VersKiK: Study protocol of an observational registry-based study on the current state of follow-up care and adherence to follow-up guidelines after cancer in childhood or adolescence.

BACKGROUND: This article describes the study design of the quantitative part of the VersKiK study, The primary objectives of this study are to examine the occurrence of late effects in survivors of childhood or adolescent cancer (module 1), investigate health-related vulnerabilities and medical service utilization within this survivor group (modules 1 and 3), and assess the alignment between documented follow-up care for cardiological and audiological late effects with guideline recommendations, along with evaluating the extent of adherence among paediatric cancer survivors (module 3). METHODS: This is a non-interventional retrospective observational cohort study. It is based on stochastically linked insurance claims data from approximately 150,000 statutory insured persons with information concerning around 25,000-30,000 cancer survivors recorded in the German Childhood Cancer Register (GCCR). To explore adherence to selected follow-up guidelines, intention to treat treatment data from clinical study groups for particular diagnostic entities will be additionally included. DISCUSSION: The growing group of survivors after cancer in childhood and adolescence is representing a special population with an increasing demand for life-long healthcare services through relative high probability of late effects. Currently, there is a limited evidence in Germany on utilization of corresponding medical services and adherence to follow-up guidelines. With this study design, we are aiming to address these gaps and, consequently, suggest improvements to existing follow-up guidelines and follow-up care provision in Germany.

Burden of cardiovascular risk factors and cardiovascular disease in childhood cancer survivors: data from the German CVSS-study.

Aims: The cardiac and vascular late sequelae in long-term survivors of childhood cancer (CVSS)-study aimed to quantify the prevalence of cardiovascular risk factors (CVRF) and cardiovascular disease (CVD) in German childhood cancer survivors (CCS). Methods and results: In the CVSS-study (NCT02181049), 1002 CCS (age range 23-48 years) diagnosed with neoplasia prior to 15 years of age between 1980 and 1990 prospectively underwent a systematic, standardized clinical and laboratory cardiovascular screening, identical to the population-based Gutenberg Health Study (GHS) cohort. For 951 individuals, prevalences of CVRF and CVD were primarily compared to the GHS sample and to two further German population-based cohorts. Using log-binomial regression models, an increased risk for occurrence of arterial hypertension [relative risk (RR) 1.38, 95% confidence interval (95% CI 1.21-1.57)] and dyslipidaemia [RR 1.26 (95% CI 1.12-1.42)] was found. This indicates a premature occurrence compared to the general population of approximately 6 and 8 years, respectively [rate advancement period estimator, RAPhypertension 5.75 (95% CI 3.5-8.0) and RAPdyslipidaemia 8.16 (95% CI 4.4-11.9)]. Overall, no differences were observed for obesity and diabetes. Overt CVD was present in 4.5% (95% CI 3.0-6.6%) of CCS [RR 1.89 (95% CI 1.34-2.66), RAPCVD 7.9 (95% CI 4.1-11.7)], of which the most frequent entities were congestive heart failure and venous thromboembolism. Prevalences of CVRF and CVD increased with age without reaching a plateau over time. Conclusion: This large CCS screening examination revealed consistently in comparison to three population samples a considerably increased risk for premature CVD. The findings in these young adult CCS indicate a high burden of cardiovascular morbidity and mortality in the long term. Clinicaltrials. gov-Nr: NCT02181049.

[Screening for colorectal cancer: what is the most effective strategy?]. / Früherkennung kolorektaler Tumoren: Gibt es die optimale Screeningmassnahme?

Colorectal cancer is one of the most common cancers in Western countries. The long natural history of colorectal cancer provides opportunities for detection of early stage cancer and for prevention of cancer by removal of adenomas. An effective screening technique should significantly reduce morbidity and mortality in the population. Several tests are available to screen healthy subjects at average risk for colorectal cancer: total colonoscopy, combined sigmoidoscopy and faecal occult blood test (FOBT), FOBT alone. At the present time clear evidence for the most effective screening strategy is not available. Colonoscopy screening in Germany needs an adequate tool to evaluate the programme. Follow up is essential and cancer registries would be an important partner.

Biomonitoring on carcinogenic metals and oxidative DNA damage in a cross-sectional study.

Oxidative DNA damage is mediated by reactive oxygen species and is supposed to play an important role in various diseases including cancer. The endogenous amount of reactive oxygen species may be enhanced by the exposure to genotoxic metals. A cross-sectional study was conducted from 1993 to 1994 in an urban population in Germany to investigate the association between metal exposure and oxidative DNA damage. The cross-sectional sample of 824 participants was recruited from the registry of residents in Bremen, comprising about two-third males and one-third females with an average age of 61.1 years. A standardized questionnaire was used to obtain the occupational and smoking history. The incorporated dose of exposure to metals was assessed by biological monitoring. Chromium, cadmium, and nickel were measured in 593 urine samples. Lead was determined in blood samples of 227 participants. As a biomarker for oxidative DNA damage, 7,8-dihydro-8-oxoguanine has been analyzed in lymphocytes of 201 participants. Oxidative lesions were identified by single strand breaks induced by the bacterial formamidopyrimidine-DNA glycosylase (Fpg) in combination with the alkaline unwinding approach. The concentrations of metals indicate a low body load (median values: 1.0 microg nickel/l urine, 0.4 microg cadmium/l urine, and 46 microg lead/l blood; 83% of chromium measures were below the technical detection limit of 0.3 microg/l). The median level of Fpg-sensitive DNA lesions was 0.23 lesions/10(6) bp. A positive association between nickel and the rate of oxidative DNA lesions (Fpg-sensitive sites) was observed (odds ratio, 2.15; tertiles 1 versus 3, P < 0.05), which provides further evidence for the genotoxic effect of nickel in the general population.

