Invitation to cervical cancer screening does increase participation in Germany: Results from the MARZY study.

The effect of different invitation models on participation in cervical cancer screening (CCS) was investigated in a randomized population-based cohort study in Germany. Participants were randomly selected via population registries and randomized into intervention Arm A (invitation letter) and Arm B (invitation letter and information brochure) or control Arm C (no invitation). The intervention and control arms were compared with regard to 3-year participation and the two invitation models were compared between intervention arms. Of the 7,758 eligible women aged 30-65 years, living in the city of Mainz and in the rural region of Mainz-Bingen, 5,265 were included in the analysis. Differences in proportions of women attending CCS were investigated and logistic regression was performed to analyze various factors influencing participation. In the intervention group, 91.8% participated in CCS compared to 85.3% in the control group (p < 0.0001), with a 6.6 percentage point increase in participation [95% confidence interval (CI) 4.6-8.6] and an adjusted odds ratio (OR) of 2.69 (95% CI 2.15-3.37). Effect estimators increased to 21.9 percentage points (95% CI 16.7-27.1) and an OR of 3.64 (95% CI 2.74-4.82), respectively, when women who participated in screening annually were excluded from the analysis. The invitation letter was particularly effective among women with lower school education, migrant women and older women. No difference in participation was found between the intervention Arm A and Arm B. An accompanying information brochure did not motivate more women to undergo CCS. However, a written invitation statistically significantly increased participation in CCS in Germany.

Tumour stage distribution and survival of malignant melanoma in Germany 2002-2011.

BACKGROUND: Over the past two decades, there has been a rising trend in malignant melanoma incidence worldwide. In 2008, Germany introduced a nationwide skin cancer screening program starting at age 35. The aims of this study were to analyse the distribution of malignant melanoma tumour stages over time, as well as demographic and regional differences in stage distribution and survival of melanoma patients. METHODS: Pooled data from 61 895 malignant melanoma patients diagnosed between 2002 and 2011 and documented in 28 German population-based and hospital-based clinical cancer registries were analysed using descriptive methods, joinpoint regression, logistic regression and relative survival. RESULTS: The number of annually documented cases increased by 53.2% between 2002 (N = 4 779) and 2011 (N = 7 320). There was a statistically significant continuous positive trend in the proportion of stage UICC I cases diagnosed between 2002 and 2011, compared to a negative trend for stage UICC II. No trends were found for stages UICC III and IV respectively. Age (OR 0.97, 95% CI 0.97-0.97), sex (OR 1.18, 95% CI 1.11-1.25), date of diagnosis (OR 1.05, 95% CI 1.04-1.06), 'diagnosis during screening' (OR 3.24, 95% CI 2.50-4.19) and place of residence (OR 1.23, 95% CI 1.16-1.30) had a statistically significant influence on the tumour stage at diagnosis. The overall 5-year relative survival for invasive cases was 83.4% (95% CI 82.8-83.9%). CONCLUSIONS: No distinct changes in the distribution of malignant melanoma tumour stages among those aged 35 and older were seen that could be directly attributed to the introduction of skin cancer screening in 2008.

Factors influencing uptake of HPV vaccination among girls in Germany.

BACKGROUND: Adequate coverage is key to the success of human papillomavirus (HPV) vaccination programmes. There is currently no organised HPV vaccination programme in Germany. The aim of this analysis was to determine HPV vaccine uptake as well as factors associated with uptake in nine to 17 year-old girls in Germany during the first year of vaccine availability. METHODS: This analysis is based on data from the Healthcare Access Panel, an established population-based household panel consisting of 55 000 representative households in Germany who were contacted between September and October 2007. A total of 4 747 households included at least one girl aged nine to 17 years. After reading a description of the HPV vaccine, these girls were asked, "Would you have yourself vaccinated against HPV?" Logistic regression analyses were performed to investigate associations between vaccination status and socio-demographic characteristics of the girls and their mothers. RESULTS: Of the 4 747 girls in the households who received questionnaires, 2 224 (46.9 %) participated in the study and 1 906 (40.2 %) answered the vaccination question. A total of 17.4 % of the girls were already vaccinated, 61.5 % felt positively about doing so, 4.7 % said they would not be vaccinated, and 16.3 % were not sure. The probability of a girl being vaccinated increased with each additional year of age (Odds Ratio (OR): 1.6, 95 % Confidence Interval (CI) 1.5-1.7). Among the 17 year-old girls, 38.5 % (95 % CI 32.6-44.4 %) had been vaccinated. Having a mother with high education (OR: 1.5, 95 % CI 1.0-2.3) or medium education (OR: 1.5, 95 % CI 1.1-2.1) versus basic education was a significant predictor for having been vaccinated. Similarly, medium (OR: 1.5, 95 % CI 1.0-2.4) versus low SES was significantly associated with having been vaccinated. Our analysis showed that during the first year of HPV vaccine availability in Germany, vaccination uptake was low. CONCLUSIONS: Countries with organised HPV vaccination programmes showed much higher vaccination uptake, even in the first year after programme introduction. If vaccination uptake in Germany is to significantly improve in the future, an organised vaccination programme will need to be introduced.

