[Show abstract][Hide abstract] ABSTRACT: We aimed at investigating the distribution and risk of all second discordant primary cancers (SDPCs) after a specific first primary cancer in Germany and Sweden to provide etiological understanding of SDPCs and insight into their incidence rates and recording practices. Among 1,537,004 survivors of first primary cancers in Germany and 588,103 in Sweden, overall 80,162 and 32,544 SDPCs were recorded, respectively. Standardized incidence ratios (SIRs) of all SDPCs were elevated at levels between 1.1 and 2.1 after 23 (out of overall 29) cancers in Germany and at levels between 1.1 and 1.6 after 24 cancers in Sweden, and among them, elevated SIRs were found after 19 cancers in both populations. Decreased SIRs at levels ranging from 0.5 to 0.9 were found for some cancers with poor prognosis in Germany only. We found elevated risk after 19 out of 29 cancers in both countries, suggesting common etiology of SDPCs after most of first cancers and registration similarity. Decreased risks after some fatal cancers were found only in Germany, which may be attributed to reporting practices or missed death data in Germany.
[Show abstract][Hide abstract] ABSTRACT: Objectives:
Lung cancer is the most common cancer-related death worldwide. In Germany it accounts for 25% of cancer deaths in men, and 14% in women. The aim of this study is to provide an overview of 5-year relative survival by sex, age, histology, and tumour stage in Germany representing a population of 26.7 million people.
Materials and methods:
The study is based on a pooled German dataset including data from 12 population-based cancer registries covering around one third of the German population. A total of 132,612 patients diagnosed with lung cancer from 2002 to 2010 were included in the analysis. Survival estimates for the time period 2007-2010 were calculated using period analysis. Differences in survival between sexes were tested for statistical significance by model-based period analysis (poisson regression model). The relative excess risk (RER) of death (women vs. men) was extracted from the model with the p value for the difference in RER.
The overall age adjusted 5-year relative survival was 15.5% (standard error (SE) 0.2) for men and 20.3% (SE 0.3) in women. Survival differed markedly according to age (men: <60 years 18.5% vs. 80+ years 8.4% and women 23.7% vs. 10.6%, respectively), histology (largest difference between histological groups: men 25.7 and women 44.4% points) and stage (men: UICC Ia 62.9%, vs. UICC IV 4.6% and women 75.2% vs. 7.0%, respectively). Our study showed survival advantages for women compared to men, most notably in younger aged patients (RER 0.83, p<0.0001), patients with adenocarcinoma (RER 0.80, p<0.0001), and patients with lower stage cancer (RER 0.62, p<0.0001).
This study presents up-to-date survival estimates for lung cancer in Germany. Compared to other European countries survival was relatively high. Women showed higher survival than men independent of age, histology and stage. The reasons for the survival differences require further clarification.
No preview · Article · Oct 2015 · Lung cancer (Amsterdam, Netherlands)
[Show abstract][Hide abstract] ABSTRACT: Background:
European regional variation in cancer survival was reported in the EUROCARE-4 study for patients diagnosed in 1995-1999. Relative survival (RS) estimates are here updated for patients diagnosed with cancer of the oesophagus, stomach and small intestine from 2000 to 2007. Trends in RS from 1999-2001 to 2005-2007 are presented to monitor and discuss improvements in patient survival in Europe.
Materials and methods:
EUROCARE-5 data from 29 countries (87 cancer registries) were used to investigate 1- and 5-year RS. Using registry-specific life-tables stratified by age, gender and calendar year, age-standardised 'complete analysis' RS estimates by country and region were calculated for Northern, Southern, Eastern and Central Europe, and for Ireland and United Kingdom (UK). Survival trends of patients in periods 1999-2001, 2002-2004 and 2005-2007 were investigated using the 'period' RS approach. We computed the 5-year RS conditional on surviving the first year (5-year conditional survival), as the ratio of age-standardised 5-year RS to 1-year RS.
