 70-year-old women since 1990. Mortality
rates have declined by 30% overall, the largest
decrease being among women under 60 years
old.
Survival and prevalence
The survival prospects of patients with ovarian
cancer are poorer compared to female patients
with other cancers of the genital organs. Population-based cancer registries in Germany put
the relative 5-year survival rates at between 35%
and 49%. These rates are comparable with those
in Finland and the USA (49% and 46% respectively). Calculations carried out in the USA show
that the survival rates vary with age (70% among
the under-45-year-olds, approx. 30% among
women over 65 years old). Approximately 26,000
women living in Germany in 2006 had been
diagnosed with ovarian cancer within the previous five years (5-year prevalence).
ICD-10 C56 | Cancer in Germany
Figure 3.13.1
Age-standardized incidence rates in Germany for 1980, 1990 and 2006, ICD-10 C56
per 100,000
90
Women
80
70
60
50
40
30
20
10
15–34
1980
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
69
Cancer in Germany 70
| Ovaries
Figure 3.13.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C56
Incidence per 100,000 (European Standard)
20
18
16
14
12
10
8
6
4
2
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.13.1
Cancer incidence and mortality risks in Germany by age, ICD-10 C56
Data basis 2006
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.2%
(1 in 640)
1.8%
(1 in 56)
<0.1%
(1 in 2,400)
1.1%
(1 in 87)
50
0.3%
(1 in 340)
1.6%
(1 in 61)
0.1%
(1 in 880)
1.1%
(1 in 89)
60
0.5%
(1 in 220)
1.4%
(1 in 72)
0.3%
(1 in 380)
1.0%
(1 in 96)
70
0.6%
(1 in 180)
1.0%
(1 in 98)
0.4%
(1 in 240)
0.8%
(1 in 120)
1.8%
(1 in 54)
1.1%
(1 in 88)
Lifetime risk
ICD-10 C56 | Cancer in Germany
Figure 3.13.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C56
New cases per 100,000 (European Standard)
Women
Germany, estimated
Bremen
Schleswig-Holstein
NRW (Münster dist.)
Lower Saxony
Bavaria
Rhineland-Palatinate
Hamburg
Saarland
Berlin
Brandenburg
Saxony
Meckl.-Western Pom.
Thuringia
Saxony-Anhalt
0
at least 90% registration:
cases
5
10
less than 90% registration rate:
15
20
25
cases
30
DCO cases
Figure 3.13.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C56
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Women
England
Denmark
Czech Republic
Norway
Germany
Poland
Finland
Belgium
Sweden
Austria
USA
Switzerland
France
Hong Kong
Netherlands
Australia
0
3
6
9
12
15
Incidence
Mortality
18
71
72
Cancer in Germany | Prostate
3.14 Prostate
Occurrence
Men
Incidence in 2006
60,120
Projection for 2010
64,370
Crude incidence rate*
149.1
Standardized incidence rate (Europe)*
110.1
Standardized incidence rate (World)*
Deaths 2006
over are asked once a year if they have any symptoms or have noticed any other changes in their
health; screening also includes an examination of
the sexual organs and the lymph nodes, as well
as a palpation examination of the prostate via the
rectum. Up to now, the PSA blood test has not
been made part of the statutory screening.
74.4
11,577
Standardized mortality rate (Europe)*
21.2
Standardized mortality rate (World)*
12.3
* per 100,000
Prostate cancer is now the most common cancer among men (26%) and causes 10% of cancer-related deaths among men. The median age
at onset is approx. 69 years, which corresponds
roughly to the figure for all cancer sites. Very few
people are diagnosed before the age of 50 years.
The risk of a 40-year-old man developing the disease in the following ten years is only 0.1%. The
risk of a 70-year-old man developing the disease
in the following ten years is 60 times higher at
6%.
The development in prostate cancer is characterized by decreasing mortality rates and a considerable increase in age-standardized incidence
rates, which can be largely attributed to the use of
prostate specific antigen (PSA) in prostate-cancer
screening.
Incidence and mortality trends
The annual number of new prostate cancer cases
in Germany has risen by 200%, the age-standardized incidence rate by 110% since 1980. This
increase can be largely attributed to the use of
new diagnostic methods, e.g. testing for prostate-specific antigen (PSA). Earlier diagnosis – in
terms of both the cancer’s stage of development
and the patient’s age – has led to significantly
higher incidence rates in the 50- to 69-year-old
age group, lower incidence rates among over-75year-olds, and a falling median age at onset from
73 years in 1980 to 69 years in 2006. Although
the number of deaths has increased by 30% since
1980 as a result of demographic trends (i.e. the
increase in the number of older men in the population), the age-standardized mortality rate has
fallen by 20%.
Survival and prevalence
Risk factors and screening
Up to now, the causes of prostate carcinoma and
the factors affecting the progression of the disease are essentially unknown. There is no doubt
that a role is played by male sex hormones, without which prostate cancer would not develop. The
connection with a positive family history (clustering of the disease among close relatives) has
also been shown, although there is as yet no conclusive evidence as to which inheritable genetic
defects are involved. Despite extensive research,
there is little in the way of reliable findings on
risk factors relating to lifestyle, diet or the environment. Under the current statutory screening
programme in Germany, men aged 45 years and
The relative 5-year survival rates of men with
prostate cancer in Germany are between 83% and
94%. Survival has improved considerably in the
last few years, particularly as a result of earlier
diagnosis due to screening.
In 2006, about 238,500 men living in Germany had been diagnosed with prostate cancer
within the previous five years (5-year prevalence).
ICD-10 C61 | Cancer in Germany
70–74
80–84
Figure 3.14.1
Age-standardized incidence rates in Germany for 1980, 1990 and 2006, ICD-10 C61
per 100,000
800
Men
700
600
500
400
300
200
100
45–49
1980
1990
2006
50–54
55–59
60–64
65–69
75–79
85+
Age group
73
74
Cancer in Germany | Prostate
Figure 3.14.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C61
Incidence per 100,000 (European Standard)
150
135
120
105
90
75
60
45
30
15
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among men
Mortality rate among men
Table 3.14.1
Cancer incidence and mortality risks in Germany by age, ICD-10 C61
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.1%
(1 in 1,000)
12.6%
(1 in 8)
<0.1%
(1 in 14,000)
3.3%
(1 in 30)
50
1.4%
(1 in 71)
12.8%
(1 in 8)
0.1%
(1 in 1,300)
3.4%
(1 in 29)
60
4.8%
(1 in 21)
12.4%
(1 in 8)
0.4%
(1 in 260)
3.6%
(1 in 28)
70
6.3%
(1 in 16)
9.5%
(1 in 11)
1.3%
(1 in 77)
3.8%
(1 in 27)
12.3%
(1 in 8)
3.3%
(1 in 31)
Lifetime risk
ICD-10 C61 | Cancer in Germany
Figure 3.14.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C61
New cases per 100,000 (European Standard)
Men
Lower Saxony
Schleswig-Holstein
Meckl.-Western Pom.
Brandenburg
NRW (Münster dist.)
Bavaria
Rhineland-Palatinate
Germany, estimated
Saarland
Hamburg
Saxony
Saxony-Anhalt
Bremen
Thuringia
Berlin
180
150
120
90
at least 90% registration:
60
cases
30
0
less than 90% registration rate:
cases
DCO cases
Figure 3.14.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C61
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Men
France
Australia
Sweden
USA
Belgium
Finland
Norway
Switzerland
Austria
Germany
Netherlands
Denmark
England
Czech Republic
Poland
Incidence
Mortality
180
Hong Kong
150
120
90
60
30
0
75
76
Cancer in Germany | Testis
3.15 Testis
Occurrence
Men
Incidence in 2006
4,960
Projection for 2010
4,700
Crude incidence rate*
12.3
Standardized incidence rate (Europe)*
11.7
Standardized incidence rate (World)*
11.2
Deaths 2006
154
Standardized mortality rate (Europe)*
0.3
Standardized mortality rate (World)*
0.3
* per 100.000
According to the RKI estimate, about 4,960 men
were diagnosed with testicular cancer in Germany in 2006. This corresponds to 2% of all
malignant cancers among men, making testicular cancer one of the rarer cancer sites. Because of
this disease’s low mortality rate, the assessment
of completeness and, therefore, the projection of
the nationwide incidence rate involves a certain
amount of uncertainty. The most recent evaluations of DRG (diagnosis-related group) statistics
and results in the countries bordering on Germany suggest slightly lower figures.
Unlike virtually all other cancers, most cases
of testicular cancer occur between the ages of 25
and 45 years. In this age group, testicular cancer
is the most common malignant tumour among
men. Accordingly, the median age at onset is 38
years. Assuming constant incidence rates, the
demographic development in Germany would
lead to a reduction in the annual number of testicular cancer cases up to 2010.
Risk factors
Undescended testis (cryptorchism) is regarded as
a confirmed risk factor for testicular cancer, even
if it has been properly treated. Men who have
already developed testicular cancer on one side
are at increased risk of also developing a testicular tumour on the side that was initially healthy. A
small proportion of the people affected evidently
have a genetic predisposition, since the sons and
brothers of patients with testicular cancer have
a markedly increased risk of developing the dis-
ease. However, at present there is little reliable
information on which inheritable genetic defects
are involved.
One hypothesis suggests that a predisposition
for germ-cell tumours, which are the most common form in the testes, possibly already develops
during the embryonic period from scattered cells
that go through a malignant development during
puberty. Up to now little is known about what
has caused the observed increase in incidence
in recent decades. Research is currently concentrating on prenatal risk factors, among others.
Several postnatal characteristics (early onset of
puberty, gigantism and subfertility) have also
been discussed as possible risk factors.
Incidence and mortality trends
A rise in the age-adjusted incidence of testicular cancer and falling mortality rates have been
observed for decades both in Germany and in the
rest of Europe. Both trends continue. The falling
mortality rates are explained by the successful
use of cis-platinum in the cytostatic treatment of
testicular cancer.
Survival and prevalence
With a relative 5-year survival rate of over 95%,
testicular cancer is one of the malignant neoplasms with the most favourable prognoses. At
the end of 2006, about 22,800 men living in
Germany had been diagnosed with this disease
within the previous five years.
ICD-10 C62 | Cancer in Germany
Figure 3.15.1
Age-standardized incidence rates in Germany for 1980, 1990 and 2006, ICD-10 C62
per 100,000
35
Men
30
25
20
15
10
5
0–14
1980
15–34
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
77
Cancer in Germany 78
| Testis
Figure 3.15.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C62
Incidence per 100,000 (European Standard)
20
18
16
14
12
10
8
6
4
2
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among men
Mortality rate among men
Table 3.15.1
Cancer incidence and mortality risks in Germany by age, ICD-10 C62
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
20
0.2%
(1 in 520)
0.8%
(1 in 130)
<0.1%
(1 in 31,000) <0.1%
(1 in 3,700)
30
0.3%
(1 in 360)
0.6%
(1 in 170)
<0.1%
(1 in 24,000) <0.1%
(1 in 4,200)
40
0.2%
(1 in 490)
0.3%
(1 in 320)
<0.1%
(1 in 18,000) <0.1%
(1 in 5,000)
50
0.1%
(1 in 1,600)
0.1%
(1 in 930)
<0.1%
(1 in 25,000) <0.1%
(1 in 6,700)
0.9%
(1 in 120)
<0.1%
(1 in 3,500)
Lifetime risk
ICD-10 C62 | Cancer in Germany
Figure 3.15.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C62
New cases per 100,000 (European Standard)
Men
Germany, estimated
NRW (Münster dist.)
