[Rising incidence of papillary thyroid carcinoma in Germany]. / Inzidenzzunahme des papillären Schilddrüsenkarzinoms in Deutschland.

BACKGROUND: 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. AIM: 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. METHODS: 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. RESULTS: 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. DISCUSSION: 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. CONCLUSION: An epidemiological study of the possible causes of the rising TC incidence and of the regional differences of TC incidence in Germany is recommended.

[Linkage of secondary data with cancer registry data on the basis of encrypted personal identifiers - results from a pilot study in North Rhine-Westphalia]. / Abgleich von Sekundärdaten mit einem epidemiologischen Krebsregister auf der Basis verschlüsselter Personendaten - Ergebnisse einer Pilotstudie in Nordrhein-Westfalen.

BACKGROUND: The Cancer Registry of North-Rhine-Westphalia stores exclusively encrypted personal identifiers of registered cancer patients. Therefore, comparisons with secondary data sets can only be performed by record linkage procedures that are based on encrypted personal identifiers. We report on a pilot study which linked encrypted personal data from the disease management program for patients with diabetes mellitus type 2 (DMP-DM2) with the database of the EKR NRW in order to test the feasibility and efficiency of these record linkage procedures. METHODS: Personal identifying variables of the DMP records were encrypted in a 2-stage process before being sent electronically to the EKR NRW where they were subsequently submitted to a probabilistic record linkage with the registry data. The study included 27 450 participants who were insured at the AOK NordWest, residents of the district Münster and who were aged 40-79 years at the time of first enrolment to the DMP-DM2 between June 2003-July 2008. RESULTS: The electronic processing time of the semi-automatic record linkage procedure took about 24 h. Approximately 2% of the records had to be reviewed manually. After exclusion of prevalent cancer cases, multiple primaries and inadequate data, 26 742 participants (47.3% men; 52.7% women) remained in the data set. About 1 364 cohort members (759 men, 605 women) were diagnosed with cancer after submission to the disease management program. DISCUSSION: The DMP-DM2 records were encrypted and linked to cancer registry data with a moderate personnel and financial input and high efficiency. Linked records were instantly usable for epidemiological analyses. Experiences of the pilot study suggest that future linkage studies can further advance the level of data protection, without losses in efficiency, by moderately complex software modifications and amendments of the data flow.

First epidemiological analysis of breast cancer incidence and tumor characteristics after implementation of population-based digital mammography screening.

PURPOSE: To epidemiologically evaluate the impact of digital mammography screening on incidence rates and tumor characteristics for breast cancer. MATERIALS AND METHODS: The first German digital screening units in the clinical routine were evaluated during the implementation period by using data from the cancer registry to compare the incidence rate of breast cancers and prognostic characteristics. 74 % of women aged 50 - 69 within the region of Muenster/Coesfeld/Warendorf were invited between 10 / 2005 and 12 / 2007 for initial screening; 55 % participated (n = 35 961). RESULTS: In 2002 - 2004 the average breast cancer incidence rate (per 100,000) was 297.9. During the implementation of screening, the rate rose to 532.9 in 2007. Of the 349 cancers detected with screening, 76 % (265 / 349) were invasive compared to 90 % (546 / 608) of cases not detected with screening during the same period. 37 % (97 / 265) of cancers detected in the screening program had a diameter of

[The use of the Epidemiology Cancer registry Baden-Württemberg in the follow-up of the EPIC cohort]. / Nutzung des Epidemiologischen Krebsregisters Baden-Württemberg bei der Nachbeobachtung der EPIC-Kohorte.

The European Prospective Investigation into Cancer and Nutrition (EPIC) is a prospective multicentre study that has been implemented to further the understanding of the association between diet and chronic diseases with emphasis on cancer. In Heidelberg from June 1994 until October 1998 about 25,500 subjects aged 35 to 65 years in women and 40 to 65 years in men were recruited. Apart from extensive questions about food intake, the participants were also asked to provide detailed information about their smoking habits, physical activity, subjective well-being, medical history and use of medications. As well as completing the questionnaire and a personal interview, the participants also gave blood samples and anthropometiric measures and the blood pressure were taken in standardized manner. The analyses of the EPIC study will depend on achieving a comprehensive record of all new cancer cases, and all deaths, together with the corresponding cause of death, within the study population. To date all self-reported incident cancer cases are verified by comparing them with pathology reports and hospital records. They are then coded according to the coding list for the International Classification of Diseases (ICD-O2) issued by the World Health Organisation (WHO). Since at begin of the investigation in the study region no cancer registration existed, the participants are followed -up by interval questioning ('active follow-up'). In order to integrate increasingly the data of the Cancer registry Baden-Württemberg (EKR-BW) attempts were made to explore record linkage systems. For this purpose, in the years 2000, 2002, 2003 record linkages between EPIC-Heidelberg and EKR-BW were performed. Procedures were evaluated for performing an anonymous linkage of the EPIC data with the data of the EKR-BW. After a pilot project on the feasibility of the linkage the program was evaluated on the EPIC data, record linkages are performed regularly. Different coding systems were applied. Simultaneously, the EPIC data about on cancer cases among the Heidelberg study participants are passed on to the Cancer Registry, thus contributing to improve completeness of the registry. So far the active follow-up can not be replaced by passive follow-up through record linkage with the cancer registry, but in the long-term it may be possible. Since the technical requirements are complied with, attempts should be made to improve the completeness of the epidemiological cancer registry Baden- Württemberg.