Oesophageal cancer 1- and 5-year RS (40% and 12%, respectively) remained poor in Europe. Patient survival was worst in Eastern (8%), Northern (11%) and Southern Europe (10%). Europe-wide, there was a 3% improvement in oesophageal cancer 5-year survival by 2005-2007, with Ireland and the UK (3%), and Central Europe (4%) showing large improvements. Europe-wide, stomach cancer 5-year RS was 25%. Ireland and UK (17%) and Eastern Europe (19%) had the poorest 5-year patient survival. Southern Europe had the best 5-year survival (30%), though only showing an improvement of 2% by 2005-2007. Small intestine cancer 5-year RS for Europe was 48%, with Central Europe having the best (54%), and Ireland and UK the poorest (37%). Five-year patient survival improvement for Europe was 8% by 2005-2007, with Central, Southern and Eastern Europe showing the greatest increases (⩾9%).
Survival for these cancer sites, particularly oesophageal cancer, remains poor in Europe with wide variation. Further investigation into the wide variation, including analysis by histology and anatomical sub-site, will yield insights to better monitor and explain the improvements in survival observed over time.
Full-text · Article · Oct 2015 · European Journal of Cancer
[Show abstract][Hide abstract] ABSTRACT: Background:
Survival differences across Europe for patients with cancers of breast, uterus, cervix, ovary, vagina and vulva have been documented by previous EUROCARE studies. In the present EUROCARE-5 study we update survival estimates and investigate changes in country-specific and over time survival, discussing their relationship with incidence and mortality dynamics for cancers for which organised screening programs are ongoing.
We analysed cases archived in over 80 population-based cancer registries in 29 countries grouped into five European regions. We used the cohort approach to estimate 5-year relative survival (RS) for adult (⩾15years) women diagnosed 2000-2007, by age, country and region; and the period approach to estimate time trends (1999-2007) in RS for breast and cervical cancers.
In 2000-2007, 5-year RS was 57% overall, 82% for women diagnosed with breast, 76% with corpus uteri, 62% with cervical, 38% with ovarian, 40% with vaginal and 62% with vulvar cancer. Survival was low for patients resident in Eastern Europe (34% ovary-74% breast) and Ireland and the United Kingdom [Ireland/UK] (31-79%) and high for those resident in Northern Europe (41-85%) except Denmark. Survival decreased with advancing age: markedly for women with ovarian (71% 15-44years; 20% ⩾75years) and breast (86%; 72%) cancers. Survival for patients with breast and cervical cancers increased from 1999-2001 to 2005-2007, remarkably for those resident in countries with initially low survival.
Despite increases over time, survival for women's cancers remained poor in Eastern Europe, likely due to advanced stage at diagnosis and/or suboptimum access to adequate care. Low survival for women living in Ireland/UK and Denmark could indicate late detection, possibly related also to referral delay. Poor survival for ovarian cancer across the continent and over time suggests the need for a major research effort to improve prognosis for this common cancer.
Full-text · Article · Oct 2015 · European Journal of Cancer
[Show abstract][Hide abstract] ABSTRACT: Background and AimTo examine survival for gastric lymphomas and its main subtypes, mucosa-associated lymphoid tissue lymphoma (MALT) and the diffuse large B-cell lymphoma (DLBCL), in Germany and the United States (US).Methods
Data for patients diagnosed in 1997-2010 were used from 10 population-based German cancer registries and compared to data from the US SEER (Surveillance, Epidemiology and End Results) 13 registries database. Patients age 15-74 diagnosed with gastric lymphomas were included in the analysis. Period analysis and modelled period analysis were used to estimate 5- and 10-year relative survival (RS) in 2002-2010 and survival trends from 2002-2004 to 2008-2010.ResultsOverall, the database included 1,534 and 2,688 patients diagnosed with gastric lymphoma in 1997-2010 in Germany and the US, respectively. Survival was substantially higher for MALT (5- and 10-year RS: 89.0% and 80.9% in Germany, 93.8% and 86.8% in US) than for DLBCL (67.5% and 59.2% in Germany, and 65.3% and 54.7% in the US) in 2002-2010. Survival was slightly higher among female patients and decreased by age for gastric lymphomas combined and its main subtypes. A slight, non-significant, increase in the 5-year RS for gastric lymphomas combined was observed in Germany and the US, with increases in 5-year RS between 2002-2004 and 2008-2010 from 77.1% to 81.0% and from 77.3% to 82.0%, respectively. Five-year RS of MALT exceeded 90% in 2008-2010 in both countries.Conclusions
Five-year RS of MALT meanwhile exceeds 90% in both Germany and the US but DLBCL has remained below 70% in both countries.
