Proportion and characteristics of screen-detected and non-screen-detected colorectal cancers in Germany
DOI:
https://doi.org/10.2340/1651-226X.2024.40234Keywords:
Screening, colonoscopy, fecal occult blood test, GermanyAbstract
Background: Germany has a long-standing colorectal cancer (CRC) screening offer. We aimed to quantify and characterize screen-detected colorectal cancers (sdCRCs) in Germany.
Methods: We conducted a cross-sectional study based on a healthcare database covering ~20% of the German population; we included CRC patients aged ≥ 55 years diagnosed in 2010–2018. Patients with a screening colonoscopy or a fecal occult blood test followed by colonoscopy within 180 days before diagnosis were classified as sdCRCs and compared to non-sdCRCs regarding age, stage and comorbidities.
Results: In 2018, 25% of male and 22% of female CRC patients were screen-detected. Regarding characteristics of all included CRC cases (N = 82,538), sdCRC patients were younger than non-sdCRCs (average difference men / women: 2.6 / 4.4 years). The proportion of advanced CRC among sdCRCs and non-sdCRCs, respectively, was 33 and 42% in women (men: 36 and 45%). Severe comorbidities were more prevalent in non-sdCRCs compared to sdCRCs (e.g. in male / female patients aged 65–74: 35% vs. 27% / 26% vs. 19%). Prevalences of hypertension and obesity were similar in both groups.
Interpretation: Our study suggests that about one fourth of CRCs in Germany are screen-detected. Among patients with non-sdCRC, not only advanced stage but also severe comorbidity was more common than in sdCRCs.
Downloads
References
Robert-Koch Institut und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. Krebs in Deutschland für 2017/2018 [Internet]. 2021. [cited 3. September 2022] Available from: https://www.krebsdaten.de/Krebs/DE/Content/Publikationen/Krebs_in_Deutschland/krebs_in_deutschland_node.html
Cardoso R, Zhu A, Guo F, et al. Incidence and mortality of proximal and distal colorectal cancer in Germany – trends in the tra of screening colonoscopy. Dtsch Arztebl Int. 2021;118(16):281–7.
https://doi.org/10.3238/arztebl.m2021.0111 DOI: https://doi.org/10.3238/arztebl.m2021.0111
Haug U. Current evidence and development of colorectal cancer screening in Germany. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2018;61(12):1513–16.
https://doi.org/10.1007/s00103-018-2832-x DOI: https://doi.org/10.1007/s00103-018-2832-x
Kramer J, Früh U. Prävention von Darmkrebserkrankungen. Prävention Gesundheitsförderung. 2019;14(4):407–13.
https://doi.org/10.1007/s11553-019-00705-8 DOI: https://doi.org/10.1007/s11553-019-00705-8
Gemeinsamer Bundesausschuss. Richtlinie des Gemeinsamen Bundesausschusses für organisierte Krebsfrüherkennungsprogramme [Internet]. oKFE-Richtlinie/oKFE-RL. 2022. [cited 11. December 2023] Available from: https://www.g-ba.de/downloads/62-492-3039/oKFE-RL-2022-11-17-iK-2023-01-26.pdf
Senore C, Basu P, Anttila A, et al. Performance of colorectal cancer screening in the European Union Member States: data from the second European screening report. Gut. 2019;68(7):1232–44.
https://doi.org/10.1136/gutjnl-2018-317293 DOI: https://doi.org/10.1136/gutjnl-2018-317293
Brenner H, Jansen L, Ulrich A, et al. Survival of patients with symptom- and screening-detected colorectal cancer. Oncotarget. 2016;7(28):44695–704.
https://doi.org/10.18632/oncotarget.9412 DOI: https://doi.org/10.18632/oncotarget.9412
Chan YM, MacKay C, Ritchie DT, et al. Screen detection is a survival predictor independent of pathological grade in colorectal cancer. A prospective cohort study. Surgeon. 2021;19(1):20–6.
https://doi.org/10.1016/j.surge.2020.02.004 DOI: https://doi.org/10.1016/j.surge.2020.02.004
Pande R, Froggatt P, Baragwanath P, et al. Survival outcome of patients with screening versus symptomatically detected colorectal cancers. Colorectal Dis. 2013;15(1):74–9.
https://doi.org/10.1111/j.1463-1318.2012.03120.x DOI: https://doi.org/10.1111/j.1463-1318.2012.03120.x
Parente F, Vailati C, Boemo C, et al. Improved 5-year survival of patients with immunochemical faecal blood test-screen-detected colorectal cancer versus non-screening cancers in northern Italy. Dig Liver Dis. 2015;47(1):68–72.
https://doi.org/10.1016/j.dld.2014.09.015 DOI: https://doi.org/10.1016/j.dld.2014.09.015
Pigeot I, Ahrens W. Establishment of a pharmacoepidemiological database in Germany: methodological potential, scientific value and practical limitations. Pharmacoepidemiol Drug Saf. 2008;17(3):215–23.