Lower Saxony
Brandenburg
Schleswig-Holstein
Meckl.-Western Pom.
Saxony
Bremen
Saarland
Thuringia
Hamburg
Bavaria
Saxony-Anhalt
Berlin
Rhineland-Palatinate
18
15
12
9
at least 90% registration:
6
cases
3
0
less than 90% registration rate:
cases
DCO cases
Figure 3.15.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C62
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Men
Germany
Denmark
Norway
Switzerland
Austria
Czech Republic
Netherlands
Sweden
France
England
Australia
Belgium
USA
Poland
Finland
Incidence
Mortality
18
Hong Kong
15
12
9
6
3
0
79
80
Cancer in Germany | Kidney and efferent urinary tract
3.16 Kidney and efferent urinary tract
younger ages than kidney cancers not associated
with genetic predisposition.
Occurrence
Men
Women
10,050
6,440
10,750
6,650
Crude incidence rate*
24.9
15.3
Standardized incidence rate (Europe)*
19.2
9.9
Standardized incidence rate (World)*
13.5
6.9
Incidence in 2006
Projection for 2010
Deaths 2006
4,086
2,629
Standardized mortality rate (Europe)*
7.5
3.2
Standardized mortality rate (World)*
4.8
2.1
* per 100,000
Categorizing these diseases together makes it
possible to show trends in incidence rates over
time after 1998. 85% of malignant neoplasms
of the kidney in adults are renal cell carcinomas
(hypernephromas), whereas nephroblastomas
(Wilms’ tumours), sarcomas and lymphomas of
the kidney are more common among children.
Kidney cancer accounts for 4.4% of all cancers
among men and 3.3% among women; it causes
3.6% and 2.7% respectively of all cancer-related
deaths.
Risk factors
Smoking and passive smoking are regarded as
the most important risk factors. There appears to
be a connection between overweight and the incidence of kidney cancer, primarily among women.
In men, the type of fat distribution seems to be a
crucial determinant.
The uncontrolled intake of phenacetin-containing painkillers (which are no longer used
today) and the resultant damage to the kidneys
have been confirmed as risk factors for kidney
cancer. Chronic renal insufficiency, irrespective
of the cause, favours carcinogenesis in the kidney. Occupational exposure to kidney-damaging substances (e.g. halogenated hydrocarbons,
cadmium, etc.) can increase cancer risk by causing renal insufficiency. A family predisposition
is probably only a factor in relatively few cases.
Renal cell carcinomas, which occur in the context
of the rare, hereditary Hippel-Lindau syndrome,
are often multifocal and occur more frequently at
Incidence and mortality trends
The age-standardized incidence rates of kidney
cancer rose for both sexes until the mid-1990s
and have remained virtually unchanged since
then. The overall increase in rates since 1980 was
between 50% and 70%; by contrast, the number
of cases has more than doubled during this
period. The age-standardized mortality rate, too,
developed similarly for women and men; after
rates initially rose, a downward trend has been
observed since the early 1990s.
Survival and prevalence
The relative 5-year survival rates of patients with
kidney cancer were around 50% in the Saarland
in the 1980s; the state cancer registries currently
put the 5-year survival rates between 65% and
75%. A growing number of new kidney-cancer
cases per annum and generally more favourable
survival rates have meant that in 2006 about
60,000 people living in Germany, including
more than 37,000 men, had been diagnosed with
kidney cancer within the past five years (5-year
prevalence).
ICD-10 C64 – 66, C68 | Cancer in Germany
Figure 3.16.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C64 – 66, C68
per 100,000
140
Men
120
100
80
60
40
20
0–14
1980
15–34
1990
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
140
Women
120
100
80
60
40
20
15–34
1980
1990
35–39
40–44
2006
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
81
Cancer in Germany 82
| Kidney and efferent urinary tract
Figure 3.16.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C64 – 66, C68
Incidence per 100,000 (European Standard)
30
27
24
21
18
15
12
9
6
3
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.16.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C64 – 66, C68
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.1%
(1 in 860)
2.0%
(1 in 51)
<0.1%
(1 in 4,900)
1.0%
(1 in 100)
50
0.3%
(1 in 310)
1.9%
(1 in 52)
0.1%
(1 in 1,200)
1.0%
(1 in 100)
60
0.6%
(1 in 160)
1.7%
(1 in 59)
0.2%
(1 in 470)
1.0%
(1 in 110)
70
0.9%
(1 in 110)
1.3%
(1 in 79)
0.4%
(1 in 240)
0.9%
(1 in 120)
2.0%
(1 in 50)
0.9%
(1 in 110)
Lifetime risk
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.1%
(1 in 1,500)
1.2%
(1 in 82)
<0.1%
(1 in 10,000)
0.6%
(1 in 180)
50
0.2%
(1 in 620)
1.2%
(1 in 86)
<0.1%
(1 in 3,100)
0.6%
(1 in 180)
60
0.3%
(1 in 290)
1.0%
(1 in 96)
0.1%
(1 in 1,100)
0.5%
(1 in 190)
70
0.5%
(1 in 200)
0.8%
(1 in 130)
0.2%
(1 in 500)
0.5%
(1 in 210)
1.2%
(1 in 81)
0.6%
(1 in 180)
Lifetime risk
ICD-10 C64 – 66, C68 | Cancer in Germany
Figure 3.16.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C64 – 66, C68
New cases per 100,000 (European Standard)
Men
Women
Brandenburg
Meckl.-Western Pom.
Meckl.-Western Pom.
Brandenburg
Thuringia
Saxony
Saxony
Thuringia
Germany, estimated
Saxony-Anhalt
Saarland
Saxony-Anhalt
Germany, estimated
Bavaria
Rhineland-Palatinate
Lower Saxony
Bavaria
Bremen
Lower Saxony
Berlin
Bremen
Hamburg
Hamburg
Rhineland-Palatinate
Berlin
Schleswig-Holstein
NRW (Münster dist.)
Saarland
Schleswig-Holstein
30
25
NRW (Münster dist.)
20
15
at least 90% registration:
10
5
cases
0
0
5
10
less than 90% registration rate:
15
20
cases
25
30
DCO cases
Figure 3.16.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C64 – 66, C68 (except
France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Men
Women
Czech Republic
Czech Republic
USA
USA
Germany
Germany
Austria
Austria
Belgium
Finland
Belgium
Australia
Netherlands
France
Australia
Netherlands
Norway
Norway
England
Poland
Poland
England
Sweden
Schwitzerland
France
Finland
Denmark
Denmark
Incidence
Mortality
42
Schwitzerland
Sweden
35
28
21
14
7
Incidence
Mortality
Hong Kong
Hong Kong
0
0
7
14
21
28
35
42
83
84
Cancer in Germany | Bladder
3.17 Bladder
Occurrence
Incidence in 2006
Projection for 2010
Men
Women
19,360
8,090
21,420
8,480
Crude incidence rate*
48.0
19.2
Standardized incidence rate (Europe)*
35.7
11.1
Standardized incidence rate (World)*
23.0
7.4
3,549
1,893
Standardized mortality rate (Europe)*
6.5
2.0
Standardized mortality rate (World)*
3.9
1.2
Deaths 2006
* per 100,000
Invasive and surface-growing malignant neoplasms of the bladder are counted together with
tumours of uncertain or unknown behaviour,
because the criteria for categorizing the malignancy of a tumour of the bladder have changed
repeatedly over time. This makes it impossible
to map a trend over time of exclusively malignant neoplasms. As a result, the value of international comparisons is restricted, because many
cancer registries only count invasive tumours of
the bladder.
Virtually all malignant neoplasms of the bladder are carcinomas of the urothelium, which are
also called transitional-cell carcinomas and are
frequently multifocal (i.e. occurring in different
places in the same organ at the same time). Squamous cell carcinomas and adenocarcinomas of
the bladder are much rarer. A distinction is made
between flat and papillary (wart-shaped) growth
forms.
One in 23 men and one in 62 women develop
bladder cancer in the course of their lives, albeit
usually late in life: the median age at onset is
comparatively high at 72 years among men and
74 years among women.
Risk factors
Tobacco consumption is the main risk factor in
the development of bladder cancer. Passive smoking also increases the risk. Apart from tobacco
consumption, exposure to certain chemicals
(e.g. aromatic amines) is regarded as a risk. The
known, most hazardous substances have been
largely removed from the working processes of
the chemical industry as well as from rubber, textile and leather processing, and protective measures have been introduced in Europe over the
years. Despite these measures, bladder carcinomas caused by occupational exposure still occur
today because of the disease’s long latency.
Cytostatic drugs used in cancer therapy and
chronic-inflammatory damage to the bladder
mucosa also increase the risk of developing bladder cancer. Familial clustering is sometimes
observed, although no link to a corresponding
genetic defect has yet been confirmed.
Incidence and mortality trends
After a marked increase in the 1990s, which was
probably related to some extent to the abovementioned changes in malignancy criteria, the
age-standardized incidence rates have been falling markedly among men since the mid-1990s,
whereas the figures for women have tended to
stagnate. The age-standardized mortality rates,
however, have fallen by 20% among women and
40% among men since 1980.
Survival and prevalence
The prognosis in the case of bladder cancer varies
considerably, depending on how far the disease
has spread at the time of diagnosis. Many bladder
tumours with a favourable prognosis have been
added as a result of the above-mentioned aggregation of tumours, leading to 5-year survival rates
of 70% among women and 75% among men. In
2006, a total of 105,000 people (of whom 80,000
were men) living in Germany had developed bladder cancer within the previous five years (5-year
prevalence).
ICD-10 C67, D09.0, D41.4 | Cancer in Germany
Figure 3.17.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C67, D09.0, D41.4
per 100,000
400
Men
350
300
250
200
150
100
50
40–44
1980
1990
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
400
Women
350
300
250
200
150
100
50
40–44
1980
1990
2006
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
85
Cancer in Germany 86
| Bladder
Figure 3.17.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C67, D09.0, D41.4
Incidence per 100,000 (European Standard)
50
45
40
35
30
25
20
15
10
5
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.17.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C67, D09.0, D41.4
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.1%
(1 in 930)
4.5%
(1 in 22)
<0.1%
(1 in 13,000)
1.0%
(1 in 100)
50
0.4%
(1 in 230)
4.5%
(1 in 22)
<0.1%
(1 in 2,600)
1.0%
(1 in 100)
60
1.0%
(1 in 97)
4.4%
(1 in 23)
0.1%
(1 in 750)
1.0%
(1 in 98)
70
2.0%
(1 in 49)
4.0%
(1 in 25)
0.4%
(1 in 260)
1.0%
(1 in 95)
4.4%
(1 in 23)
1.0%
(1 in 110)
Lifetime risk
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.1%
(1 in 1,500)
1.6%
(1 in 61)
<0.1%
(1 in 23,000)
0.4%
(1 in 240)
50
0.2%
(1 in 610)
1.6%
(1 in 62)
<0.1%
(1 in 6,600)
0.4%
(1 in 230)
60
0.3%
(1 in 300)
1.5%
(1 in 67)
<0.1%
(1 in 2,600)
0.4%
(1 in 230)
70
0.6%
(1 in 170)
1.3%
(1 in 79)
0.1%
(1 in 830)
0.4%
(1 in 240)
1.6%
(1 in 62)
0.4%
(1 in 240)
Lifetime risk
ICD-10 C67, D09.0, D41.4 | Cancer in Germany
Figure 3.17.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C67, D09.0, D41.4
New cases per 100,000 (European Standard)
Men
Women
Schleswig-Holstein
Lower Saxony
Germany, estimated
NRW (Münster dist.)