No preview · Article · May 2015 · Journal of Gastroenterology and Hepatology
[Show abstract][Hide abstract] ABSTRACT: The incidence of thyroid cancer (TC), a rare malignancy, has strongly risen in recent decades. Possible causes of this rise include increasing diagnostic activity, nuclear tests after World War II, and the Chernobyl disaster.
This article presents the time trends of TC incidence between 2003 and 2008 in Germany according to histological tumor type and sex, and provides a description of TC incidence according to districts (Kreise) and sex in Germany.
Data on persons newly diagnosed with thyroid cancer (ICD-10 code, C73) between 2003 and 2008 were obtained from the Center of Cancer Registry Data at the Robert Koch Institute. Official population and mortality data were used. Age-specific and age-standardized incidence rates (ASIR) were calculated according to sex and tumor histology.
Between 2003 and 2008, the ASIR of TC rose from 2.7 to 3.4 (men) and from 6.5 to 8.9 (women) per 100,000 per year. This rise can be almost completely attributed to the rising incidence of papillary TC. The steepest rise in frequency was observed in TNM-T1 tumors. A positive north-south gradient of TC incidence was found.
The cause of the marked rise of TC incidence in recent decades is unknown. The positive north-south gradient of the TC incidence may possibly be attributed in part to long-standing differences of iodine intake between different German regions.
An epidemiological study of the possible causes of the rising TC incidence and of the regional differences of TC incidence in Germany is recommended.
No preview · Article · Jan 2014 · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz
[Show abstract][Hide abstract] ABSTRACT: Hintergrund
Die Inzidenz von Schilddrüsenkrebs (SDK), einem seltenen Malignom, ist in den letzten Jahrzehnten stark gestiegen. Als mögliche Ursachen für den Inzidenzanstieg werden eine Zunahme der diagnostischen Aktivität, oberirdische Kernwaffentests seit dem Zweiten Weltkrieg sowie die Tschernobyl-Katastrophe diskutiert.
Darstellung der Inzidenzentwicklung von SDK in Deutschland in den Jahren 2003 bis 2008 separat nach Tumorhistologie und Geschlecht sowie der SDK-Inzidenz nach Kreisen und Geschlecht in Deutschland.
Sämtliche Neuerkrankungen an SDK (ICD-10 Schlüssel, C73) aus den Jahren 2003 bis 2008 werden vom Zentrum für Krebsregisterdaten am Robert Koch-Institut bezogen sowie amtliche Bevölkerungs- und Mortalitätsdaten verwendet. Altersspezifische und altersstandardisierte Inzidenzraten (ASIR) werden separat nach Geschlecht und Tumorhistologie berechnet.
Die ASIR von SDK stieg zwischen 2003 bis 2008 von 2,7 auf 3,4 (Männer) sowie von 6,5 auf 8,9 (Frauen) pro 100.000 pro Jahr an. Dieser Anstieg ist nahezu ausschließlich auf die Zunahme der Inzidenz des papillären SDK zurückzuführen, vor allem der Kategorie TNM-T1. Die Inzidenzverteilung in Deutschland ist durch einen deutlichen Nord-Süd-Anstieg gekennzeichnet.
Die Ursache für den erheblichen Anstieg der beobachteten SDK-Inzidenz in den letzten Jahrzehnten ist unbekannt. Der beobachtete Nord-Süd-Anstieg der SDK-Inzidenz in Deutschland könnte zum Teil auf langfristige Unterschiede in der Jodversorgung der Bevölkerung zurückzuführen sein.
Eine epidemiologische Studie zur Erforschung der Ursachen für den Anstieg der SDK-Inzidenz sowie für die regionalen Unterschiede in Deutschland wird empfohlen.
No preview · Article · Jan 2014 · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz
[Show abstract][Hide abstract] ABSTRACT: Background
Cancer survival is a key measure of the effectiveness of health-care systems. EUROCARE—the largest cooperative study of population-based cancer survival in Europe—has shown persistent differences between countries for cancer survival, although in general, cancer survival is improving. Major changes in cancer diagnosis, treatment, and rehabilitation occurred in the early 2000s. EUROCARE-5 assesses their effect on cancer survival in 29 European countries.
