Cancer Registries in Germany and. Screening Program. Wolf Ulrich Batzler. Epidemiologisches Krebsregister NRW ggmbh
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1 Cancer Registries in Germany and Evaluation of the Mammography Screening Program Epidemiologisches Krebsregister NRW ggmbh
2 Outline Mammography screening in Germany Current status of cancer registration Aspects of cooperation between registries and screening current situation in Germany
3 Mammography-Screening Program Characteristics of the German Program Based on European Guidelines for Quality Assurance Target population: - women yrs - nationwide (approx. 10,5 Mio. target pop.) Responsible for implementation: - National al Association o of Statutory Health Insurance Physicians - Federal Association of Health Insurance Funds Contractual base: - Program for Early Detection of Cancer 2004 MX Screening part of the Program for Early Detection
4 Mammography-Screening Program: Program specific institutions Coordination Office Mammography Screening (Kooperationsgemeinschaft)( p g f ) - Organization & program evaluation - federal level 94 Screening Units (with 376 mammography units) - regional level 17 Central Units invitation, 2 yrs. interval 5 Reference-Centers (inter-regional) - Quality assurance & training
5 Mammography-Screening Program: Organizational Structure Federal level State level Regional level KV: Association of Statutory Health Insurance Physicians KK: Statutory Health insurance SE: Screening unit ME: Mammography unit AE: Assessment unit
6 Mammography-Screening Program Implementation process Pilot projects in three regions, 2001/ Wiesbaden, Hessen (target pop ) Bremen (target pop ) 000) Weser-Ems, Lower Saxony (target pop ) Since January 2004 nationwide build-up; first Screening Units took up service end of 2005.
7 Mammography-Screening Program Implementation process Routine Screening
8 Epidemiological Cancer Registration ti in Germany 11 epidemiological cancer registries Association of German Epidemiological Cancer Registries (GEKID) as national cooperation Start Nation wide: German Childhood Cancer Registry
9 Mammography-Screening Program: Cooperation: Responsibilities
10 Evaluation of Mammography-Screening: Contributions of Cancer Registries Basic information on Incidence rates Incidence rate trends Tumor stage distribution Surrogate indicator: interval cancer rate Impact Evaluation: mortality reduction
11 Evaluation of Mammography-Screening: Contributions of Cancer Registries Basic information on Incidence rates Incidence rate trends Tumor stage distribution Surrogate indicator: interval cancer rate Impact Evaluation: mortality reduction
12 First results of routine screening in the region of Münster Cancer Registry of North Rhine-Westphalia in cooperation with the Reference Center Münster 2 screening units in the Münster region (target pop. p ) Start of MX screening in October 2005
13 First results of routine screening in the region of Münster Method: Data of screen detected breast cancer cases made available through Reference Center Münster Data status: December 31, 2008 Record-Linkage with registry s routine data Identification of non-screen detected cases Analysis of incidence trend by age group and stage distribution
14 First results of routine screening, Münster region Incidence trend, invasive BC (C50) Incidence rates (per ) of invasive breast cancer (C50) in women aged 30-49, (= target population of mammography screening, fat line), and 70+ years, in the Muenster, Coesfeld, Warendorf region, from 1993 to yrs yrs yrs.
15 First results of routine screening, Münster region Incidence trend, invasive BC (C50) Incidence rates (per ) of invasive breast cancer (C50) in women aged 30-49, (= target population of mammography screening, fat line), and 70+ years, in the Muenster, Coesfeld, Warendorf region, from 1993 to yrs yrs yrs. Start of Screening Units
16 First results of routine screening, Münster region Incidence trend, in situ (D05) Incidence rates (per ) of ductal carcinoma in situ (DCIS, D05) in women aged 30-49, (= target population of mammography screening, fat line), and 70+ years, in the Muenster, Coesfeld, Warendorf region, from 1993 to yrs yrs yrs. Start of Screening Units
17 First results of routine screening, Münster region Tumor stages (T categories) Screen detected Non-screen detected N % N % DCIS (D05) Invasive Cancers (C50) Tmic T1a T1b T1c T T T T Tx Missing
18 Further cooperation between Cancer Registries and Screening in Germany CR Bremen: Basic evaluation of pilot project Bremen CR Lower-Saxony: Continuing evaluation of pilot project Weser-Ems (e.g. Urbschat I, Kieschke J: Onkologie 2008) GEKID: Definition of background incidence (registry specific) in close cooperation with the Coordination Office Screening Mammography
19 Cancer Registries and Mammography Screening Basic information on Incidence rates Incidence rate trends Tumor stage distribution Surrogate indicator: interval cancer rate Impact Evaluation: mortality reduction
20 Ascertainment of Interval Cancers: Regulations First concept of data exchange in 2004 proved impracticable Since 2004 revision with support of GEKID Final version to become effective in October 2009
21 Ascertainment of Interval cancers: Next steps Adoption of new regulations in states cancer registry laws Implementation of data exchange in Screening software Cancer registries software First routine linkage between screening data and registries expected in near future
22 Evaluation of Mammography-Screening: Contributions of Cancer Registries Basic information on Incidence rates Incidence rate trends Tumor stage distribution Surrogate indicator: interval cancer rate Impact Evaluation: mortality reduction
23 Impact evaluation: mortality reduction Long term evaluation not further specified in EU guidelines (and in Germany) Program specific concept required Evaluation concept has to account for specific implementation process in Germany Recent call for conceptual proposals by the National Board for Radiation Protection
24 Summary The German mammography screening program successfully implemented nationwide German cancer registries provide data for program evaluation in most regions of the country German cancer registries contributed already to the initial evaluation process Ascertainment of interval cancers as routine procedure of cancer registries expected in the near future Concept for mortality evaluation under consideration
25 Thanks to Dr. Martin Meyer, Cancer Registry of Bavaria Dr. Stefanie Weigel, Prof. Walter L. Heindel Reference Center Münster Peter Rabe, Coordination Office Mammography Screening
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