Saarland
Schleswig-Holstein
Lower Saxony
Saarland
Brandenburg
Bremen
Bremen
Brandenburg
NRW (Münster dist.)
Hamburg
Germany, estimated
Berlin
Meckl.-Western Pom.
Rhineland-Palatinate
Rhineland-Palatinate
Hamburg
Berlin
Meckl.-Western Pom.
Saxony
Bavaria
Thuringia
Saxony
Bavaria
Thuringia
Saxony-Anhalt
60
50
40
Saxony-Anhalt
30
at least 90% registration:
20
cases
10
0
0
10
20
less than 90% registration rate:
30
40
cases
50
60
DCO cases
Figure 3.17.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C67, D09.0, D41.4
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100.000 (European Standard), *excl. in situ tumours and neoplasms of uncertain or unknown behaviour (D 09.0, D41.4)
Data sources, see appendix, page 117
Men
Women
Denmark
Denmark
Germany
Germany
Norway
Norway
Czech Republic*
Czech Republic*
Sweden
USA
USA
Austria*
Austria*
Sweden
England*
Belgium*
Netherlands*
Poland*
Finland
France*
Switzerland*
Netherlands*
Finland
Belgium*
Switzerland*
Poland*
Australia*
England*
Incidence
Mortality
60
France*
Australia*
50
40
30
20
10
Incidence
Mortality
Hong Kong*
Hong Kong*
0
0
10
20
30
40
50
60
87
88
Cancer in Germany | Nervous system
3.18 Nervous system
izing radiation in diagnostic imaging procedures
or from exposure to radiation in other contexts.
Occurrence
Men
Women
3,880
3,290
4,060
3,340
Crude incidence rate*
9.6
7.8
Standardized incidence rate (Europe)*
8.2
6.3
Standardized incidence rate (World)*
6.7
5.2
Incidence in 2006
Projection for 2010
Deaths 2006
2,955
2,600
Standardized mortality rate (Europe)*
5.9
4.1
Standardized mortality rate (World)*
4.4
3.0
* per 100,000
Most cancers of the central nervous system (CNS)
are brain tumours, although the latter do not
develop from nerve cells, but (for example) from
nerve sheaths and meninges. They are the source
of 1.7% of all cancer cases among women and
men and cause 2.6% of cancer-related deaths.
The median age at onset is 63 years among
women and 60 years among men. Tumours of
the central nervous system account for over 20%
of all new cancer cases among children. The risk
of developing cancer of the central nervous system in the following ten years is about the same
for 60-year-old as for 70-year-old women and
men: 0.2%. The lifetime risk is 0.6% for women
and 0.7% for men.
In this publication, the RKI estimate has
determined the incidence of cancers of the central nervous system in Germany for the first time.
The results of this initial estimate are still uncertain, however, because up to now it has only been
possible to use data from the Saarland cancer registry.
Risk factors
The causes of the various brain tumours are
largely unclear to date. According to the information currently available, neither environmental
factors nor electromagnetic radiation (e.g. from
mobile phones) contribute to an increase in risk.
Although the therapeutic irradiation of the head
in children increases risk after a long latency
period, according to data available up to now
there is no measurable risk from the use of ion-
Incidence and mortality trends
From the 1980s to the mid-1990s, the age-standardized mortality rate from cancer of the central
nervous system among women and men rose by
50% and the number of cancer deaths by more
than 100%. The increase in mortality rates from
malignant neoplasms of the central nervous system affected almost exclusively people over the
age of 65 years and was recorded against the
background of a falling number of deaths due
to neoplasms of uncertain and unknown behaviour. The increase in incidence figures (+50%)
and rates (+25% among women, +30% among
men) was less steep than the rise in deaths and
mortality rates. As already observed in the case of
mortality rates, only the incidence rates among
older women and men (70 years old and over)
kept rising. By contrast, the incidence rates
among women and men under 60 years old have
declined since the 1990s.
Survival and prevalence
The state population-based cancer registries have
not yet reported survival rates for patients with
cancer of the brain and the central nervous system. Current overall survival rates in the USA
are between 34% and 38%. Older patients have
a much poorer prognosis: women and men over
65 years old in the USA have very unfavourable
5-year survival rates of only 5% to 7%.
There is currently no reliable information on
the prevalence of cancers of the CNS in Germany.
ICD-10 C70–72 | Cancer in Germany
Figure 3.18.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C70 – 72
per 100,000
40
Men
35
30
25
20
15
10
5
0–14
1980
15–34
1990
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
40
Women
35
30
25
20
15
10
5
0–14
1980
15–34
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
89
Cancer in Germany 90
| Nervous system
Figure 3.18.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C70 – 72
Incidence per 100,000 (European Standard)
10
9
8
7
6
5
4
3
2
1
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.18.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C70 – 72
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.1%
(1 in 1,300)
0.6%
(1 in 160)
<0.1%
(1 in 2,100)
0.5%
(1 in 190)
50
0.1%
(1 in 700)
0.6%
(1 in 180)
0.1%
(1 in 1,000)
0.5%
(1 in 200)
60
0.2%
(1 in 540)
0.5%
(1 in 220)
0.2%
(1 in 610)
0.4%
(1 in 230)
70
0.2%
(1 in 460)
0.3%
(1 in 320)
0.2%
(1 in 490)
0.3%
(1 in 310)
0.7%
(1 in 140)
0.6%
(1 in 170)
Lifetime risk
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.1%
(1 in 1,800)
0.5%
(1 in 190)
<0.1%
(1 in 3,400)
0.5%
(1 in 210)
50
0.1%
(1 in 1,000)
0.5%
(1 in 210)
0.1%
(1 in 1,700)
0.5%
(1 in 220)
60
0.2%
(1 in 640)
0.4%
(1 in 260)
0.1%
(1 in 840)
0.4%
(1 in 240)
70
0.2%
(1 in 630)
0.2%
(1 in 410)
0.2%
(1 in 580)
0.3%
(1 in 310)
0.6%
(1 in 160)
0.5%
(1 in 200)
Lifetime risk
ICD-10 C70–72 | Cancer in Germany
Figure 3.18.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C70–72
New cases per 100,000 (European Standard)
Men
Women
Germany, estimated
Saarland
Germany, estimated
Schleswig-Holstein
Saxony
Saxony
Thuringia
Berlin
Berlin
Saarland
Brandenburg
Bavaria
Bavaria
Brandenburg
Meckl.-Western Pom.
Saxony-Anhalt
Bremen
Bremen
Schleswig-Holstein
Thuringia
NRW (Münster dist.)
Lower Saxony
Hamburg
Hamburg
Saxony-Anhalt
Meckl.-Western Pom.
Lower Saxony
NRW (Münster dist.)
Rhineland-Palatinate
12
10
8
Rhineland-Palatinate
6
at least 90% registration:
4
cases
2
0
0
2
4
less than 90% registration rate:
6
8
cases
10
12
DCO cases
Figure 3.18.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C70 – 72
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100.000 (European Standard), *incl. benign tumours and neoplasms of uncertain or unknown behaviour (D32, D33, D42, D43)
Data sources, see appendix, page 117
Men
Women
Norway*
Denmark*
Denmark*
Norway*
Finland*
Finland*
Sweden*
Sweden*
Poland
Poland
Germany
Germany
Australia
Australia
Czech Republic
England
England
Czech Republic
Belgium
Belgium
Netherlands
France
Switzerland
Austria
Switzerland
USA
Incidence
Mortality
30
France
USA
Austria
Netherlands
25
20
15
10
5
Incidence
Mortality
Hong Kong
Hong Kong
0
0
5
10
15
20
25
30
91
92
Cancer in Germany | Thyroid gland
3.19 Thyroid gland
Occurrence
Incidence in 2006
Projection for 2010
Men
Women
1,620
3,660
1,670
3,680
Crude incidence rate*
4.0
8.7
Standardized incidence rate (Europe)*
3.4
7.5
Standardized incidence rate (World)*
2.7
6.1
Deaths 2006
258
502
Standardized mortality rate (Europe)*
0.5
0.6
Standardized mortality rate (World)*
0.3
0.4
* per 100,000
There are four types of thyroid cancer with different clinical progressions and prognoses:
▶▶ papillary carcinomas (approx. 50%, typically
affecting young adults),
▶▶ follicular carcinomas (20-30%, for which frequency peaks in the 50- to 60-year-old age
group),
▶▶ anaplastic carcinomas (10%, predominantly
affecting the elderly) and
▶▶ medullary or C-cell carcinomas.
The latter develop from special cells in the thyroid gland which regulate calcium metabolism.
Thyroid cancer makes up 1.9% of all malignant
neoplasms among women and 0.7% among
men; it causes 0.5% and 0.2% of cancer-related
deaths respectively. The highest risk of developing this cancer in the following ten years is
among 50-year-old women.
Risk factors
One confirmed (albeit comparatively rare) risk
factor is exposure to ionizing radiation, above all
in childhood. Goitre diseases, which are common in regions of iodine deficiency, increase the
risk, especially among people under the age of 50
years. Furthermore, the proportion of papillary
and anaplastic carcinomas is regularly higher in
such regions. Benign adenomas also increase thyroid cancer risk. About a quarter of patients with
rare medullary thyroid carcinomas have inheritable genetic defects (multiple endocrine neoplasia
type 2, or MEN 2) with an autosomal dominant
inheritance pattern. A genetic component is also
regarded as a probable risk factor in the case of
non-medullary forms of the disease. Apart from
iodine deficiency, no risk factors related to diet
or lifestyle have yet been reliably substantiated.
Incidence and mortality trends
Thyroid cancer mortality rates for women and
men in Germany have fallen by more than 40%,
while the number of new cases and the age-standardized incidence rates have risen considerably.
Incidence rates among women have risen sharply
among under-60-year-olds since 1990; rates have
increased slightly among 60- to 75-year-olds and
remained constant among older women. Incidence rates have also risen among younger and
fallen among older men. Cancers of the thyroid
are being detected earlier and at a more easily
treatable stage, especially among women. This
has led to higher incidence rates among younger
people, lower incidence rates among older people, and declining mortality rates.
Survival and prevalence
The best survival prospects are associated with
papillary carcinoma, the typical thyroid carcinoma in young people, while the chances of survival with an anaplastic thyroid carcinoma are
slim. The state cancer registries report relative
5-year survival rates of 90% for women. Survival
rates for men are currently between 77% and
87%. In Finland and the USA, too, the survival
rates for women (93% and 98% respectively) are
better than for men (85% and 94%). The 5-year
survival rates of patients with thyroid cancer
in the Saarland before 1990 were 77% among
women and 67% among men. In 2006, 15,300
women and 6,000 men living in Germany had
been diagnosed with thyroid cancer within the
previous five years (5-year prevalence).
