Serum oestrogen receptor alpha and beta bioactivity are independently associated with breast cancer: a proof of principle study.

BACKGROUND: Oestrogens play a crucial role in breast carcinogenesis. Earlier studies have analysed the serum levels of endogenous hormones measured by conventional assays. In this study, we analysed the capacity of serum from breast cancer cases and controls to transactivate the oestrogen receptor alpha (ER-alpha) and beta (ER-beta). METHODS: We used a receptor oestrogen-responsive element (ERE) -- the green fluorescent protein (GFP)-reporter test system in Saccharomyces cerevisiae. Oestrogen receptor-alpha or ER-beta bioactivity was determined in serum from 182 randomly chosen postmenopausal women with breast cancer and from 188 age-matched controls. RESULTS: High serum ER-alpha and ER-beta bioactivity were independently associated with the presence of breast cancer. Women whose levels of serum ER-alpha and ER-beta bioactivity were in the highest quintile among controls had a 7.57-(95% confidence interval (CI): 2.46-23.32; P=0.0004) and a 10.14 (95% CI: 3.19-32.23; P<0.0001)-fold risk for general and oestrogen receptor-positive breast cancer, respectively. CONCLUSION: The use of serum ER-alpha and ER-beta bioactivity assays as clinical tools in the management of breast cancer warrants further research. Future studies will dictate whether surrogate markers of ER-alpha and ER-beta bioactivity will provide a means to monitor the efficacy of anti-endocrine, adjuvant and chemopreventive strategies.

Subtype-specific incidence of testicular cancer in Germany: a pooled analysis of nine population-based cancer registries.

Comparisons of incidence estimates of testicular cancer subtypes beyond seminoma and non-seminoma are virtually missing in the epidemiologic literature. We analysed incidence data from population-based German cancer registries to provide subtype-specific incidences of testicular cancer. We pooled data from nine cancer registries from 1998 to 2003. We estimated incidence and mortality time trends of West and East Germany. Incidence and mortality were standardized by the European standard population. The annual percentage incidence change from 1961 through 1989 was 4.9% in East Germany and 3.0% from 1970 through 2004 in Saarland. Incidence increases were the most pronounced among adolescents and young men aged 15-49 years. In 1998-2003, the seminoma incidence rate was 5.1 per 100,000; among non-seminomas, the rates were the highest for malignant teratoma (1.6 per 100,000), followed by embryonal carcinoma (1.2 per 100,000). Testicular lymphomas were rare (0.1 per 100,000). The incidence of testicular cancer among children aged 0-14 years was nearly constant from 1987 through 2004. Majority of these cancers were yolk sac tumours (0.1 per 100,000). In East and West Germany, rates of embryonal carcinoma in the early periods were considerably lower than the rates of malignant teratoma. In the most recent periods, rates of embryonal carcinoma became quite similar to the rates of malignant teratoma. The mortality decline started in West Germany roughly 12 years earlier than in East Germany. The later start of the mortality decline in East Germany may be because of a later introduction of platinum-based chemotherapy compared to West Germany.

Epidemiology of chronic atrophic gastritis: population-based study among 9444 older adults from Germany.

BACKGROUND: Epidemiological data on chronic atrophic gastritis from general population samples are sparse in Germany. AIM: To assess prevalence of chronic atrophic gastritis according to potential risk factors and clinical outcomes in a large-scale population-based study. METHODS: In the baseline examination of ESTHER, a population-based cohort study conducted in Germany, serological measurements of pepsinogen (PG) I and II and Helicobacter pylori antibodies were taken in 9444 women and men aged 50-74 years. Information on potential risk factors and medical history were obtained by questionnaire. RESULTS: With the definition used in the EUROGAST study (PG I < 25 ng/mL), prevalence of chronic atrophic gastritis increased from 4.8% in age group 50-54 to 8.7% in age group 70-74. An alternative definition of chronic atrophic gastritis (PG I < 70 ng/mL and PG I/PG II < 3), used in multiple studies from Japan, revealed a greater increase with age (from 2.7% to 9.1%) and a strong association with H. pylori infection (adjusted odds ratio: 2.9, 95% confidence interval: 2.4-3.7). With both definitions, a strong inverse association with heartburn was observed. CONCLUSIONS: Overall chronic atrophic gastritis prevalence is low among older adults in Germany, but it strongly increases with age and H. pylori infection.

