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Article

Divergent Patterns and Trends in Breast Cancer Incidence, Mortality and Survival Among Older Women in Germany and the United States

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Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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Saarland Cancer Registry, 66119 Saarbrücken, Germany
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German Centre for Cancer Registry Data (ZfKD), Robert Koch-Institute, 13353 Berlin, Germany
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Cancer Registry of Bremen, Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany
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Cancer Registry of Rhineland-Palatinate, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, 55116 Mainz, Germany
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Cancer Registry of North Rhine-Westphalia, 44801 Bochum, Germany
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Cancer Registry of Schleswig-Holstein, 23552 Lübeck, Germany
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Cancer Registry of Lower Saxony, 26121 Oldenburg, Germany
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Hamburg Cancer Registry, 20539 Hamburg, Germany
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Department of Gynecology and Obstetrics, University Women’s Clinic, 69120 Heidelberg, Germany
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National Center for Tumor Diseases, Division Gynecologic Oncology, University Hospital and German Cancer Research Center, 69120 Heidelberg, Germany
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Division of Preventive Oncology, German Cancer Research Center (DKFZ), and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
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German Cancer Consortium (DKTK), German Cancer Research Center, 69120 Heidelberg, Germany
*
Author to whom correspondence should be addressed.
Both authors contributed equally to this manuscript.
Cancers 2020, 12(9), 2419; https://doi.org/10.3390/cancers12092419
Received: 20 July 2020 / Revised: 14 August 2020 / Accepted: 20 August 2020 / Published: 26 August 2020
(This article belongs to the Section Cancer Epidemiology and Prevention)
Background: Breast cancer treatment has changed tremendously over the last decades. In addition, the use of mammography screening for early detection has increased strongly. To evaluate the impact of these developments, long-term trends in incidence, mortality, stage distribution and survival were investigated for Germany and the United States (US). Methods: Using population-based cancer registry data, long-term incidence and mortality trends (1975–2015), shifts in stage distributions (1998–2015), and trends in five-year relative survival (1979–2015) were estimated. Additionally, trends in five-year relative survival after standardization for stage were explored (2004–2015). Results: Age-standardized breast cancer incidence rates were much higher in the US than in Germany in all periods, whereas age-standardized mortality began to lower in the US from the 1990s on. The largest and increasing differences were observed for patients aged 70+ years with a 19% lower incidence but 45% higher mortality in Germany in 2015. For this age group, large differences in stage distributions were observed, with 29% (Germany) compared to 15% (US) stage III and IV patients. Age-standardized five-year relative survival increased strongly between 1979–1983 and 2013–2015 in Germany (+17% units) and the US (+19% units) but was 9% units lower in German patients aged 70+ years in 2013–2015. This difference was entirely explained by differences in stage distributions. Conclusions: Overall, our results are in line with a later uptake and less extensive utilization of mammography screening in Germany. Further studies and efforts are highly needed to further explore and overcome the increased breast cancer mortality among elderly women in Germany. View Full-Text
Keywords: breast cancer; incidence; survival; mortality; Germany; United States; trends breast cancer; incidence; survival; mortality; Germany; United States; trends
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MDPI and ACS Style

Jansen, L.; Holleczek, B.; Kraywinkel, K.; Weberpals, J.; Schröder, C.C.; Eberle, A.; Emrich, K.; Kajüter, H.; Katalinic, A.; Kieschke, J.; Nennecke, A.; Sirri, E.; Heil, J.; Schneeweiss, A.; Brenner, H., for the GEKID Cancer Survival Working Group. Divergent Patterns and Trends in Breast Cancer Incidence, Mortality and Survival Among Older Women in Germany and the United States. Cancers 2020, 12, 2419. https://doi.org/10.3390/cancers12092419

AMA Style

Jansen L, Holleczek B, Kraywinkel K, Weberpals J, Schröder CC, Eberle A, Emrich K, Kajüter H, Katalinic A, Kieschke J, Nennecke A, Sirri E, Heil J, Schneeweiss A, Brenner H for the GEKID Cancer Survival Working Group. Divergent Patterns and Trends in Breast Cancer Incidence, Mortality and Survival Among Older Women in Germany and the United States. Cancers. 2020; 12(9):2419. https://doi.org/10.3390/cancers12092419

Chicago/Turabian Style

Jansen, Lina, Bernd Holleczek, Klaus Kraywinkel, Janick Weberpals, Chloé C. Schröder, Andrea Eberle, Katharina Emrich, Hiltraud Kajüter, Alexander Katalinic, Joachim Kieschke, Alice Nennecke, Eunice Sirri, Jörg Heil, Andreas Schneeweiss, and Hermann Brenner for the GEKID Cancer Survival Working Group. 2020. "Divergent Patterns and Trends in Breast Cancer Incidence, Mortality and Survival Among Older Women in Germany and the United States" Cancers 12, no. 9: 2419. https://doi.org/10.3390/cancers12092419

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