Conclusions

Since the early 1990s, the cancer landscape of Germany has shown evidence of a marked change whose essential features can be summarized as follows:

  1. Following a trend reversal in the early 1990s, the age-adjusted cancer mortality for males is starting to decline. The age-adjusted cancer mortality for females has already been on the decline for decades. Moreover, there appears to be no further rise in the incidence rates for cancer. A decline may have started, but this cannot be confirmed on the basis of available data.

  2. Because of increasing life expectancy, the number of persons dying from cancer each year is continuing to rise. There has been an apparent slowing of this trend in recent years, however.

  3. Today cancer ranks behind cardiovascular diseases as the second leading cause of death in Germany. Unless dramatic breakthroughs are achieved in cancer prevention in the next few years comparable to those achieved for cardiovascular disease, cancer will become the leading cause of death in Germany within 15-20 years.

Our knowledge of how cancer can be prevented has expanded greatly during the past 10-15 years. Epidemiologic data on lung cancer illustrate how effective preventive measures can be in lowering mortality rates: The marked decline in lung cancer mortality in west German males observed since the late 1980s occurred several years after cigarette smoking began to decline significantly in the same population.

Given current knowledge on the preventability of cancer, it is clear that the annual number of cancer deaths in Germany could be significantly reduced below current levels. For the individual, cancer inflicts considerable pain and suffering and often leads to premature death. For society, cancer exacts high costs associated with long-term treatment and care needs. The systematic implementation of available preventive measures should be vigorously pursued.

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