ICD-10 C73 | Cancer in Germany
Figure 3.19.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C73
per 100,000
21
Men
18
15
12
9
6
3
15–34
1980
1990
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
21
Women
18
15
12
9
6
3
15–34
1980
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
93
Cancer in Germany 94
| Thyroid gland
Figure 3.19.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C73
Incidence per 100,000 (European Standard)
10
9
8
7
6
5
4
3
2
1
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.19.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C73
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
<0.1%
(1 in 2,200)
0.2%
(1 in 400)
<0.1%
(1 in 56,000)
0.1%
(1 in 1,600)
50
0.1%
(1 in 1,400)
0.2%
(1 in 480)
<0.1%
(1 in 13,000)
0.1%
(1 in 1,600)
60
0.1%
(1 in 1,300)
0.1%
(1 in 690)
<0.1%
(1 in 8,300)
0.1%
(1 in 1,700)
70
0.1%
(1 in 1,600)
0.1%
(1 in 1,300)
<0.1%
(1 in 4,600)
0.1%
(1 in 1,900)
0.3%
(1 in 350)
0.1%
(1 in 1,600)
Lifetime risk
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.1%
(1 in 820)
0.5%
(1 in 190)
<0.1%
(1 in 58,000)
0.1%
(1 in 950)
50
0.1%
(1 in 690)
0.4%
(1 in 250)
<0.1%
(1 in 18,000)
0.1%
(1 in 950)
60
0.1%
(1 in 770)
0.3%
(1 in 370)
<0.1%
(1 in 6,700)
0.1%
(1 in 970)
70
0.1%
(1 in 970)
0.2%
(1 in 650)
<0.1%
(1 in 2,600)
0.1%
(1 in 1,000)
0.7%
(1 in 150)
0.1%
(1 in 950)
Lifetime risk
ICD-10 C73 | Cancer in Germany
Figure 3.19.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C73
New cases per 100,000 (European Standard)
Men
Women
Bavaria
Bavaria
Germany, estimated
Berlin
Brandenburg
Brandenburg
Germany, estimated
Berlin
NRW (Münster dist.)
Meckl.-Western Pom.
Saxony
NRW (Münster dist.)
Saxony-Anhalt
Lower Saxony
Saarland
Bremen
Lower Saxony
Saxony-Anhalt
Saxony
Rhineland-Palatinate
Rhineland-Palatinate
Schleswig-Holstein
Schleswig-Holstein
Thuringia
Saarland
Meckl.-Western Pom.
Thuringia
Bremen
Hamburg
Hamburg
12
10
8
6
at least 90% registration:
4
2
cases
0
0
2
4
6
less than 90% registration rate:
8
10
cases
12
DCO cases
Figure 3.19.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C73
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Men
Women
USA
USA
France
Austria
Austria
France
Australia
Australia
Hong Kong
Germany
Czech Republic
Switzerland
Norway
Belgium
Belgium
Finland
Switzerland
Hong Kong
Germany
Czech Republic
Poland
Finland
Norway
Poland
England
Denmark
Sweden
Sweden
18
Denmark
England
Incidence
Mortality
15
12
9
6
3
Incidence
Mortality
Netherlands
Netherlands
0
0
3
6
9
12
15
18
95
96
Cancer in Germany | Hodgkin‘s lymphoma
3.20 Hodgkin‘s lymphoma
Occurrence
Men
Women
1,130
890
Projection for 2010
970
870
Crude incidence rate*
2.8
2.1
Standardized incidence rate (Europe)*
2.7
2.0
Incidence in 2006
Standardized incidence rate (World)*
2.5
2.0
Deaths 2006
180
162
Standardized mortality rate (Europe)*
0.3
0.2
Standardized mortality rate (World)*
0.2
0.2
* per 100,000
Hodgkin’s lymphoma, formerly known as Hodgkin’s disease, is distinguished from non-Hodgkin lymphomas by the histologically confirmed
presence of microscopic Reed-Sternberg giant
cells in the bone marrow and the lymph nodes.
About 2,020 people were diagnosed with Hodgkin’s lymphoma in Germany in 2006. The disease can occur at all ages; the median age at diagnosis is about 46 years among men and 41 years
among women.
Risk factors
The risk factors for Hodgkin’s lymphoma have
only been partly clarified up to now. According to
the data currently available, lifestyle-related risk
factors or environmental risks cannot be held
responsible for the development of Hodgkin’s
lymphoma. As in the case of non-Hodgkin lymphomas, congenital and acquired characteristics
of the immune system as well as viral infections
are under discussion. However, up to now their
respective influence has not been quantified, and
certainly no proven cause has been identified for
any individual case.
Epstein-Barr viruses, the pathogens of
Pfeiffer’s glandular fever (infectious mononucleosis), and retroviruses (e.g. HTLV and HIV) have
been under discussion as possible contributory
factors for a long time. New study findings have
confirmed the role of the Epstein-Barr virus: the
proportion of Hodgkin patients was nine times
higher among study participants who had developed mononucleosis before their sixth birthday
than in the control group. The hepatitis B virus
also seems to play a role, according to recent studies. Children and siblings of patients with Hodgkin’s lymphoma have a markedly enhanced risk
of developing the disease themselves. Scientific
interest is therefore increasingly focusing on
hereditary factors, although up to now research
has not identified unequivocally risk-enhancing
or inheritable genetic defects.
Incidence and mortality trends
Age-standardized incidence rates estimated for
Germany reveal a consistently decreasing trend
among men; the same trend was not recorded
among women until the 1990s. This estimate
involves uncertainties, however, because the
number of cases is small. Mortality fell markedly
in both sexes during the observation period.
Survival and prevalence
The prognosis for patients with Hodgkin’s lymphoma is favourable. The relative 5-year survival rates lie between approx. 75% and 90%. At
the end of 2006, about 4,500 men and 4,300
women living in Germany had been diagnosed
with Hodgkin’s lymphoma within the previous
five years (5-year prevalence).
ICD-10 C81 | Cancer in Germany
Figure 3.20.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C81
per 100,000
8
Men
7
6
5
4
3
2
1
0–14
1980
15–34
1990
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
8
Women
7
6
5
4
3
2
1
0–14
1980
15–34
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
97
98
Cancer in Germany | Hodgkin‘s lymphoma
Figure 3.20.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C81
Incidence per 100,000 (European Standard)
5.0
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.20.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C81
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
20
<0.1%
(1 in 3,700)
0.2%
(1 in 580)
<0.1%
(1 in 88,000)
<0.1%
(1 in 2,600)
30
<0.1%
(1 in 3,800)
0.2%
(1 in 680)
<0.1%
(1 in 40,000)
<0.1%
(1 in 2,700)
40
<0.1%
(1 in 3,900)
0.1%
(1 in 810)
<0.1%
(1 in 40,000)
<0.1%
(1 in 2,900)
50
<0.1%
(1 in 3,300)
0.1%
(1 in 1,000)
<0.1%
(1 in 27,000)
<0.1%
(1 in 3,000)
0.2%
(1 in 480)
<0.1%
(1 in 2,600)
Lifetime risk
Risk of developing the disease
Women
aged
in the next 10 years
ever
20
<0.1%
(1 in 3,400)
0.1%
30
<0.1%
(1 in 3,800)
40
<0.1%
(1 in 6,200)
50
<0.1%
(1 in 7,100)
Lifetime risk
Risk of dying of the disease
in the next 10 years
ever
(1 in 720)
<0.1%
(1 in 180,000)
<0.1%
(1 in 3,000)
0.1%
(1 in 920)
<0.1%
(1 in 90,000)
<0.1%
(1 in 3,100)
0.1%
(1 in 1,200)
<0.1%
(1 in 61,000)
<0.1%
(1 in 3,200)
0.1%
(1 in 1,470)
<0.1%
(1 in 40,000)
<0.1%
(1 in 3,300)
0.2%
(1 in 610)
<0.1%
(1 in 3,000)
ICD-10 C81 | Cancer in Germany
Figure 3.20.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C81
New cases per 100,000 (European Standard)
Men
Women
Saarland
Brandenburg
Schleswig-Holstein
Berlin
Saxony
Schleswig-Holstein
Germany, estimated
Hamburg
Lower Saxony
Meckl.-Western Pom.
Germany, estimated
Bavaria
Thuringia
Lower Saxony
Saarland
Brandenburg
Hamburg
NRW (Münster dist.)
Saxony-Anhalt
Bavaria
NRW (Münster dist.)
Rhineland-Palatinate
Berlin
Bremen
Rhineland-Palatinate
Saxony
Bremen
Saxony-Anhalt
Meckl.-Western Pom.
Thuringia
6
5
4
3
2
at least 90% registration:
cases
1
0
0
1
2
3
less than 90% registration rate:
4
cases
5
6
DCO cases
Figure 3.20.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C81
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Men
Women
France
Belgium
USA
Finland
Denmark
Switzerland
Switzerland
Denmark
Australia
USA
Netherlands
England
Czech Republic
Norway
Czech Republic
England
Australia
Belgium
Germany
Germany
Finland
Austria
Norway
France
Poland
Netherlands
Sweden
Sweden
Incidence
Mortality
6
Austria
Poland
5
4
3
2
1
Incidence
Mortality
Hong Kong
Hong Kong
0
0
1
2
3
4
5
6
99
100
Cancer in Germany | Non-Hodgkin lymphomas
3.21 Non-Hodgkin lymphomas
Occurrence
Men
Women
6,410
6,350
Projection for 2010
6,820
6,580
Crude incidence rate*
15.9
15.1
Standardized incidence rate (Europe)*
12.6
9.9
Standardized incidence rate (World)*
9.2
7.2
2,732
2,734
Standardized mortality rate (Europe)*
5.2
3.4
Standardized mortality rate (World)*
3.3
2.2
Incidence in 2006
Deaths 2006
* per 100,000
Several different malignant diseases of the lymphatic
system are subsumed under the term “non-Hodgkin
lymphomas”. There were about 12,800 new cases
in Germany in 2006, divided approximately equally
between men and women. The median age at onset
is higher among women (70 years) than among men
(67 years).
Risk factors
In the group of non-Hodgkin lymphomas, little can
be said about risk factors that is valid for all forms.
A weakening of the immune system (e.g. as a result
of an HIV infection or immunosuppressive treatment) involves an increased risk of developing the
disease. Viral infections also contribute to the development of these diseases, although the extent of their
influence is difficult to assess. There is a confirmed
causal association between an infection with the
Epstein-Barr virus (EBV, the pathogen of Pfeiffer’s
glandular fever, also known as infectious mononucleosis) and Burkitt’s lymphoma, which occurs predominantly in Africa. Clusters of T-cell lymphomas
are observed in association with human T-cell leukaemia virus HTLV-1 infections. Recent studies also
suggest that certain types of lymphoma are more
likely to develop in the context of chronic infections with hepatitis viruses (type B or C). A chronic
inflammation of the gastric mucosa (stomach lining)
with the bacterium Helicobacter pylori (which also
causes stomach ulcers) seems to increase the risk of
developing a local lymphoma of the gastric mucosa
(MALT lymphoma). Furthermore, occupational and
industrial exposure to heavy metals, certain organic
solvents, herbicides, organophosphate insecticides
and fungicides are under discussion as causal factors. However, it is very rare that a specific cause can
be identified in an individual patient’s case history.