[Correlation between educational status, chronic diseases and cardiovascular risk factors in young adults 18-29 years of age: results of a 1998 comprehensive German health survey]. / Der Zusammenhang zwischen Bildungsstatus, chronischen Krankheiten und kardiovaskulären Risikofaktoren bei jungen Erwachsenen im Alter von 18 bis 29 Jahren: Ergebnisse des Bundesgesundheitssurveys 1998.

OBJECTIVES: The aim of the study is to investigate the association between educational attainment and the prevalence of chronic diseases and cardiovascular risk factors for the German population aged 18-29 years. METHODS: The data source is the Federal Health Survey 1998 (BGS98), which is representative for Germany. The response rate for the survey is 61.4%. Included in the analysis are 616 females and 637 males. Indicator for educational atteinment is the highest achieved school degree ("Abitur" n = 375, "mittlere Reife" n = 566, "Hauptschule" n = 312). RESULTS: For eight of the 43 items for self-reported diseases in the BGS98-questionnaire persons in the age group 18-29 yielded a higher prevalence than older adults. For altogether 11 diseases, which showed a prevalence greater than 3% in the age group 18-29 years, only minor associations with educational attainment were observed. Statistically significantly increased prevalences are observed for allergic disorders in persons with higher education and for long-term headache in persons with lower education. Regarding smoking, obesity and lack of sports activities remarkably and statistically significant education related differences are observed. The percentage of persons showing simultaneously two or three of these risk factors was 33% for study subjects with "Hauptschulabschluss" compared to only 8% for study subjects with "Abitur". CONCLUSIONS: Educational attainment is still a strong predictor for health behaviour. This finding should be considered in future health promotion compaigns.

Sorting the hype from the facts in testicular cancer: is testicular cancer related to trauma?

PURPOSE: The rate of testicular cancer is increasing. Trauma severe enough to cause testicular atrophy is a putative risk factor for testicular cancer but the epidemiological evidence is not conclusive. A population based, multicenter case-control study was performed from 1995 to 1997 to investigate potential risk factors for gonadal and extragonadal germ cell cancer. MATERIALS AND METHODS: The study was done in 5 German regions. Interviews were performed with 269 eligible male patients with a histologically verified diagnosis and 797 controls. Detailed information on medical and family history was collected at personal interviews. RESULTS: We identified a significantly elevated risk for testicular cancer in relation to testis and/or groin trauma (odds ratio 2.5, 95% confidence interval [CI] 1.51 to 4.20). After introducing a lag time by excluding reports of trauma within the last 12 months before diagnosis or interview the corresponding odds ratio was 2.1 (95% CI 1.24 to 3.61). Analysis of the circumstances and the reported types of injury allowed us to restrict the study to testis trauma specifically, which had an odds ratio of 3.49 (95% CI 1.78 to 6.81). To account for a potential reporting bias analysis was restricted to traumatic episodes for which medical attention was sought. This restriction resulted in an odds ratio of 0.70 (95% CI 0.19 to 2.63) after excluding from study trauma reports within the last 12 months. CONCLUSIONS: The results of our study do not support the hypothesis that testicular trauma is an important risk factor for testicular cancer. The possibility of recall bias should be considered.

Meta-analysis of studies on breast cancer risk and diet: the role of fruit and vegetable consumption and the intake of associated micronutrients.

A meta-analysis was carried out, in order to summarise published data on the relationship between breast cancer, fruit and vegetable consumption and/or the intake of beta-carotene and vitamin C. Relative risks were extracted from 26 published studies from 1982 to 1997. Random and fixed effects models were used. Between studies, heterogeneity was found for vegetables, fruit, vitamin C but not for beta-carotene. Summary relative risk (RR) estimates based upon a random effects model, except for beta-carotene, for 'high consumption' compared with 'low consumption', derived from the studies satisfying the inclusion criteria were as follows: vegetable consumption: RR=0.75 (95% CI (confidence interval) 0.66-0.85) from 17 studies; fruit consumption: RR=0.94 (95% CI 0.79-1.11) from 12 studies; vitamin C: RR=0.80 (95% CI 0.68-0.95) from 9 studies; beta-carotene: RR=0.82 (95% CI 0.76-0.91) from 11 studies. This analysis confirms the association between intake of vegetables and, to a lesser extent, fruits and breast cancer risk from published sources. Increasing vegetable consumption might reduce the risk of breast cancer.

Dietary fat and sports activity as determinants for age at menarche.

A prospective study (1985-1991) was conducted to evaluate the role of nutrition, physical activity, and other life-style factors for the age at menarche, a known breast cancer risk factor. In 1988-1989, a total of 261 girls, aged 8-15 years, from a nationwide representative nutrition and activity survey (1985-1988) responded additionally to a mailed questionnaire on personal maturation and anthropometric data, physical activity, and information about nutritional habits, measured by a short food-frequency questionnaire. All girls without menarche at the time of questionnaire mailing were observed for 2 years or until the event of menarche. At the end of the follow-up period, 79% of the girls had experienced menarche. The survey and questionnaire data were analyzed for their relation to age at menarche using Cox's proportional hazards method. After excluding participants with largely deviating measurements between survey and questionnaire, the increased energy-adjusted fat intake was associated with accelerated menarche (relative risk = 2.1; 95% confidence interval 1.1-4.0; lowest vs. highest quartile), while increased sports activity was associated with a delay in menarche (relative risk = 0.3; 95% confidence interval 0.1-0.5; lowest vs. highest quartile). Parameters of physical development such as body weight or body fatness were found to be predictors of menarche. The study provides evidence that dietary effects on breast cancer risk might be indirect by influencing hormonal events like the age at menarche.