[Determination of interval cancer rates in the German mammography screening program using population-based cancer registry data]. / Ermittlung der Rate von Intervallkarzinomen im deutschen Mammographie-Screening-Programm mit Hilfe epidemiologischer Krebsregister.

GOAL: The evaluation of interval cancers (ICA) and false-negative diagnoses (FND) is important for the quality assurance of the mammography screening program (MSP) for women aged 50-69 years. We aimed to investigate ICA in the states of Lower Saxony (NDS) and North Rhine-Westphalia (NRW). ICA could be identified by record linkage of data from screening attendees (TN) with data from population-based cancer registries. The frequencies of ICA and FND are described, and problems in the categorization of ICA according to EU guidelines are discussed. METHODS: Record linkage in the cancer registries was performed with the encrypted data from 83,724 TN in NDS and 885,940 TN in NRW. ICA were identified; in NDS, ICA were categorized by the regional MSP reference center. RESULTS: In all, 208 ICA in NDS and 2.018 ICA in NRW were ascertained. In relation to the regional background incidence rate (IR), the relative ICA rates were 22.5%/26.7% in the first year after screening (recommendation of EU guidelines <30% of IR) and 55.6%/54.2% in the second year after screening (recommendation of EU guidelines <50% of IR). It was found that 17.3% of all categorized ICA in NDS were FND (recommendation of EU guidelines <20%). DISCUSSION: The relative ICA rates for the 2-year interval are consistent with the recommendations of the EU guidelines. Unlike in NDS, the categorization of ICA was not possible in NRW. The MSP needs the diagnostic mammograms of all ICA in order to identify FND. However, data protection regulations are hindering this process and nationwide comparability of FND is therefore not guaranteed. In NDS, the state government has enacted laws to facilitate the transfer of diagnostic mammograms to the MSP. There is need for this sort of action in other federal states too.

[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.

[Contributions of the epidemiological cancer registries to the evaluation of mammography screening in Germany]. / Beiträge bevölkerungsbezogener Krebsregister zur Evaluation des bundesweiten Mammographie-Screenings. Erste Ergebnisse zu Brustkrebsinzidenz und T-Stadienverteilung von Teilnehmerinnen des Mammographie-Screenings Weser-Ems (MSWE) im bevölkerungsbezogenen Vergleich.

INTRODUCTION: Before the country-wide introduction of mammography screening, testing of the organised screening took place in Weser-Ems, Bremen and Wiesbaden. Important quality assurance parameters (carcinomas detected during checkup intervals, tumour stage distribution, breast cancer incidence rate, breast cancer mortality rate) are to be evaluated via epidemiological cancer registries. For the model region Weser-Ems (MSWE) the record linkage with the epidemiological cancer registry Lower Saxony (EKN) was successfully accomplished. The technical realisation and first comparison analyses for the development of breast cancer incidence and of tumour size are reported. MATERIAL AND METHODS: The target population of the MSWE was 22,600 women aged 50-69 years. They were invited since May 2002 to mammography screening with a screening interval of two years. The record linkage of 12,913 women who participated until February 2004 in the MSWE, was realised by the use of the control number system of the epidemiological cancer registries. The observation time was between 6 and 25 month (median: 15 month). Reference population for comparison analyses were all women between 50 and 69 years of the remaining governmental district Weser-Ems (255,000 women). RESULTS: In the first record linkage 96 screening-cases (ICD-10 C50 + D05) could be identified. Additionally six interval cancers were determined (time between screening and diagnosis in months: median 5.5; mean 7.7). The breast cancer incidence increased in the MSWE area and in the control-area, the rise in the MSWE area being higher. The increase was especially observed with the small tumours. Women with breast cancer diagnosed by screening: 19.8% in-situ-cancer and 18.8% very small tumours < = 10 mm. In the control area Weser-Ems this rate with 5.6% in-situ-cancer and 14.5% very small tumours, was relatively high, indicating the spread of opportunistic mammographies in absence of organised screening. CONCLUSION: First effects of mammography screening can be evaluated early by comparison between screening data and the data of population-based cancer registries. Using the control number system of the epidemiological cancer registries and comparison by pseudonyms the evaluation of quality assurance parameters of the MSWE can be realised in compliance with the data security law. The feedback of cancers, detected during checkup intervals is not covered by the cancer registry law. For the implementation of the guidelines for early recognition cancer legal adjustments will be necessary. This concept can be easily adapted to other screening programme.