Radioactive radiation can trigger malignant lymphomas. In addition, smoking seems to play a role in the
case of highly aggressive forms.
New studies suggest that certain congenital
genetic defects might influence the risk of developing the disease without themselves being the
direct trigger of lymphomas. These include variations in genes that regulate programmed cell
death, become active in inflammation processes
or in the context of an immune reaction, or are
relevant for the stability of the genetic code.
Incidence and mortality trends
The age-standardized incidence rates rose for both
sexes between 1980 and 1995. There are signs of a
slight decrease since the turn of the millennium. The
mortality rates have developed in a similar way.
Survival and prevalence
The 5-year survival rate among people with nonHodgkin lymphomas is 45% to 62% among men
and 56% to 69% among women. At the end of 2006,
about 22,000 women and about 20,700 men living
in Germany had been diagnosed with a non-Hodgkin lymphoma within the previous five years (5-year
prevalence).
ICD-10 C82 – 85 | Cancer in Germany
Figure 3.21.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C82 – 85
per 100,000
80
Men
70
60
50
40
30
20
10
0–14
1980
15–34
1990
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
80
Women
70
60
50
40
30
20
10
0–14
1980
15–34
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
101
Cancer in Germany 102
| Non-Hodgkin lymphomas
Figure 3.21.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C82 – 85
Incidence per 100,000 (European Standard)
20
18
16
14
12
10
8
6
4
2
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.21.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C82 – 85
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
0.1%
(1 in 1,100)
1.2%
(1 in 82)
<0.1%
(1 in 5,200)
0.6%
(1 in 160)
50
0.2%
(1 in 500)
1.2%
(1 in 86)
0.1%
(1 in 2,000)
0.6%
(1 in 160)
60
0.3%
(1 in 300)
1.0%
(1 in 96)
0.1%
(1 in 760)
0.6%
(1 in 160)
70
0.5%
(1 in 200)
0.8%
(1 in 120)
0.3%
(1 in 340)
0.6%
(1 in 170)
1.3%
(1 in 77)
0.6%
(1 in 160)
Lifetime risk
Risk of developing the disease
Women
aged
in the next 10 years
ever
40
0.1%
(1 in 1,400)
1.2%
50
0.2%
(1 in 600)
60
0.3%
(1 in 360)
70
0.4%
(1 in 240)
Lifetime risk
Risk of dying of the disease
in the next 10 years
ever
(1 in 84)
<0.1%
(1 in 9,300)
0.6%
(1 in 180)
1.1%
(1 in 88)
<0.1%
(1 in 3,400)
0.6%
(1 in 180)
1.0%
(1 in 100)
0.1%
(1 in 1,100)
0.6%
(1 in 180)
0.8%
(1 in 130)
0.2%
(1 in 460)
0.5%
(1 in 200)
1.2%
(1 in 81)
0.6%
(1 in 170)
ICD-10 C82 – 85 | Cancer in Germany
Figure 3.21.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C82 – 85
New cases per 100,000 (European Standard)
Men
Women
Schleswig-Holstein
Schleswig-Holstein
Meckl.-Western Pom.
Lower Saxony
Lower Saxony
Bremen
Meckl.-Western Pom.
Bremen
NRW (Münster dist.)
Germany, estimated
Berlin
NRW (Münster dist.)
Saarland
Saarland
Brandenburg
Hamburg
Germany, estimated
Berlin
Saxony-Anhalt
Bavaria
Rhineland-Palatinate
Thuringia
Hamburg
Saxony
Saxony
Brandenburg
Thuringia
Rhineland-Palatinate
Bavaria
Saxony-Anhalt
24
20
16
12
at least 90% registration:
8
4
cases
0
0
4
8
less than 90% registration rate:
12
16
cases
20
24
DCO cases
Figure 3.21.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C82 – 85
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Cases per 100,000 (European Standard)
Data sources, see appendix, page 117
Men
Women
USA
USA
Australia
Netherlands
Netherlands
Australia
Finland
Finland
Switzerland
Norway
Belgium
Norway
Switzerland
Belgium
England
England
France
Denmark
France
Denmark
Germany
Sweden
Sweden
Germany
Austria
Austria
Hong Kong
Czech Republic
Incidence
Mortality
24
Czech Republic
Hong Kong
Poland
20
16
12
8
Incidence
Mortality
Poland
4
0
0
4
8
12
16
20
24
103
104
Cancer in Germany | Leukaemias
3.22 Leukaemias
Occurrence
Men
Women
5,080
4,220
Projection for 2010
5,440
4,350
Crude incidence rate*
12.6
10.0
Standardized incidence rate (Europe)*
10.3
7.2
Standardized incidence rate (World)*
8.0
5.8
3,720
3,387
Standardized mortality rate (Europe)*
7.0
4.3
Standardized mortality rate (World)*
4.7
2.9
Incidence in 2006
Deaths 2006
* per 100,000
Leukaemias originate in the bone marrow and
are classified according to acute and chronic
forms and the different cell types affected. The
main groups – acute lymphatic leukaemia (ALL),
acute myeloid leukaemia (AML), chronic myeloid
leukaemia (CML) and chronic lymphatic leukaemia (CLL) – differ substantially in terms of epidemiology, disease biology and prognosis. While
chronic forms of leukaemia only occur in adults,
ALL is the most common cancer among children.
AML occurs at all ages, but reaches its frequency
peak at an older age. It should be noted in particular that, depending on molecular biological findings, chronic lymphatic leukaemias can also be
classified as low-risk lymphomas with a leukemic
progression. This blurs the distinction between
leukaemias and non-Hodgkin lymphomas. About
9,300 people were diagnosed with a form of leukaemia in Germany in 2006. The median age at
diagnosis of the disease is 68 years among men
and 69 years among women.
Risk factors
Although there are known risk factors that can
trigger acute leukaemias (e.g. ionizing radiation,
cytostatic drugs used in cancer therapy, and probably certain chemicals), these are not documented
in the medical history of most patients Several
comparatively rare genetic defects can increase
the risk of leukaemia. The influence of viruses
is under discussion but has not been unequivocally verified. There is also discussion on whether
insufficient training of the immune system in
childhood might contribute to an increase in the
risk, although this discussion has been inconclusive up to now. An association with exposure to
electromagnetic fields of various origins has not
been proven so far.
The causes of chronic leukaemias, the most
common leukemic diseases in adults, are largely
unknown. Research is currently being carried out
on genetic defects, which might possibly contribute to an increased risk.
No evidence exists to link people’s eating habits or lifestyle to risk of either acute or chronic
leukaemias.
Incidence and mortality trends
Following an upward trend through the early
1990s, age-standardized incidence rates of leukaemias have been falling. The mortality rates
have already been declining since 1980. The classification problems vis-à-vis non-Hodgkin lymphomas make it more difficult to interpret these
results, although incidence rates of the latter are
also falling.
Survival and prevalence
The relative 5-year survival rates for all forms
of leukaemia in Germany are between 35% and
50%; acute leukaemias in adults have the worst
prognosis. In turn, the survival prospects of children are much better than those of adults (see
section 4). In 2006, about 12,800 men and
10,700 women living in Germany had been diagnosed with a leukaemia within the previous five
years (5-year prevalence).
ICD-10 C91 – 95 | Cancer in Germany
Figure 3.22.1
Age-standardized incidence rates in Germany by gender for 1980, 1990 and 2006, ICD-10 C91 – 95
per 100,000
140
Men
120
100
80
60
40
20
0–14
1980
15–34
1990
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
2006
140
Women
120
100
80
60
40
20
0–14
1980
15–34
1990
35–39
2006
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Age group
105
106
Cancer in Germany | Leukaemias
Figure 3.22.2
Age-standardized incidence and mortality rates in Germany, 1980 – 2006, ICD-10 C91 – 95
Incidence per 100,000 (European Standard)
20
18
16
14
12
10
8
6
4
2
1980
1982
1984
1986
Incidence rate among men
Mortality rate among men
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Incidence rate among women
Mortality rate among women
Table 3.22.1
Cancer incidence and mortality risks in Germany by age and gender, ICD-10 C91 – 95
Data basis 2006
Risk of developing the disease
Men
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
<0.1%
(1 in 2,200)
1.0%
(1 in 100)
<0.1%
(1 in 5,200)
0.9%
(1 in 120)
50
0.1%
(1 in 870)
1.0%
(1 in 100)
0.1%
(1 in 1,900)
0.9%
(1 in 120)
60
0.3%
(1 in 400)
0.9%
(1 in 110)
0.2%
(1 in 610)
0.9%
(1 in 120)
70
0.4%
(1 in 240)
0.8%
(1 in 130)
0.4%
(1 in 250)
0.8%
(1 in 120)
1.1%
(1 in 90)
0.9%
(1 in 120)
Lifetime risk
Risk of developing the disease
Women
aged
in the next 10 years
ever
Risk of dying of the disease
in the next 10 years
ever
40
<0.1%
(1 in 2,300)
0.7%
(1 in 140)
<0.1%
(1 in 6,700)
0.7%
(1 in 150)
50
0.1%
(1 in 1,000)
0.7%
(1 in 140)
<0.1%
(1 in 2,800)
0.7%
(1 in 150)
60
0.2%
(1 in 580)
0.6%
(1 in 160)
0.1%
(1 in 950)
0.7%
(1 in 150)
70
0.2%
(1 in 420)
0.5%
(1 in 200)
0.2%
(1 in 420)
0.6%
(1 in 160)
0.8%
(1 in 120)
0.7%
(1 in 140)
Lifetime risk
ICD-10 C91 – 95 | Cancer in Germany
Figure 3.22.3
Registered age-standardized incidence rates in the regions of Germany, 2005 – 2006, ICD-10 C91 – 95
New cases per 100,000 (European Standard)
Men
Women
Lower Saxony
Schleswig-Holstein
Schleswig-Holstein
Lower Saxony
Meckl.-Western Pom.
Saarland
Saxony
Saxony-Anhalt
Berlin
Brandenburg
Brandenburg
Meckl.-Western Pom.
Hamburg
Hamburg
Bavaria
Thuringia
Saxony-Anhalt
Saxony
Rhineland-Palatinate
Berlin
Thuringia
NRW (Münster dist.)
Germany, estimated
NRW (Münster dist.)
Saarland
Bavaria
Germany, estimated
Rhineland-Palatinate
Bremen
18
15
12
9
at least 90% registration:
Bremen
6
cases
3
0
0
3
6
9
less than 90% registration rate:
12
cases
15
18
DCO cases
Figure 3.22.4
Age-standardized incidence and mortality rates in Germany in 2006 compared internationally, ICD-10 C91 – 95
(except France, Australia in 2005, Switzerland in 2003–2006, Belgium [mortality rates] in 2004)
Fälle per 100,000 (Europastandard)
Data sources, see appendix, page 117
Men
Women
Netherlands
Australia
USA
USA
Australia
Denmark
Norway
Netherlands
Sweden
Switzerland
England
Austria
Norway
Denmark
Switzerland
Czech Republic
Finland
Sweden
Germany
Austria
Finland
Czech Republic
Belgium
England
Belgium
Germany
France
France
18
Hong Kong
Poland
Incidence
Mortality
15
12
9
Incidence
Mortality
Poland
Hong Kong
6
3
0
0
3
6
9
12
15
18
107
108
Cancer in Germany | Cancer in children
4 Cancer in children
The German Childhood Cancer Registry (GCCR)
has been based at the Institute of Medical Biostatistics, Epidemiology and Informatics at the University Medical Centere of the Johannes Gutenberg University, Mainz, since beginning its work
in 1980. Close cooperation with the Society for
Paediatric Oncology and Haematology (GPOH)
and its associated hospitals was part of the
GCCR‘s original conception. This is a characteristic feature of the registry which cannot be easily
applied to adult oncology. This nationwide, population-based childhood cancer registry with a high
level of data quality and a degree of completeness
of over 95% (since about 1987) has been built up
covering the whole of Germany. The GCCR thus
meets international standards for populationbased cancer registries. Tumours of the central
nervous system (CNS tumours) are an exception
here; completeness in this field is slightly lower.