Trends in population-based cancer survival in Germany: to what extent does progress reach older patients?

BACKGROUND: The ageing of populations makes outcome monitoring among elderly cancer patients particularly important. PATIENTS AND METHODS: Using data from the population-based Cancer Registry of Saarland, we examined age-specific trends in 5-year relative survival from 1979 to 2003 for patients with 15 common cancers in Germany. Model-based period analysis was applied to estimate 5-year relative survival for four age groups (15-54, 55-64, 65-74, 75+) in the periods 1979-1983, 1984-1988, 1989-1993, 1994-1998, and 1999-2003. RESULTS: Overall, 5-year relative survival improved steadily from 42.2% in 1979-1983 to 56.7% in 1999-2003. From the youngest to the oldest age group, 5-year relative survival increased by 14.5, 12.1, 12.5, and 8.4 percent units, respectively, after adjusting for changes in the spectrum of cancer sites, and survival significantly improved for 10, 12, 11, and 5 cancer sites, respectively. The age gradient particularly increased for cancer sites with major progress in chemotherapeutic treatment regimens, such as ovarian cancer, non-Hodgkin's lymphoma and leukemia. CONCLUSIONS: Relative survival of cancer patients increased considerably for many forms of cancer in Germany from 1979 to 2003. Increases were much less pronounced among elderly patients, leading to an increasing age gradient in prognosis.

Lifetime prevalence of self-reported atopic diseases in a population-based sample of elderly subjects: results of the ESTHER study.

BACKGROUND: Prevalence studies of atopic diseases such as atopic dermatitis (AD), hay fever and allergic asthma have mostly been performed in children. Studies in the adult population are still rare. OBJECTIVES: We estimated the lifetime prevalence of different atopic diseases in an elderly population in Saarland, Germany. Additionally we investigated the association between atopic diseases and sociodemographic factors including age, gender, duration of school education (as a proxy measure of socioeconomic status), family history, and size of place of residence. METHODS: This study was conducted between June 2000 and December 2002 in the State of Saarland, Germany. Participants aged 50-75 years (n=9961) were recruited by their general practitioner in the context of a general health screening examination. All filled out a standardized questionnaire and reported whether a physician had ever diagnosed an atopic disease (hay fever, AD or asthma). RESULTS: Overall, 9949 subjects (mean age 62 years, 45% men) were included in this analysis. The lifetime prevalence of reported AD, hay fever and asthma was 4.3%, 8.3% and 5.5%, respectively. Lifetime prevalence of AD and asthma among women, and lifetime prevalence of hay fever among both genders, strongly decreased with age. Duration of school education ( 11 years) was strongly associated with AD (3.7%, 5.7%, 6.8%; P trend < 0.0001) and hay fever (7.2%, 11.2%, 12.8%; P trend < 0.0001), but only tentatively with asthma. CONCLUSIONS: The lifetime prevalence of AD is considerably lower in the elderly compared with the prevalence reported among younger adults in recent studies. Adults with a longer duration of school education appeared to have a higher risk for atopic diseases.

Tumour M2-PK as a stool marker for colorectal cancer: comparative analysis in a large sample of unselected older adults vs colorectal cancer patients.

Stool testing based on tumour-derived markers might offer a promising approach for non-invasive colorectal cancer (CRC) screening. The aim of this study was to estimate the potential of a new test for faecal tumour M2-PK to discriminate patients with CRC from a large sample of unselected older adults. Faecal tumour M2-PK concentrations were determined in 65 CRC patients and in a population-based sample of 917 older adults (median age: 65 and 62 years, respectively). Sensitivity and specificity of the test were calculated at different cutoff values, and receiver-operating characteristic curves (ROC) were constructed to visualise the discriminatory power of the test. The median (interquartile range) faecal tumour M2-PK concentration was 8.6 U ml(-1) (2.8-18.0) among CRC patients and <2 U ml(-1) (<2-3.2; P<0.0001) in the population sample. At a cutoff value of 4 U ml(-1), sensitivity (95% confidence interval) was 85% (65-96%) for colon cancer and 56% (41-74%) for rectum cancer. Specificity (95% confidence interval) was estimated to be 79% (76-81%). Given the comparatively high sensitivity of the tumour M2-PK stool test (especially for colon cancer) and its simple analysis, the potential use of the test for early detection of CRC merits further investigation. Possibilities to enhance specificity of the test should be explored.