Penile cancer - Incidence, mortality, and survival in Saxony, Germany.

OBJECTIVE: Penile cancer is a rare disease in Europe and North America. Cancer registry data were used to estimate the incidence, mortality, and survival of penile cancer in Saxony, Germany. METHODS: Data on incidence were analyzed for the period 1961 to 2012 and mortality for the period 1990 to 2012. Trend analyses of incidence and mortality were performed using joinpoint regression. Survival rates for primary penile cancer (ICD-10 C60) were estimated; overall, by T stage, UICC stage, and by year of diagnosis for the years 1963 to 2012. RESULTS: Age-standardized incidence increased from 1.2 per 100,000 in 1961 to 1.8 per 100,000 in 2012, with a statistically significant increase between 2003 and 2012 (annual percent change: 4.66; 95% confidence interval, CI 0.62-8.86). There was a statistically significant negative trend in mortality between 1990 and 2012 (annual percent change: -3.46, 95% CI -5.21 to -1.67). A total of 430 new cases of penile cancer were registered between 2003 and 2012, with 63% of all penile cancers occurring in men aged 60 to 79 years. Almost half of those cases were located at the glans penis. The overall relative 5-year survival for the years of diagnosis 2003 to 2012 was 72.4% (95% CI 64.8%-80.0%). Relative 5-year survival decreased with higher UICC stages (I: 96%, 95% CI 84.7%-107.3%; II: 86.3%, 95% CI 71.0%-101.5%; III: 39.6%, 95% CI 19.9%-59.3%; IV: 20.3%, 95% CI 2.4%-38.2%). CONCLUSION: The incidence of penile cancer in Saxony has increased in recent years, while mortality has decreased. However, survival rates have remained constant over time.

Evaluation of the methodological quality of articles on autologous breast reconstruction.

BACKGROUND: Breast cancer remains the most common cancer among women worldwide. Autologous breast reconstruction may contribute toward restoring body image and improving quality of life after mastectomy. This systematic literature review describes differences in the quality and type of studies investigating autologous breast reconstruction techniques over time. METHODS: MEDLINE was searched for articles related to the surgical techniques, namely, TRAM, LADO, DIEP, and SGAP/IGAP, for the periods 1970 to 2007 and 2008 to 2010. The quality and type of studies were compared across the two time periods. Full-texts were evaluated according to prespecified quality criteria. RESULTS: The MEDLINE searches yielded 1,057 articles for review; of them, 517 articles were excluded, and 314 had a completed quality criteria checklist and hence were included; of these 314 articles, 206 articles investigated TRAM flaps, 85 investigated LADO flaps, 74 investigated DIEP flaps, and 6 investigated SGAP/IGAP flaps. A total of 218 articles were published between 1970 and 2007 compared to 96 articles published between 2008 and 2010. The comparison of quality scores between the two time periods showed a shift toward higher scores in the period 2008 to 2010. The DIEP technique was investigated more frequently between 2008 and 2010 than between 1970 and 2007, whereas the percentage of articles focusing on the TRAM flap decreased. The percentage of articles investigating the LADO and SGAP/IGAP techniques remained constant across the time periods. CONCLUSIONS: Results relating to the methodological quality of articles on breast reconstruction with autologous tissue show that the quality of publications has improved with time, whereas research interests concerning the type of surgical technique investigated have changed in focus.

Participation in preventive health check-ups among 19,351 women in Germany.

In Germany, a biennial preventive health check-up has been available for individuals aged 35 and older since 1989. The check-up includes identification of cardiovascular disease risk factors and examinations for diabetes mellitus type 2 and kidney disease. Participation in preventive health check-ups among 19,351 women aged 35 to 74 in Germany in 2004 was investigated. Logistic regression was performed to examine associations between participation and age, marital status, education, socio-economic status (SES) and region of residence. In total, 53.4% of women attended at least every two years, 23.4% attended irregularly and 23.2% never attended. In adjusted models, single, divorced, separated or widowed women were less likely to have a preventive health check-up at least every two years compared to married women (OR 0.63, 95% CI 0.57-0.71), while women in eastern Germany were less likely to participate (OR 0.80, 95% CI 0.75-0.86) than women in western Germany. Education showed no association with having a preventive health check-up at least every two years; however, women with low SES were less likely to participate compared to those with high SES (OR 0.82, 95% CI 0.74-0.92). About half of eligible women reported participating in health check-ups at least every two years, with participation varying according to socio-demographic characteristics. Women who are less likely to participate may benefit from receiving invitation letters within the framework of an organised programme. The benefits of general health checks, however, need to be evaluated.