B Holleczek

BACKGROUND: A quality assured colonoscopy screening was implemented in Germany in the year 2002. Persons aged 55 years or older with a health insurance are eligible. The primary aim of colonoscopy screening is the early detection of cancer. Furthermore, an incidence decrease is expected due to systematic adenomectomy. Up to date, neither a systematic monitoring of epidemiological data nor a mortality evaluation has been contracted by law. MATERIALS AND METHODS: Four population-based cancer registries of the federal states Bremen, Hamburg, Saarland, and Schleswig-Holstein in Germany provided incidence data on colorectal cancers during 2000 - 2006. Age-standardised and stage-specific incidence rates and time trends (Joinpoint analysis and APC method) are reported. RESULTS: Overall 34,100 colorectal cancers were registered, of which 91 % were within the screening-eligible age group. The incidence rise of in situ-cancers of the colon and rectum was significant. Changes in tumours of the T 3- and T 4-categories were not consistent. DISCUSSION: There seems to be a temporal linkage between the implementation of a quality assured colonoscopy screening and the epidemiology of colorectal cancers in Germany. The observed changes cannot be attributed definitively to the screening activities, because required data are not available on the population level. A linkage of screenees and cancer data from registered tumour patients, which allows an individual follow-up and a mortality evaluation, would be desirable.

Introduction: Serum 25-hydroxyvitamin D level (25(OH)D) have been linked to mortality in several studies but appropriate cut-offs to define risk categories are under debate. It was aimed for a repeated measurements analysis on the association of serum 25-hydroxyvitamin D levels with all-cause and cause-specific mortality, paying particular attention to the shape of dose-response relationships.

Background: So far, only few studies have addressed patterns and underlying factors of provision of breast cancer (BRC) treatment on a population level in Germany. Material and Methods: Routine data from the population based Saarland Cancer Registry was extended with detailed clinical information by review of individual medical records of 2300 out of 2479 patients (93%) with primary invasive BRC diagnosed in 2000–2002. Provision of surgery and radiotherapy according to available consensus recommendations on treatment of primary BRC without distant metastasis were examined by age and tumour stage. Multiple logistic regression analysis was used to investigate further determinants like tumour characteristics, residence and type of hospital. Results: Overall, 91% of the patients received recommended local treatment consisting of either breast conserving surgery (BCS) and adjuvant radiotherapy or mastectomy. The proportion of patients with local surgery was 96% (BCS: 66%, mastectomy: 37%). 92% of patients with surgery were axillary staged. The provision of mastectomy as first surgery varied significantly by age, tumor stage, area of residence and care level of hospital. Radiotherapy was given to 68% of the patients (BCS patients: 86%, patients with mastectomy: 50%). Overall, patients aged 70 years or older received BCS, axillary staging and adjuvant radiotherapy less often compared to younger patients (differences of 26, 18 and 34 percentage points respectively). Discussion/Conclusions: Data from population based cancer registries may provide a valuable tool for measuring access and provision of cancer care on a population level, if detailed clinical information on cancer treatment is available. This study showed overall good adherence to consensus recommendations with respect to local treatment. However, substantial variation of treatment by age was observed. The study further indicated major variation in health care provision between different counties and hospitals.