In this retrospective observational study, we analysed data from 107 cancer registries for more than 10 million patients with cancer diagnosed up to 2007 and followed up to 2008. Uniform quality control procedures were applied to all datasets. For patients diagnosed 2000–07, we calculated 5-year relative survival for 46 cancers weighted by age and country. We also calculated country-specific and age-specific survival for ten common cancers, together with survival differences between time periods (for 1999–2001, 2002–04, and 2005–07).
5-year relative survival generally increased steadily over time for all European regions. The largest increases from 1999–2001 to 2005–07 were for prostate cancer (73·4% [95% CI 72·9–73·9] vs 81·7% [81·3–82·1]), non-Hodgkin lymphoma (53·8% [53·3–54·4] vs 60·4% [60·0–60·9]), and rectal cancer (52·1% [51·6–52·6] vs 57·6% [57·1–58·1]). Survival in eastern Europe was generally low and below the European mean, particularly for cancers with good or intermediate prognosis. Survival was highest for northern, central, and southern Europe. Survival in the UK and Ireland was intermediate for rectal cancer, breast cancer, prostate cancer, skin melanoma, and non-Hodgkin lymphoma, but low for kidney, stomach, ovarian, colon, and lung cancers. Survival for lung cancer in the UK and Ireland was much lower than for other regions for all periods, although results for lung cancer in some regions (central and eastern Europe) might be affected by overestimation. Survival usually decreased with age, although to different degrees depending on region and cancer type.
The major advances in cancer management that occurred up to 2007 seem to have resulted in improved survival in Europe. Likely explanations of differences in survival between countries include: differences in stage at diagnosis and accessibility to good care, different diagnostic intensity and screening approaches, and differences in cancer biology. Variations in socioeconomic, lifestyle, and general health between populations might also have a role. Further studies are needed to fully interpret these findings and how to remedy disparities.
Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation, Cariplo Foundation.
Full-text · Article · Dec 2013 · The Lancet Oncology
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Population-based studies on cervical cancer providing survival estimates by age, histology, and stage have been sparse. We aimed to derive most up-to-date and detailed survival estimates for cervical cancer patients in Germany.
We used a pooled German national dataset including data from 11 cancer registries covering a population of 33 million people. Included were 15 685 patients diagnosed with cervical cancer from 1997 to 2006. Period analysis was performed to calculate the five-year relative survival (RS) 2002-2006. Trends in survival between 2002 and 2006 were examined using model-based period analysis. Age-adjustment was done using five age groups (15-44, 45-54, 55-64, 65-74, and 75 + years).
Overall, age-adjusted five-year relative survival in 2002-2006 was 64.7%. A strong age gradient was observed, with five-year RS decreasing from 81.7% in age group 15-49 years to 46.3% in age group 70 + years. Prognosis furthermore strongly varied by stage, with age-adjusted five-year RS reaching 84.6% for localized, 48.2% for regional, and 17.9% for distant stage. From 2002 to 2006, a significant improvement (4.7 percent units) in overall age-adjusted five-year RS was seen. The improvement was most pronounced for age groups 55-64 years (from 54.2 to 65.6%) and 65-74 years (from 50.0 to 58.1%).
In this first comprehensive population-based study from Germany, prognosis of cervical cancer strongly varied by age and stage. Prognosis continued to improve, in particular in age range 55-74 years, in the five-year period assessed.
[Show abstract][Hide abstract] ABSTRACT: Population-based studies on ovarian cancer providing survival estimates by age, histology, laterality, and stage have been sparse. We aimed to derive the most up-to-date and detailed survival estimates for ovarian cancer patients in Germany. We used a pooled German national dataset including data from 11 cancer registries covering 33 million populations. A total of 21 651 patients diagnosed with ovarian cancer in 1997-2006 were included. Period analysis was carried out to calculate the 5-year relative survival (RS) for the years 2002-2006. Trends in survival between 2002 and 2006 were examined using model-based period analysis. Age adjustment was performed using five age groups (15-44, 45-54, 55-64, 65-74, and 75+ years). Overall, the age-adjusted 5-year RS in 2002-2006 was 41%. A strong age gradient was observed, with a decrease in the 5-year RS from 67% in the age group 15-49 years to 28% in the age group 70+ years. Furthermore, the prognosis varied markedly by histology, laterality, and stage, with the age-adjusted 5-year RS ranging from 25% (for carcinoma not otherwise specified) to 81% (for stromal cell carcinoma), reaching 46% for unilateral and 32% for bilateral carcinoma and reaching 82% for Federation of Gynecology and Obstetrics (FIGO) stages I and II, 36% for FIGO stage III, and 18% for FIGO stage IV. No improvement in survival could be observed for any of the subgroups in the period between 2002 and 2006. Our analyses suggest that an improvement in the 5-year RS for ovarian cancer may have stagnated in the early 21st century and underline the need for a more effective translation of therapeutic innovation into clinical practice.