A further characteristic of the GCCR is that it
has implemented an active, open-end, long-term
follow-up observation system which continues
long into adulthood. In this way, the registry also
provides the basis for research into long-term
effects and secondary tumours, and for studies
with long-term survivors in general.
The registry population comprises children
who are diagnosed with a malignant disease or
a histologically benign brain tumour before their
15th birthday and are part of the resident popula-
tion of the Federal Republic of Germany when
diagnosed. Cancer cases in eastern Germany
have also been registered since 1991. The current
data pool consists of over 44,000 cancer cases.
Since 1 January 2009, the GCCR has been registering all children and adolescents up to the age
of 18 years (i.e. who are diagnosed before their
18th birthday) on the basis of the „Agreement of
the Joint Federal Committee on Quality-Assurance Measures for the In-Patient Care of Children
and Adolescents with Haemato-Oncological Diseases (GBA)“. This will make it possible to better
consider the needs of the collaborating hospitals
which have been combining paediatric and adolescent medicine for several years now and thus
also treat cancer patients aged 15 years and over.
Incidence of childhood cancers
About 1,800 cases of childhood cancer are newly
diagnosed every year in Germany. With an overall
population of approx. 12.5 million children under
the age of 15 years, this means an annual incidence of about 159 per 1,000,000 children in this
age group. The likelihood that a newborn child
will develop a malignant disease within the first
15 years of his/her life is 0.2%. In other words, a
malignant cancer is diagnosed in approx. one in
500 children up to their 15th birthday.
Figure 4.1
Cancer in children (determined for the period 1999 – 2008)
Germ-cell tumours 2,9 %
Bone tumours 4,5 %
Other diagnoses 5,2 %
Kidney tumours 5,6 %
Leukaemias 34,1 %
Soft-tissue sarcomas 5,9 %
Peripheral neural-cell tumours 7,5 %
Lymphomas 11,4 %
CNS tumours 22,9 %
Cancer in children | Cancer in Germany
Figure 4.2
New cases by age and gender, all childhood malignancies
Number of cases per 100,000 by age group, determined for the period 1999 – 2008
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1
2
Males
3
4
5
6
7
8
9
10
11
12
13
14
Age
Females
Range of diagnoses
The pattern of cancer diagnoses in children is
completely different from that of adults. For
example, children are mostly affected by embryonal tumours (neuroblastomas, retinoblastomas,
nephroblastomas, medulloblastomas, embryonic
rhabdomyosarcomas or germ-cell tumours); carcinomas, by contrast, are very rare in childhood
(making up about 2% of all malignant diseases).
The largest diagnostic groups are leukaemias
(34.1%), CNS tumours (22.9%) and lymphomas
(11.4%). Overall cancer incidence among children
under the age of five is about twice as high as in
the 5- to 14-year-old age group. The median age at
onset among the under-15-year-olds is five years,
ten months. Boys are diagnosed with cancer 1.2
times more frequently than girls.
Leukaemias
Leukaemias make up more than a third of all
cancers among the under-15-year-olds. The most
Figure 4.3
New cases by age and gender, childhood acute lymphatic leukaemia (ALL)
Number of cases per 100,000 by age group, determined for the period 1999 – 2008
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��
��
��
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<1
Males
1
2
Females
3
4
5
6
7
8
9
10
11
12
13
14
Age
109
Cancer in Germany 110
| Cancer in children
Figure 4.4
Trends in the incidence of selected diagnostic groups and for all childhood malignancies
Number of cases per 1,000,000 (age-standardized), including eastern Germany since 1991
180
150
120
90
60
30
1988
1990
1992
1994
leukaemias
all malignancies
1996
1998
CNS tumours
2000
2002
2004
2006
2008
Year
lymphomas
Figure 4.5
Trends in the incidence of childhood leukaemias, myeloproliferative and myelodysplastic disorders
Number of cases per 1,000,000 (age-standardized), including eastern Germany since 1991
50
40
30
20
10
1988
1990
1992
1994
acute lymphatic leukaemia (ALL)
1996
1998
2000
2002
2004
2006
2008
Year
acute myeloid leukaemia (AML)
common single diagnosis overall (27.0%) is acute
lymphatic leukaemia (ALL). It occurs more than
twice as frequently among children under the age
of four as in the other age groups. 4.6% of all
childhood malignancies are acute myeloid leukaemias (AML). AML is most common among
children under the age of two. The survival prospects for AML are markedly lower than for ALL.
The causes of leukaemias in childhood remain
largely uncertain, even today. For a long time,
environmental influences were suspected of
causing childhood leukaemias. Since then it has
been shown that the number of cases caused by
most environmental factors (low-dose ionizing
radiation, non-ionizing radiation and pesticides)
is quite small after all, even if an association with
leukaemias in childhood cannot be ruled out.
A number of clues have meanwhile strengthened hypotheses that assign a key role to infectious pathogens in the development of childhood
leukaemias. Especially children with an insufficiently modulated immune system in infancy can
have a higher risk of developing leukaemia.
Cancer in children CNS tumours
The most common single diagnoses among CNS
tumours are astrocytomas (total: 10.6%), intracranial and intraspinal embryonal tumours (5.0%)
and ependymomas (2.3%). The increase in the
incidence of CNS tumours observed in a number
of western countries over the past decades may be
connected with general changes in environmental factors and related exposures. For example, a
number of epidemiological studies are looking
into the possible influence of ionizing radiation,
electromagnetic fields, pesticides, the mother‘s
diet and genetic aspects.
Lymphomas
The most common lymphomas are Non-Hodgkin lymphomas (NHL), including Burkitt‘s lymphoma (total: 6.5%), and Hodgkin’s lymphoma
(4.8%). The chances of survival with Hodgkin’s
lymphoma are among the best in paediatric
oncology. Children with congenital or acquired
immunodeficiency and those who have had
| Cancer in Germany
immunosuppressive therapy are at increased risk
of developing NHL. An association is suspected
between lymphomas and ionizing radiation; this
has not, however, been substantiated.
Other common malignant diseases
Other common malignant diseases in childhood
include neuroblastomas (nerve-cell tumours),
nephroblastomas (kidney tumours), germ-cell
tumours, bone tumours and rhabdomyosarcomas
(tumours of the skeletal musculature). Among
these malignancies, the prognosis for children
with nephroblastoma or a germ-cell tumour is
much more favourable than for the others.
Survival
Children with cancer make up fewer than 1%
of all cancer patients. However, malignant neoplasms are the second most common cause of
death among children. Fortunately, the survival
Table 4.1
Cancer in children
Percentage incidence and survival rates for the most common diagnoses, determined for the period 1999 – 2008
Cancer sites
Incidence*
Survival rate in percent **
after 3 years
after 5 years
after 10 years
Retinoblastomas
4
99
98
98
Hodgkin's lymphomas
6
98
98
97
Germ-cell tumours
5
97
95
94
Nephroblastomas
10
94
93
92
Acute lymphatic leukaemias
44
92
90
87
6
90
89
88
14
84
79
77
3
84
76
72
16
81
79
76
Ewing's tumours & related bone sarcomas
3
76
72
68
Rhabdomyosarcomas
5
76
71
69
Intracranial & intraspinal embryonal tumours
8
71
65
57
Acute myeloid leukaemias
7
69
66
64
159
86
83
81
Non-Hodgkin lymphomas
Neuroblastomas and ganglioneuroblastomas
Osteosarcomas
Astrocytomas
All malignancies
* related to 1,000,000 children under the age of 15, age-standardized (standard: Segi world population)
** Brenner, Spix (2003)
111
112
Cancer in Germany | Cancer in children
rates have improved dramatically over the last 30
years thanks to significantly more differentiated
diagnostics and the use of multimodal therapy
concepts. In the early 1980s the chances of children with cancer being still alive five years after
diagnosis were 67%; this figure has risen to 83%
since then. Looking at all patients of the registry
population who were diagnosed between 1999
and 2008 and followed up, the overall chance
of survival is 83% after five years, 81% after ten
years, and 79% after 15 years.
The encouraging increase in the number of
long-term survivors is increasingly focusing
attention on the long-term observation of former
paediatric cancer patients. The GCCR provides
an ideal data basis for carrying out studies with
long-term survivors. As the above figures show,
it is already possible to provide information on
long-term survival (after 10 or 15 years) and to
estimate the risk of developing a second malignancy after cancer in childhood. Examples of further research possibilities include the incidence
of other long-term effects, such as the possible
effects of therapy on fertility, and studies examining the health risks of the descendants of fathers
and mothers who had childhood cancer. About
17,000 of the more than 33,000 patients currently
known to be alive have been under observation
by the registry for at least ten years. About half
of these patients are at least 18 years old in the
meantime and are thus, in principle, available for
studies with long-term survivors.
Literature on childhood cancer
Brenner H, Spix C (2003) Combining cohort and period
methods for retrospective time trend analyses of
long-term cancer patient survival rates. Br J Cancer
89: 1260–1265
Creutzig U, Hentze G, Bielack S et al. (2003) Krebserkrankungen bei Kindern – Erfolg durch einheitliche Therapiekonzepte seit 25. Dt. Ärzteblatt 100:
A842–A852
Debling D, Spix C, Blettner M et al. (2008) The cohort
of long-term survivors at the German Childhood
Cancer Registry. Klin Padiatr 220: 371–377
Kaatsch P (2004) Das Deutsche Kinderkrebsregister
im Umfeld günstiger Rahmenbedingungen. Bundesgesundheitsblatt 47: 437–443
Kaatsch P, Steliarova-Foucher E, Crocetti E et al.