[Malignant melanoma of the skin as evidenced by epidemiological cancer registries in Germany -- incidence, clinical parameters, variations in recording]. / Das maligne Melanom der Haut in epidemiologischen Krebsregistern in Deutschland -- Inzidenz, klinische Parameter, Variationen in der Erhebung.

PURPOSE: To exclude bias of registration evidenced by relevant differences among German cancer registries in the incidence of malignant melanoma (melanocarcinoma). METHODS: Cancer registries in the Federal German states of Hamburg, Schleswig-Holstein, Bremen, Rhineland-Palatinate, Saarland, the Munich District and the County of Münster featured registration data of malignant melanoma diagnosed in 2000 A. D. Figures and incidence rates, distribution of T-stage of the primary tumour were analysed as well as the distribution of sources reporting melanoma to the registries. Details of outpatient treatment of cutaneous melanoma by dermatologists in private practice were investigated. RESULTS: Data of 2,471 malignant melanoma cases were analysed. The highest age standardised incidence rates were 15.7 per 100,000 women and 19 per 100,000 men while the lowest rates were reported as 7.8 and 6.6 per 100,000, respectively (European standard). The proportion of stage T1 tumours varied between 21.5 and 59.2 %. We observed remarkable variations in the structure of reporting sources among the registries. The proportion of reports from dermatologists in private practice varied between 2.2 and 62 %, with higher proportions associated with more T1-T2 tumours but also lower completeness of stage reports. No clear association was identified between incidence of melanoma and reporting sources. CONCLUSION: Malignant melanomas of smaller size (T1-T2) are reported more frequently in an outpatient setting but very often without data. Hospital departments of dermatology contribute high-quality data with better completeness especially for later stage melanomas. Desirable inclusion of notifications from nationwide operating dermatopathology laboratories is complicated by the Federal German structure of cancer registration. Especially in case of malignant melanoma of the skin notification reports from all sectors of the health care system are imperative for valid epidemiological results.

Reduction of clinically manifest colorectal cancer by endoscopic screening: empirical evaluation and comparison of screening at various ages.

Endoscopic screening (sigmoidoscopy, colonoscopy) with removal of precancerous lesions can prevent a large proportion of colorectal cancers (CRCs). However, there is lack of data regarding optimal age, time intervals and numbers of screening examinations. We developed and applied modified techniques of epidemiological analysis to evaluate the impact of various endoscopy-based screening strategies on prevention of clinically manifest CRCs between the ages of 50 and 79 in a population-based case-control study (294 cases, 254 controls) conducted in Saarland, Germany. We found a strong potential for reduction of CRC occurrence even with a single screening endoscopy. The optimal age for a single screening endoscopy appears to be around 55 (estimated potential for prevention of cases between the ages of 55 and 79 in case of 100% compliance: 77% (95% confidence interval (CI) 46-90%)). A single screening endoscopy at age 50 would have a lower impact due to failure to prevent CRC at higher ages. Similarly, screening at ages 60 or older would have a lower impact because it would fail to prevent CRC at lower ages. Repeated offers of screening examinations could provide substantial additional benefit with the levels of compliance to be expected in practice, but they would have to be weighed against the increased risks and costs.

Long-term survival of cancer patients in Germany achieved by the beginning of the third millenium.

BACKGROUND: Over the last decades, long-term survival rates have substantially increased for many forms of cancer. However, these improvements have often been detected with substantial delay by traditional methods of survival analyses. PATIENTS AND METHODS: Using data of the population-based Saarland Cancer Registry, 5- and 10-year relative survival rates were derived for patients with 24 common forms of cancer in Saarland/Germany for the years 2000-2002 by period analysis and compared with conventional cohort estimates of 5- and 10-year relative survival rates pertaining to patients diagnosed in 1990-1992. RESULTS: For many forms of cancer, the 2000-2002 period survival estimates were substantially higher than the corresponding estimates for the cohorts of patients diagnosed in 1990-1992. For example, 10-year relative survival rates achieved in 2000-2002 were close to 100% for patients with testis and thyroid cancer, >85% for patients with melanomas of the skin, approximately 80% for patients with endometrial cancer and prostate cancer, close to 70% for patients with breast cancer and kidney cancer, and close to 60% for patients with colon cancer and lymphomas. CONCLUSIONS: Survival expectations of patients diagnosed with cancer at the beginning of the third millenium are substantially higher than previously available survival statistics have suggested.