https://doi.org/10.1002/pds.1545 DOI: https://doi.org/10.1002/pds.1545
Haug U, Schink T. German pharmacoepidemiological research database (GePaRD). In: Sturkenboom M, Schink T, editors. Databases for pharmacoepidemiological research. Springer Series on Epidemiology and Public Health. Cham: Springer; 2021. p. 119–24. DOI: https://doi.org/10.1007/978-3-030-51455-6_8
Rutter MD, Beintaris I, Valori R, et al. World Endoscopy Organization consensus statements on post-colonoscopy and post-imaging colorectal cancer. Gastroenterology. 2018;155(3):909–25.
https://doi.org/10.1053/j.gastro.2018.05.038 DOI: https://doi.org/10.1053/j.gastro.2018.05.038
Schwarz S, Hornschuch M, Pox C, et al. Colorectal cancer after screening colonoscopy: 10-year incidence by site and detection rate at first repeat colonoscopy. Clin Transl Gastroenterol. 2022;14(1):e00535.
https://doi.org/10.14309/ctg.0000000000000535 DOI: https://doi.org/10.14309/ctg.0000000000000535
Oppelt KA, Luttmann S, Kraywinkel K, et al. Incidence of advanced colorectal cancer in Germany: comparing claims data and cancer registry data. BMC Med Res Methodol. 2019;19(1):142.
https://doi.org/10.1186/s12874-019-0784-y DOI: https://doi.org/10.1186/s12874-019-0784-y
Asendorf M, Reinold J, Schink T, et al. Assessing the socioeconomic status in the German Pharmacoepidemiological Research Database (GePaRD): description and exemplary application using the association with obesity. GMS Med Inform Biom Epidemiol. 2022;18(1):Doc02.
Cardoso R, Guo F, Heisser T, et al. Proportion and stage distribution of screen-detected and non-screen-detected colorectal cancer in nine European countries: an international, population-based study. Lancet Gastroenterol Hepatol. 2022;7(8):711–23.
https://doi.org/10.1016/S2468-1253(22)00084-X DOI: https://doi.org/10.1016/S2468-1253(22)00084-X
Hornschuch M, Schwarz S, Haug U. 10-year prevalence of diagnostic and screening colonoscopy use in Germany: a claims data analysis. Eur J Cancer Prev. 2022;31(6):497–504.
https://doi.org/10.1097/CEJ.0000000000000736 DOI: https://doi.org/10.1097/CEJ.0000000000000736
Kretschmann J, El Mahi C, Lichter F, et al. Früherkennungskoloskopie. Jahresbericht 2019. 2021. [cited 5. July 2024] Available from: https://www.zi.de/fileadmin/Downloads/Themen/Evaluation/koloskopie/Zentralinstitut.2021.Koloskopie-Jahresbericht_2019.pdf
Kaminski MF, Thomas-Gibson S, Bugajski M, et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. United European Gastroenterol J. 2017;5(3):309–34.
https://doi.org/10.1177/2050640617700014 DOI: https://doi.org/10.1177/2050640617700014
Weiss NS, Rossing MA. Healthy screened bias in epidemiologic studies of cancer incidence. Epidemiology. 1996;7(3):319–22.
Renzi C, Kaushal A, Emery J, et al. Comorbid chronic diseases and cancer diagnosis: disease-specific effects and underlying mechanisms. Nat Rev Clin Oncol. 2019;16(12):746–61.
https://doi.org/10.1038/s41571-019-0249-6 DOI: https://doi.org/10.1038/s41571-019-0249-6
Boakye D, Rillmann B, Walter V, et al. Impact of comorbidity and frailty on prognosis in colorectal cancer patients: a systematic review and meta-analysis. Cancer Treat Rev. 2018;64:30–9.
https://doi.org/10.1016/j.ctrv.2018.02.003 DOI: https://doi.org/10.1016/j.ctrv.2018.02.003
Jansen L, Eberle A, Emrich K, et al. Socioeconomic deprivation and cancer survival in Germany: an ecological analysis in 200 districts in Germany. Int J Cancer. 2014;134(12):2951–60.
https://doi.org/10.1002/ijc.28624 DOI: https://doi.org/10.1002/ijc.28624
Jansen L, Erb C, Nennecke A, et al. Socioeconomic deprivation and cancer survival in a metropolitan area: an analysis of cancer registry data from Hamburg, Germany. Lancet Reg Health Eur. 2021;4:100063.
https://doi.org/10.1016/j.lanepe.2021.100063 DOI: https://doi.org/10.1016/j.lanepe.2021.100063
Jansen L, Behrens G, Finke I, et al. Area-based socioeconomic inequalities in colorectal cancer survival in Germany: Investigation based on population-based clinical cancer registration. Front Oncol. 2020;10:857.
https://doi.org/10.3389/fonc.2020.00857 DOI: https://doi.org/10.3389/fonc.2020.00857
Starker A, Saß AC. Participation in cancer screening in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56(5–6):858–67.
https://doi.org/10.1007/s00103-012-1655-4 DOI: https://doi.org/10.1007/s00103-012-1655-4
Additional Files
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2023 Michel Hornschuch, Sarina Schwarz, Ulrike Haug
This work is licensed under a Creative Commons Attribution 4.0 International License.