(2006) Time trends of cancer incidence in European children (1978–1997): report from the ACCIS project. Eur J Cancer 42: 1961–1971
Kaatsch P, Mergenthaler A (2008) Incidence, time
trends and regional variation of childhood leukaemia in Germany and Europe. Radiat Prot Dosimetry 132: 107–113
Kaatsch P, Debling D, Blettner M et al. (2009) Second
malignant neoplasms after childhood cancer in
Germany: Results from the long-term follow-up
at the German Childhood Cancer Registry. Strahlenther Onkol 185 (Sondernr. 2): 8–10
Kaatsch P, Spix C (2009) Jahresbericht 2008/2009
(1980–2008) des Deutschen Kinderkrebsregisters. Institut für Medizinische Biometrie, Epidemiologie und Informatik, Universität Mainz
www.kinderkrebsregister.de
Paulides M, Mergenthaler A, Peeters J et al. (2008)
Bedeutende organbezogene Langzeitfolgen von
Chemotherapie und Sekundärmalignome. Med
Welt 59: 105–109
Pommerening K, Debling D, Kaatsch P et al. (2008)
Register zu seltenen Krankheiten: Patientencompliance und Datenschutz. BundesgesundheitsblGesundheitsforsch-Gesundheitsschutz 51, 491–
499
Schüz J (2008) Leukämien im Kindesalter und die
Rolle von Umwelteinflüssen bei deren Entstehung. Umweltmed Forsch Prax 13: 342–357
Spix C, Eletr D, Blettner M et al. (2008) Temporal
trends in the incidence rate of childhood cancer in
Germany 1987–2004. Int J Cancer 122: 1859–1867
Spix C, Spallek J, Kaatsch P et al. (2008) Cancer survival among children of Turkish descent in Germany 1980–2005: a registry-based analysis. BMC
Cancer 8: 355
Cancer in Germany
Appendix
German Centre for Cancer Registry Data at the Robert Koch Institute
After the Federal Cancer Registry Data Act (Bundeskrebsregisterdatengesetz – BKRG) came into
force in August 2009, the German Centre for
Cancer Registry Data was set up as an independent division within the Robert Koch Institute’s
Department of Epidemiology and Health Reporting to perform the tasks laid down in the Act.
The Centre for Cancer Registry Data is continuing the work of the former “Federal Cancer Surveillance Unit” at the Robert Koch Institute, but
with a broader remit:
▶▶ to conduct analyses and studies on all aspects
Remit of the former Federal Cancer Surveillance
Unit:
▶▶ to check the completeness of case finding and
of the variables included in the anonymized
data submitted by the epidemiological (population-based) state cancer registries;
▶▶ to analyse these data;
▶▶ to publish the findings on cancer incidence
in Germany and its development over time
together with the Association of Populationbased Cancer Registries in Germany (GEKID).
The work of the German Centre for Cancer Registry Data is supported by a scientific advisory
board with an office at the RKI. This advisory
board can also give permission for the dataset at
the Centre for Cancer Registry Data to be made
available to third parties on application – i.e. in
addition to the state cancer registries – if a justified and, in particular, scientific interest can be
substantiated.
Further information on the German Centre
for Cancer Registry Data is available on the Internet at www.rki.de/krebs.
Additional tasks of the German Centre for Cancer
Registry Data:
▶▶ to conduct a nationwide record linkage with the
data from the different state cancer registries
to discover any duplicate notifications and to
inform the cancer registries accordingly;
▶▶ to compile, update and extrapolate a dataset
from the reviewed data from the state cancer
registries;
▶▶ to regularly estimate and analyse survival rates,
stage distribution at diagnosis of the respective cancer, and other indicators, particularly on
prevalence, the risk of developing and dying of
the disease, and how these indicators develop
over time;
▶▶ to examine data from various states to determine any regional differences in selected cancer sites;
▶▶ to provide a dataset for evaluating health-policy
measures of cancer prevention, cancer screening, cancer treatment and healthcare;
of cancer;
▶▶ to write a comprehensive report on cancer in
Germany every five years;
▶▶ to further enhance methods and standardization rules on data collection and data transfer,
and to analyse the data together with the state
cancer registries;
▶▶ to collaborate in scientific bodies as well as
European and international organizations on
cancer registration and cancer epidemiology.
Staff of the German Centre for Cancer Registry
Data:
Dr Klaus Kraywinkel (temporary head)
Dr Benjamin Barnes
Dr Joachim Bertz
Dr Jörg Haberland
Ms Ruth Krüger
Ms Katrin Schünke
Dr Ute Wolf
113
114
Cancer in Germany
Association of Population-based Cancer Registries in Germany
(Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V., GEKID)
The Association of Population-based Cancer Registries in Germany (GEKID) was formed in 2004
as a registered, non-profit-making association.
GEKID’s members include not only all Germany’s population-based cancer registries, but also
a tumour centre and interested scientists working
in the field of cancer epidemiology.
In the field of cancer control, GEKID cooperates closely with the Federal Ministry of Health,
particularly in the context of the National Cancer
Plan, and the German Centre for Cancer Registry Data based at the Robert Koch Institute (RKI).
GEKID also participates actively in a wide range
of scientific committees.
The association’s primary task is to standardize as far as possible the content and methodology of cancer registration, despite the differences in legislation between the federal states.
The comparability of results from the cancer registries can only be assured by nationwide cooperation. To promote such cooperation, GEKID published “The Manual of Population-based Cancer
Registration” in 2008. Furthermore, GEKID is
a joint point of contact for the population-based
cancer registries on all issues of common interest and represents the registries at the European
level, e.g. in the European Network of Cancer
Registries (ENCR).
In its charter, GEKID has set itself the following tasks:
▶▶ to be the point of contact both for national and
international cooperation partners and for the
interested public,
▶▶ to provide information on the status of cancer
registration in Germany and explain the aims
of population-based cancer registration,
▶▶ to engage in joint information activities and
thus help the individual cancer registries
achieve and maintain complete registration,
▶▶ to define standards on content as a basis for
the comparability of population-based cancer
registries,
▶▶ to coordinate tasks involving all the registries
and foster contacts with clinical tumour documentation,
▶▶ to initiate joint research activities,
▶▶ to promote the scientific use of the populationbased cancer registries, and
▶▶ to use the data to advance quality assurance in
oncological care.
Information on GEKID can be obtained on the
Internet at www.gekid.de, from the respective
regional member registries, and from the Board
of Directors (see address section).
Contacts for the Association of Population-based
Cancer Registries in Germany (Gesellschaft der
epidemiologischen Krebsregister in Deutschland
e.V., GEKID) (see address section):
Prof Dr Alexander Katalinic (Chair of GEKID,
Schleswig-Holstein Cancer Registry)
Dr Stefan Hentschel (1st Vice-chair, Hamburg
Cancer Registry)
Dr Bettina Eisinger (2nd Vice-chair, Joint Cancer
Registry)
Cancer in Germany
Addresses
Krebsregister Baden-Württemberg (Baden-Württemberg Cancer Registry)
Epidemiologisches Krebsregister (Population-based Cancer Registry)
Deutsches Krebsforschungszentrum (German Cancer Research Centre)
Im Neuenheimer Feld 581
69120 Heidelberg Telephone: 06221/42 42 20
Telefax: 06221/42 22 03
Email:
[email protected]
Internet: www.krebsregister-bw.de
Vertrauensstelle* Baden-Württemberg (Baden-Württemberg Confidentiality Unit)
Deutsche Rentenversicherung (German Pension Insurance) Baden-Württemberg
Gartenstr. 105
76135 Karlsruhe Telephone: 0721/82 57 90 00 Telefax: 0721/82 57 90 00
Email:
[email protected]
Klinische Landesregisterstelle* (Clinical State Registration Unit)
Baden-Württembergische Krankenhausgesellschaft e.V. (Baden-Württemberg Hospital Association)
Birkenwaldstr. 151
70191 Stuttgart Telephone: 0711/257 77 42/48 Telefax: 0711/257 77 39
Email:
[email protected]
Bevölkerungsbezogenes Krebsregister Bayern (Bavaria Population-based Cancer Registry)
Östliche Stadtmauerstr. 30
91054 Erlangen Telephone: 09131/853 60 35 (R) Telefax: 09131/853 60 40 (R)
0911/378 67 38 (V)
0911/378 76 19 (V)
Email: [email protected]
Internet: www.krebsregister-bayern.de
Gemeinsames Krebsregister der Länder Berlin, Brandenburg, Mecklenburg-Vorpommern,
Sachsen-Anhalt und der Freistaaten Sachsen und Thüringen (Joint Cancer Registry of Berlin, Brandenburg,
Mecklenburg-Western Pomerania, Saxony-Anhalt, Saxony and Thuringia), GKR
Brodauer Str. 16 – 22
12621 Berlin
Telephone: 030/56 58 14 01 (R) Telefax: 030/56 58 14 44 (R)
030/56 58 13 15 (V)
030/56 58 13 33 (V)
Email:
[email protected] (R)
[email protected] (V)
Internet: www.krebsregister-berlin.de
Krebsregister des Landes Bremen (Bremen Cancer Registry)
Bremer Institut für Präventionsforschung und Sozialmedizin (Bremen Institute for Prevention Research and
Social Medicine), BIPS
Linzer Str. 8 – 10
28359 Bremen
Telephone: 0421/595 96 49 (R) Telefax: 0421/595 96 68 (R)
0421/595 96 44 (V)
Email: [email protected] (R)
[email protected] (V)
Internet: www.krebsregister.bremen.de
Hamburgisches Krebsregister (Hamburg Cancer Registry)
Behörde für Soziales, Familie, Gesundheit und Verbraucherschutz (State Ministry of Social Affairs, Family,
Health and Consumer Protection)
Billstr. 80
20539 Hamburg
Telephone: 040/428 37 22 11
Telefax: 040/428 37 26 55
Email: [email protected]
Internet: www.hamburg.de/krebsregister
115
116
Cancer in Germany
Krebsregister Hessen (Hesse Cancer Registry)
Registerstelle* des Hessischen Krebsregisters (Registration Unit of the Hesse Cancer Registry)
Hessischen Landesprüfungs- und Untersuchungsamt im Gesundheitswesen (Hesse State Health Office, HLPUG)
Wolframstr. 33
35683 Dillenburg
Telephone: 02771/32 06 39 (R) Telefax: 02771/366 71 (R)
Email:
[email protected] (R)
Internet: www.hlpug.de
Vertrauensstelle des Krebsregisters bei der Landesärztekammer Hessen (Confidentiality Unit of the Cancer
Registry at the Hesse State Medical Council)
Im Vogelsgesang 3
60488 Frankfurt/Main
Telephone: 069/789 04 50 (V) Telefax: 069/78 90 45 29 (V)
Email:
[email protected] (V)
Internet: www.laekh.de
Epidemiologisches Krebsregister Niedersachsen (Lower Saxony Population-based Cancer Registry)
OFFIS CARE GmbH
Industriestr. 9
26121 Oldenburg Telephone: 0441/361 05 60 (R) Telefax: 0441/36 10 56 10 (R)
0511/450 53 56 (V) 0511/450 51 32 (V)
Email:
[email protected] (R)
[email protected] (V)
Internet: www.krebsregister-niedersachsen.de
Epidemiologisches Krebsregister NRW gGmbH (North Rhine-Westphalia Population-based Cancer Registry)
Robert-Koch-Str. 40
48149 Münster Telephone: 0251/835 85 71
Telefax: 0251/835 85 77
Email:
[email protected]
Internet: www.krebsregister.nrw.de
Krebsregister Rheinland-Pfalz (Rhineland-Palatinate Cancer Registry)
Institut für Medizinische Biometrie, Epidemiologie und Informatik (Institute of Medical Biostatistics, Epidemiology and Informatics), IMBEI
55101 Mainz Telephone: 06131/17 67 10 (R)
Telefax: 06131/17 47 51 86 (R)
06131/17 30 02 (V)
06131/17 34 29 (V)
Email:
[email protected]
Internet: www.krebsregister-rheinland-pfalz.de
Epidemiologisches Krebsregister Saarland (Saarland Population-based Cancer Registry)
Ministerium für Gesundheit und Verbraucherschutz (Ministry of Health and Consumer Protection)
Präsident-Baltz-Str. 5
66119 Saarbrücken
Telephone: 0681/501 59 82 (R) Telefax: 0681/501 59 98 (R)
0681/501 58 05 (V)
Email:
[email protected]
Internet: www.krebsregister.saarland.de
Krebsregister Schleswig-Holstein (Schleswig-Holstein Cancer Registry)
Institut für Krebsepidemiologie e.V. (Institute of Cancer Epidemiology)
Ratzeburger Allee 160, Haus 50 23538 Lübeck
Telephone: 0451/500 54 40 (R) Telefax: 0451/500 54 55 (R)
04551/80 31 04 (V)
Email: [email protected]
Internet: www.krebsregister-sh.de
* To protect patients’ confidentiality, responsibility for cancer registration in Germany is often divided between Confidentiality Units
(Vertrauensstellen) and Registration Units (Registerstellen). Cancer morbidity and mortality notifications are sent to the Confidentiality Units, where personal information is anonymized. Along with the corresponding medical data, these anonymized data are then
sent to the Registration Units, which are responsible for maintaining and analysing the registry database.