[Epidemiological investigations of the chances of preventing, recognizing early and optimally treating chronic diseases in an elderly population (ESTHER study)]. / Epidemiologische Studie zu Chancen der Verhütung, Früherkennung und optimierten Therapie chronischer Erkrankungen in der älteren Bevölkerung (ESTHER-Studie).

BACKGROUND AND OBJECTIVE: Demographic changes in Germany will result in a marked rise in the prevalence of chronic diseases, presenting a central challenge in the coming decades. The ESTHER study on this question has as its objective to bring about innovative ways for the early recognition and prevention of diseases in the elderly. We herein give the concept of the study and the results of the basic enquiry. PATIENTS AND METHODS: The ESTHER study includes 9961 persons, aged between 50 and 74 years, who had a health check-up by their general practitioner. Standardized questionnaires for doctors and patients were used in addition to the check-up test to provide extensive basic data on risk factors, previous illnesses, family history and relevant items on life style. Blood, urine and stool samples were kept for later testing RESULTS: This cohort had a high prevalence of known risk factors for various chronic diseases, especially of the cardiovascular system. 42% of the cohort already had a history of hypertension, 40% of hyperlipidaemia, 11% had diabetes mellitus and 9% coronary heart disease. There was an association with obesity (present in many). The check-up test newly diagnosed one of the diseases or the presence of relevant risk factors in 13.4%. CONCLUSION: The high prevalence of risk factors for chronic diseases in the elderly underlines the urgency of stressing preventive measures. The ESTHER study - because of its long-term follow-up and saved specimens for later testing - provides an excellent basis for identifying new risk factors and risk indicators of chronic diseases.

Age-specific detriments to quality of life among breast cancer patients one year after diagnosis.

The aim of our study was to identify any differences in the quality of life (QOL) of breast cancer survivors one year after diagnosis when the acute treatment effects should not longer be apparent. QOL was assessed in a population-based cohort of 387 women with breast cancer from Saarland (Germany) using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLC30). Functional and symptom QOL-scores were compared with published reference data from the general population. Breast cancer survivors and women from the general population reported similar scores of global health/QOL. However, major deficits among women with breast cancer were found, for emotional, social, role and cognitive functioning. Age-specific comparisons between breast cancer patients and the reference population revealed that these deficits are predominantly found in younger age groups. The overall QOL of life of breast cancer survivors one year after diagnosis is comparable to women from the general population. However, some differences exist that seem to predominantly affect younger women who show a poorer QOL in certain domains.

Nonmelanoma skin cancer in the Federal State of Saarland, Germany, 1995-1999.

We analysed incidence data of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin from the Cancer Registry Saarland, Germany. During 1995-1999, the age-standardised incidence rates (world standard population) of BCC and SCC were 43.7 and 11.2 per 100000 among men and 31.7 and 4.4 per 100000 among women.

[Current epidemiology of carcinoma of the esophagus and cardia in Germany]. / Aktuelle Epidemiologie des Osophaguskarzinoms und des Kardiakarzinoms in Deutschland.

BACKGROUND AND OBJECTIVE: In the past 20-30 years the incidence of adenocarcinoma (AC) of the esophagus and the cardia has risen in western countries, while that of squamous cell carcinoma (SC) of the esophagus has largely stayed constant. Current data in the epidemiology of these cancers in Germany were analysed. METHODS AND MATERIAL: The data of the epidemiological cancer register of the Saarland (Old State of former West Germany) and the combined registers of the New States of Germany (former East Germany) and Berlin were collected. Because of the excellent registration procedures, data from the Saarland and the New States, Mecklenburg-Pommern, Brandenburg and Saxony were selected for this study. The incidence was calculated and corrected for age in relation to the world population. RESULTS: The incidence of esophageal AC among males in the Saarland rose from 0.22 per 100 000 population to 1.17 between 1986 to 1997, an increase of 432%, while in Brandenburg, Mecklenburg-Vorpommern and Saxomy it rose, between 1977 and 1998, from 0.23 to 0.8 i.e. by 248%. Esophageal SC incidence remained largely constant in both cancer registers since 1986. In 1998 it was 3.31 in the three New States of Germany and 5.05 in the Saarland. In females the incidence was markedly lower. In 1996-1998 fewer than 10% of cases of esophageal cancer were in UICC stage 1 (T 1 N 0 M 0, early carcinoma). Correspondingly the 5-year survival of all patients with esophageal carcinoma in the Saarland was less than 10% in 1971-1995. AC of the cardia also increased. In the three New States of Germany the incidence among males rose from 1.27 in 1977 to 2.18 in 1998, in females from 0.4 to 0.58. During the same period malignant tumors of the entire stomach, including the cardia, decreased in males from 29.5 to 17.1, in females from 14.3 to 9.2. CONCLUSION: In Germany, during the past 15-20 years, the incidence of esophageal AC and presumably also of AC of the cardia has increased. But the incidence of squamous cell carcinoma of the esophagus has remained largely constant. The proportion of early carcinoma and the 5-year survival with esophageal carcinoma remains under 10%.

