gms | German Medical Science

Introduction: Up-to-date data as to whether incidence and mortality of total cancer and specific sites is increasing, decreasing or flat is important for public health, cancer research and the general public. Frequently, assessment of trends is done visually. To get quantitative assessments including statistical tests, we evaluated the German mortality data of the past 50 years and the incidence data of the Saarland Cancer Registry of the past 32 years with modern statistical tools.

Material and methods: The evaluations were based on the official mortality statistics of Germany and the incidence data of the Saarland Cancer Registry. We calculated age-standardized rates and analysed the trends with the freely available joinpoint regression program of the NCI of the USA.

Results: Age-standardized mortality rates for cancer and most specific sites decline with the exception of female lung cancer. Recently, also the incidence rates flatten out. However, incidence rates for cancers of the large intestine, breast and prostate as well as for lymphoma are still increasing. Trends are declining for malignancies of the stomach, gallbladder (females), larynx and lung (both males). Mortality rates from cancer will not excess those from cardiovascular diseases within a foreseeable future (15 – 25 years).

Discussion: The interplay of incidence and mortality indicates to different underlying causes for the decline of cancer mortality. Obviously, primary prevention is responsible for the decline of lung cancer mortality among males, and early detection for the decline of cervical cancer mortality among females. Advances in treatment might have promoted the decline of mortality from cancers of the breast and testis as well as for lymphoma. On the other hand, the lack of a turn-around of lung cancer mortality among females, a deferred decline of cervical cancer mortality among females and a delayed turn-around of morality from breast cancer compared to other countries, respectively, indicates to potential for improved efficiency of primary prevention, early detection and translation of novel treatment modalities into practice within the German health-care system.