Cancer in Germany
Deutsches Kinderkrebsregister (German Childhood Cancer Registry)
Institut für Medizinische Biometrie, Epidemiologie und Informatik (Institute of Medical Biostatistics, Epidemiology and Informatics), IMBEI
Telephone: 06131/17 31 11
Telefax: 06131/17 44 62
55101 Mainz Email: [email protected]
Internet: www.kinderkrebsregister.de
Futher contacts:
Zentrum für Krebsregisterdaten im RKI (German Centre for Cancer Registry Data at the Robert Koch Institute)
General-Pape-Str. 62 – 66
12101 Berlin
Telephone: 030/18 754 33 42
Telefax: 030/18 754 33 54
Email:
[email protected]
Internet: www.rki.de/krebs
Bundesministerium für Gesundheit (Federal Ministry of Health)
53107 Bonn
Referat 311
Referat 315
Telephone: 0228/99 441 15 10 Telefax: 0228/99 441 49 31
Telephone: 0228/99 441 31 08 Telefax: 0228/99 441 49 38
Email: [email protected]
Internet:www.bmg.bund.de
Sources for comparing country-specific cancer incidence and mortality rates
Hong Kong: Hong Kong Cancer Registry, Hospital Authority http://www3.ha.org.hk/cancereg/e_stat.asp
Australia: Australian Institute of Health and Welfare http://www.aihw.gov.au/cancer/data/index.cfm
Netherlands: Netherlands Cancer Registry http://www.ikcnet.nl/page.php?id=237&nav_id=97
Sweden, Finland, Norway, Denmark: Association of the Nordic Cancer Registries
http://www-dep iarc.fr/NORDCAN/english/frame.asp
France: Institut de veille sanitaire http://www.invs.sante.fr/surveillance/cancers/default.htm
Poland: National Cancer Registry http://85.128.14.124/krn/english/index.asp
Czech Republic: Institute of Health Informationd and Statistics of the Czech Republic
http://www.uzis.cz/cz/dps/english/index.html
United Kingdom: OfficeforNationalStatistics:Inzidenz http://www.statistics.gov.uk/statbase/Product.asp?vlnk=8843
Mortality http://www.statistics.gov.uk/statbase/Product.asp?vlnk=618
USA: National Cancer Institute Surveillance Epidemiology and End Results (17 Regionen)
http://seer.cancer.gov/can ques/incidence.html
Switzerland: National Institute for Cancer Epidemiology and Registration http://www.nicer-swiss.ch/
Belgium: Incidence: Belgian Cancer registry http://www.kankerregister.org
Mortality: Vlaams Agentschap Zorg en Gezondheid. Vlaamse gezondheidsindicatoren. Statistiek
van de doodsoorzaken www.zorg-en-gezondheid.be/cijfers.aspx
Observatoire de la Santé et du Social de Bruxelles (2008) Bulletins statistiques de décès
Ministère de la Communauté française-Direction générale de la Santé-Cellule des statistiques des
naissances et des décè (2008) Bulletins statistiques de décès
Austria: STATISTIK AUSTRIA, Österreichisches Krebsregister (Austrian Cancer Registry) (last revised: 27
August 2009)
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Cancer in Germany
Glossary
adenocarcinoma
malignant neoplasm (cancer) of the glandular epithelium (e.g. of the digestive tract)
adenoma
benign neoplasm of the glandular epithelium (e.g. of the digestive tract)
aetiology
study of the causes or origins of diseases
anaplastic
undifferentiated, so that the original tissue is no longer recognizable
autosomal dominant
inheritance pattern
sex-independent inheritance pattern in which a characteristic is expressed if one of the two
existing genes is affected
Barrett's oesophagus
persistent defect after healing of a reflux disease (see below) in which the surface is transformed (from a squamous epithelium into a columnar epithelium)
case-control study
epidemiological study comparing certain characteristics in patients ("cases") and nonpatients ("controls")
climacteric disorder
disorder during the menopause in women (e.g. hot flushes)
climacteric
(concerning) the menopause in women, phase of hormonal transition until menstruation
stops
cluster
accumulation of events (e.g. of cancer cases) in a certain place or period
cohort study
epidemiological study in which a certain group of people is observed over a longer period
of time
colonoscopy
internal examination of the large intestine using an inserted endoscope
colorectal carcinoma
malignant epithelial neoplasm (cancer) of the colon and rectum
congenital naevus
mole (birthmark) present from birth
corpus carcinoma
malignant neoplasm (cancer) of the uterus (corpus)
crude rate
not age-standardized rate
DCO
'death-certificate-only', i.e. based solely on information from the death certificate
diabetes mellitus
chronic disorder of carbohydrate metabolism
disposition
congenital or acquired susceptibility to diseases
DRG statistics
hospital statistics based on a flat rate per case (Diagnosis Related Groups)
dysplastic naevus
deformed, irregularly outlined and pigmented malformation of the skin with an uneven
surface
embryonic period
16th to 60th day of pregnancy
endometrial cancer
malignant neoplasm of the uterus lining
endometrial
relating to the endometrium (lining of the uterus)
ependymoma
brain tumour of the glial cells which line cavities in the brain and spinal cord
epidemiological/popula­
tion-based cancer registry
population-based cancer registry that collects data on all the cancer cases that occur in a
certain population
epidemiology
science dealing with the description and analysis of diseases in a population
epithelium
cell layers covering internal (e.g. lungs or intestines) and external (e.g. skin) body surfaces
evaluation
analysis and assessment of processes, e.g. in the field of health
exposure
being subjected to damaging influences (e.g. air pollution)
genetic predisposition
inherited tendency or susceptibility to certain diseases
HIV
human immunodeficiency virus ("AIDS virus")
HPV
human papilloma virus
Cancer in Germany
incidence
frequency of cases, morbidity, how often a disease is contracted (usually expressed as the
annual number of new cases per 100,000 of the population)
indicator
a factor that makes it possible to measure a certain condition or event
intracranial
situated in the skull
intraspinal
situated in the spinal cord canal
invasive
proliferating into the surrounding tissue; a criterion of a malignant neoplasm
log-linear model
statistical method of analysis
long-term follow-up
long-term observation of a certain group of people
malignant melanoma
malignant tumour of the pigment-forming cells (melanocytes) usually in the skin, the
mucous membranes, the choroid of the inner eye or the meninges, which cover the brain
MALT lymphoma
mucosa-associated lymphoid tissue: lymphoma that develops in lymphocyte-rich tissue
(e.g. in the mucous membranes of the gastrointestinal tract)
mammography
X-ray examination of the female breast (mamma) used in screening for breast cancer
(mastocarcinoma)
medullary thyroid
carcinoma
carcinoma of the C-cells in the thyroid gland which produce excessive amounts of calcitonin (which regulate calcium levels in the blood)
Ménétrier's disease
disorder in which the gastric mucosal folds (gastric lining) are enlarged
metastasizing
intermittent propagation of tumours to distant tissues
mortality
death rate (usually expressed as the annual number of deaths per 100,000 of the population)
oncological
concerning cancer
PAP smear
microscopic examination of a smear taken from the mouth of the uterus used in cancer
screening, named after Dr George PAPanicolaou
papillary
wart-shaped
pernicious anaemia
anaemia caused by a deficiency of cobalamin (vitamin B12)
polycyclic aromatic
hydrocarbons (PAHs)
group of organic compounds consisting of at least two interconnected benzene rings
polycystic ovaries
enlarged ovaries containing several cavities filled with liquid (cysts)
polynomial
an algebraic expression consisting of one or more summed terms, each term consisting
of a constant multiplier and one or more variables raised to integral powers
postmenopause
time after the last menstruation (menopause)
postnatal
after birth
precancerous
defined potential preliminary stage of a carcinoma
prevalence
epidemiological measure of frequency, number of people in a population living with a
certain disease at a certain time
PSA
prostate-specific antigen; a test for PSA in the blood is used in screening for prostate cancer
radon
radioactive inert gas formed by the radioactive decay of radium; can accumulate in badly
ventilated rooms
reflux disease/reflux
oesophagitis
backing up of the stomach contents into the oesophagus, leading to an inflammation of
the mucous membrane
screening
mass examination of a population group to detect diseases using simple, non-stressful
diagnostic methods
squamous-cell carcinoma malignant neoplasm of the squamous epithelium (e.g. of the lung or the skin)
stomach polyps
protuberances (usually stalk-like swelling) of the stomach lining (gastric mucosa)
subfertility
reduced fertility or ability to conceive
119
120
Cancer in Germany
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ISBN 978-3-89606-209-3
The booklet »Cancer in Germany« is published jointly every two
years by the Association of Population-based Cancer Registries
in Germany (Gesellschaft der epidemiologischen Krebsregister
in Deutschland e.V., GEKID) and the Robert Koch Institute (RKI).
This seventh edition was compiled for the first time by the newly
formed German Centre for Cancer Registry Data at the RKI, again
with the support of authors from the cancer registries. It contains
the most important population-based statistics on the incidence
of cancers in Germany in 2006, as well as observations on trends
between 1980 and 2006 for all cancer sites together and for 21
selected individual sites. Tumours of the central nervous system
have been newly included. Changes have also been introduced to
the analyses: incidence and mortality rates, prevalence estimates
and the expected number of cases in 2010 are given for the first
time. Topical population-based data, primarily from the countries
bordering on Germany, make it easier to put the findings into an
international context. As in previous years, information on cancer
in children is provided by the German Childhood Cancer Registry
in a separate section of the booklet.
The RKI‘s current estimates are based on the data from the
German population-based cancer registries in which registration
is complete; the data pool has been significantly improved in
the meantime and can be regarded as much more precise than
in earlier issues of this booklet. The estimate for 2006 is approximately 427,000 new cancer cases (229,000 men and 198,000
women). The number of new cases can be expected to rise to
450.000 (including 204,000 women) by 2010 as a result of
demographic developments alone.
The most common cancer types in 2006 were again breast
cancer among women with 58,000 new cases and prostate cancer among men (60,000).
The launch of population-based cancer registration in BadenWürttemberg means that population-based cancer registries are
now up and running in all of Germany‘s federal states. The entry
into force of the Federal Cancer Registry Data Act in August 2009
and the recent creation of the German Centre for Cancer Registry
Data at the RKI have created a basis for using the data from the
registries even more intensively in the future both by scientists
and by the interested public.