Patient delay and stage of diagnosis among breast cancer patients in Germany -- a population based study.

Early diagnosis is a tenet in oncology and should enable early treatment with the expectation of improved outcome. Extent and determinants of patient delay of diagnosis in breast cancer patients and its impact on stage of disease were examined in a population based study among female breast cancer patients in Germany. Two hundred and eighty-seven women, aged 18 to 80 years with newly diagnosed invasive symptomatic breast cancer, were interviewed with respect to the diagnostic process. Patient delay was defined as time from onset of first symptoms to first consultation of a doctor. Median patient delay was 16 days among symptomatic patients. Eighteen per cent of all breast cancer patients waited longer than 3 months before consulting a physician. Long patient delay was associated with old age, history of a benign mastopathy, obesity, and indices of health behaviour such as not knowing a gynaecologist for out-patient care and non-participation in general health screening examinations. A strong association between patient delay and stage at diagnosis was observed for poorly differentiated tumours. These results suggest that at risk groups for delaying consultation can be identified and that a substantial proportion of late stage diagnoses of poorly differentiated breast cancer cases could be avoided if all patients with breast cancer symptoms would present to a doctor within 1 month.

Transition in cancer patterns among Turks residing in Germany.

Cancer mortality among the 2.1 million Turks residing in Germany is assumed to change from a pattern typical for a developing country towards one of an industrialised country. To test this hypothesis, we compared age-standardised cancer mortality rates among Turkish residents and (West) Germans using death registration data. In addition, we assessed proportional cancer incidence ratios among Turkish cases (n=144) in a German population-based cancer registry. All-cancer mortality 1992-1997 (per 100000) was 34.8 (n=4192) among Turkish men (Germans: 72.3) and 21.5 (n=1862) among Turkish women (Germans: 52.4). Over time, gastric and lung cancer mortality increased among Turkish men, as did breast cancer mortality among Turkish women. The proportional cancer incidence (PCIR) for stomach cancer among men was 2.9 (95% Confidence Interval (CI): 1.7-4.8), and that for breast cancer among women was 0.7 (95% CI: 0.4-1.1). Turks had an increased proportional incidence ratio for non-Hodgkin's lymphoma. Our findings partly support a transition of cancer patterns among Turks in Germany.

Skin melanoma in Saarland: incidence, survival and mortality 1970-1996.

Over the past few decades, the incidence of cutaneous malignant melanoma has been rising in both sexes in almost all developed countries, notably those with fair-skinned populations. Detailed population-based time trend analyses of skin melanoma incidence and survival in Germany accounting for stage have not been published until now. We analysed skin melanoma data from the population-based Saarland Cancer Registry in Germany from 1970 to 1996. Incidence rates were age-standardized. We estimated 5-year disease-specific survival rates and evaluated the effects of sex, age, calendar period and staging on the prognosis in Cox's proportional hazards models. From 1970-1972 to 1994-1996, melanoma incidence increased 170% from 2.4 to 6.5 per 100 000 person-years among men and 150% from 2.4 to 6.0 per 100 000 person-years among women. Mortality rates peaked in 1988-1990. After 1988-1990, mortality rates declined among women and remained roughly constant among men. The increase in the incidence of localized melanoma and T1-T2 melanoma respectively is driving the overall incidence trend. The improvement of survival over time is most likely due to earlier detection of skin melanoma. In the 1990s, about 30% of all newly diagnosed skin melanoma had stage T3 or T4, implying that further improvement in survival by earlier detection is feasible.