Full-text · Article · Jun 2012 · European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP)
[Show abstract][Hide abstract] ABSTRACT: Prior analyses of survival of patients with primary cutaneous malignant melanoma from Germany were based only on small populations and need to be updated.
We give a detailed overview of relative 5-year survival by sex, age group, histology, tumour stage and body site, and of time trends in a population of 33 million (40% of Germany), and compare survival in the federal states.
Conventional and model-based period analysis using the Ederer II method was applied to patients with melanoma diagnosed during 1997-2006 in Germany to assess 5-year relative survival (RS) rates and time trends.
In total, 37,155 melanoma cases were included. Overall age-adjusted 5-year RS for the time period 2002-2006 was 91·9% for women and 87·0% for men. Survival differences by age group, histology, tumour stage and body site were found. No significant overall trend (2002-2006) was seen either in women or in men. Differences in survival between federal states were small; no clear pattern was seen.
Based on the most recent and high-quality data from population-based cancer registries a comprehensive picture on melanoma survival in Germany was given. Survival from cutaneous malignant melanoma was high compared with other cancer sites and did not change during the analysed period 2002-2006. Patterns in melanoma survival by sex, age, tumour stage, histology and body site were in good agreement with previously published findings. No relevant differences between federal states were found.
No preview · Article · May 2012 · British Journal of Dermatology
[Show abstract][Hide abstract] ABSTRACT: Abstract Background. Esophagus and stomach cancers are associated with poor prognosis. But most published population-based cancer survival estimates for stomach and esophagus cancer refer to survival experience of patients diagnosed in the 1990s or earlier years. The aim of this study was to provide up-to-date survival estimates and trends for patients with stomach and esophagus cancer in Germany. Material and methods. Our analysis is based on data from 11 population-based cancer registries, covering 33 million inhabitants. Patients diagnosed with stomach and esophagus cancer in 1997-2006 were included. Period analysis was used to derive five-year relative survival estimates and trends by age, sex, cancer subsite, and stage for the time period of 2002-2006. German and US survival estimates were compared utilizing the SEER 13 database. Results. Overall age-standardized five-year relative survival was 31.8% and 18.3% for stomach and esophagus cancer, respectively, compared to 27.2% and 17.4% in the US. Survival was somewhat higher among female than among male patients for both cancer sites (33.6% vs. 30.6% and 21.5% vs. 17.5%, respectively) and much higher for non-cardia stomach cancer (40.4%) than for cardia cancer (23.4%). From 2002 to 2006, a moderate increase in five-year relative survival by 2.7 percent units was observed for non-cardia stomach cancer patients in Germany (p < 0.001). Conclusion. Five-year relative cancer survival has reached levels around 40% for patients with non-cardia stomach cancer in Germany in the early 21st century, whereas it remained at lower levels around 20% for patients with esophagus and cardia cancer.
[Show abstract][Hide abstract] ABSTRACT: Until recently, population-based data of cancer survival in Germany mostly relied on one registry covering ∼1 million people (1.3% of the German population). Here, we provide up-to-date cancer survival estimates for Germany based on data from 11 population-based cancer registries, covering 33 million people and compare them to survival estimates from the United States.
Cancer patients diagnosed in 1997-2006 were included. Period analysis was employed to calculate 5-year relative survival for 38 cancers for 2002-2006. German and USA survival rates were compared utilizing the Surveillance, Epidemiology and End Results 13 database.