Undescended testis and the risk of testicular cancer: importance of source and classification of exposure information.

BACKGROUND: The strength of the association between undescended testis and testicular cancer varies considerably across studies. Here we report the effect of various classifications of self-reported history of undescended testis and different data sources on the estimates of the risk of testicular cancer from a case-control study. METHODS: We performed a population-based case-control study including 269 testicular cancer cases and 797 controls matched on age and region. Medical history was assessed by interviews (index persons) and mailed questionnaires (mothers). We used conditional logistic regression to calculate odds ratios (OR) and kappa coefficients to assess agreement between different sources of information. RESULTS: Odds ratios for testicular cancer ranged between 2.4 and 5.4 based on the sons' self-reports and between 1.1 and 1.9 based on the mothers' reports. The agreement between the sons and mothers on undescended, gliding or retractile testis was fair (kappa 0.53) and was good when these conditions were treated by surgery (kappa 0.89). The rating of a history of undescended testis by two urologists was fair (kappa 0.54). CONCLUSIONS: The questionnaire design, the classifications of undescended testis and data sources have an important impact on the OR for the association of undescended testis and testicular cancer. These factors may partially explain the heterogeneity of the OR for this association in case-control studies relying on self-reports.

Long-lasting reduction of risk of colorectal cancer following screening endoscopy.

Several studies have suggested that incidence and mortality of colorectal cancer (CRC) may be strongly reduced for up to 10 years by endoscopic screening with removal of precancerous lesions, but so far there are no data on risk reduction beyond this period. We assessed long-term reduction of CRC risk following screening endoscopy in a statewide population-based case-control study in Saarland, Germany. Lifetime history of screening endoscopy was compared between 320 cases with CRC aged 45-80 and 263 controls with other forms of cancer recruited from the same population. Potential confounding factors were controlled for by multiple logistic regression. 11% of cases compared to 27% of controls had a history of endoscopy for screening purposes (adjusted odds ratio (OR) = 0.28, 95% confidence interval (CI): 0.16-0.48). This strong risk reduction was also seen (OR = 0.41, 95% CI: 0.19-0.89) in subjects who had their last screening endoscopy more than 10 years ago (median: 18.9 years). Long term (> 10 years since last screening) risk reduction appeared to be particularly strong for advanced (Dukes C or D) CRC (OR = 0.19, 95% CI: 0.06-0.64). We conclude that risk reduction by screening endoscopy is long lasting, in particular with respect to advanced CRC.

More up-to-date monitoring of long-term survival rates by cancer registries: an empirical example.

A few years ago, a new method of survival analysis, denoted period analysis, has been developed to derive more up-to-date estimates of long-term survival rates of cancer patients, but this method has rarely been applied so far. Using empirical examples from the Saarland Cancer Registry, we illustrate how seriously traditional long-term survival estimates may lag behind survival expectations of newly diagnosed cancer patients in the case of recent improvement in prognosis, and to what extent this problem may be reduced by period analysis of survival. We conclude that period analysis should be more widely used for deriving more up-to-date long-term survival estimates.

Socio-demographic factors, health behavior and late-stage diagnosis of breast cancer in Germany: a population-based study.

Late-stage diagnosis of breast cancer is associated with poor survival. Identification of individuals at high risk of late-stage diagnosis could be an effective step to reduce breast cancer mortality. We examined the association of socio-demographic factors and health behavior with breast cancer stage in a population-based sample of 380 female breast cancer patients in Saarland, Germany. Overall, 182 women (47.9%) were diagnosed with late-stage (regional or distant) breast cancer. After control for potential confounding by multivariate logistic regression, an increased risk of late-stage diagnosis was observed for older age (OR = 1.8; 95% CI 1.0-3.2), foreign nationality (OR = 3.9; 95% CI 0.7-20.8), living in large households (OR = 1.7; 95% CI 1.0-2.9), non-participation in general health check-up (OR = 1.5; 95% CI 0.9-2.4) and low interest in health care (OR = 1.6; 95% CI 1.0-2.7). The proportion of late-stage cancer was clearly decreased when tumors were detected by screening (OR = 0.4; 95% CI 0.2-0.8). Certain socio-demographic factors and characteristics of health behavior seem to represent independent risk indicators of late-stage diagnosis.