Five-year relative survival >80% was observed for testicular cancer (93.5%), skin melanoma (89.4%), cancers of the prostate (89.1%) and thyroid (87.8%), Hodgkin's lymphoma (84.5%) and cancers of the breast (83.7%) and endometrium (81.0%), which together account for almost 40% of cases. For the majority of cancers, German survival estimates were close to or below those in the United States. Exceptions with higher survival in Germany were cancers of the stomach, pancreas and kidney and Hodgkin's lymphoma.
German cancer survival estimates are mostly higher than the 2000-2002 pan-European estimates. Further research is needed to investigate causes responsible for differences between German and USA cancer survival rates.
No preview · Article · May 2011 · Annals of Oncology
[Show abstract][Hide abstract] ABSTRACT: Aim
Several international studies have already investigated the influence of socioeconomic factors on the risk of cancer. For Germany, however, the data are still insufficient. We examined the effects of social differences on cancer incidence and mortality on the population of Bremen, a town in northwest Germany.
Subjects and methods
Data were obtained from the Bremen Cancer Registry, a population-based registry. The database comprised 27,430 incident cases, newly diagnosed between 2000 and 2006. The allocation of social class for each patient was based on the home address at the time of diagnosis, which led to the corresponding town district, which again could be linked to the “Bremen discrimination index.” Based on this index, cases were allocated to five categories, for which we compared standardized incidence ratios (SIR) and mortality ratios (SMR) for different cancers: prostate, breast, lung, colorectal, bladder, uterine, ovarian, cervical, malignant melanoma of the skin, non-melanoma skin cancer and all cancer sites summarized.
The influence of social status was observed for different cancer sites. An inverse association was ascertained for all cancer sites (only men) and for tumors of the oral cavity and pharynx, and for lung, cervical and bladder cancers. A positive correlation was observed for female breast cancer, malignant melanoma, non-melanoma skin tumors and prostate cancer.
In spite of the methodical restrictions, our analyses suggest an association between social factors and cancer incidence and mortality. The results are in agreement with international studies. Many of the observed social class differences could probably be explained by known risk factors, such as smoking, alcohol consumption, diet and physical activity.
Full-text · Article · Jun 2010 · Journal of Public Health
[Show abstract][Hide abstract] ABSTRACT: Weltweit erkranken jedes Jahr etwa 12,4 Millionen Menschen neu an einer Krebserkrankung, über 7,6 Millionen Menschen sterben an Krebs. Die epidemiologischen Krebsregister in Deutschland können ein umfassendes Bild zum aktuellen Krebsgeschehen liefern. Die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (GEKID) präsentiert dazu aktuelle Daten in einem interaktiven Atlas der Krebsinzidenz und Krebsmortalität. Nach einer Hochrechnung der GEKID gab es im Jahr 2007 rund 460.000 neue bösartige Tumorerkrankungen in Deutschland. Räumlich betrachtet zeigt die Krebsinzidenz deutliche regionale Unterschiede, z.B. eine hohe Brustkrebsinzidenz im Nordwesten Deutschlands und eine niedrige in Ostdeutschland. In der zeitlichen Betrachtung ergeben sich unterschiedliche Trends, so hat sich z.B. Prostatakrebs sseit 1980 mehr als verdoppelt, Magenkrebs dagegen halbiert.
Mit solchen Zahlen lässt sich Präventionsbedarf im Bereich von Krebserkrankungen spezifischer und zielgerichteter ableiten als bisher.
Angesichts des demographischen Wandels in Deutschland mit weiter steigenden Erkrankungszahlen für Krebs ist eine Stärkung der Krebsprävention zur Verminderung der Krankheitslast Krebs dringend angezeigt.
World wide about 12.4 million new cancer cases appear each year, 7.6 million people die of cancer. Population-based cancer registries in Germany can give a comprehensive picture on the actual burden of cancer. The association of population-based cancer registries in Germany (GEKID) presents actual data on cancer incidence and mortality with an interactive cancer atlas. An estimate of cancer incidence in Germany gives a number of 460.000 new cancer cases in 2007. Spatial analyses reveal clear differences within Germany, e.g. high breast cancer incidence in North-West Germany and low rates in East Germany. There are different time trends for single cancers, e.g. a doubling of prostate cancer since 1980 or a halving of stomach cancer. Using such figures the need of prevention can be addressed much more precisely. In the light of the demographic change in Germany with increasing numbers of cancer cases a strengthening of cancer prevention is needed to lower the current and future burden of cancer.