Poor progress of cancer treatment and the basic rule that prevention of disease is preferential to its treatment justify high priority to research on cancer prevention. The already now perceivable high costs of promising future molecular genetically-based treatment approaches underline the long-term relevance of cancer prevention.
The Unit Fundamentals of Cancer Prevention promotes projects which investigate or evaluate new issues or improved strategies of cancer prevention. Another focal point is secondary prevention (especially screening) because from this area the most rapid effects in terms of reduction of cancer mortality, and partially cancer incidence (including costs of treatment), can be expected.
Further activities are directed towards the identification and quantification of new risk factors for specified cancers including gene-environment intercations, especially immune response-environment (virus) interactions in order (a) to reach a mechanistic understanding, and (b) to identify possible genetically-determined high risk groups in the population. A research platform for the investigation of these factors in the field of malignant neoplasms of the hematopoietic system is being established by our participation in the European multicenter study on the etiology of lymphoma EPILYMPH (see below).
Finally, the Unit conducts the regular update of the cancer mortality data of Germany and its presentation in the Internet presentation of the dkfz. Various evaluations are performed with these data.

Descriptive Epidemiology

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The working group provides regularly updated data on cancer mortality in Germany. These data are the basis for analyses of time trends and regional variations of cancer mortality. Additionally, they are the baseline for a quantification of the potential of primary and secondary prevention in Germany.

Epidemiologic aspects of cancer prevention in Germany

In Germany, as in other highly industrialized countries, cancer is the second most common cause of death. With approximately 210 000 individuals dying each year from malignant tumours, roughly one in four deaths in Germany can currently be attributed to cancer. Only in the past few years has there been a slow decline in the age-standardized mortality rates for cancer, even among men. This follows a long period of some decades, during which the mortality steadily increased and then persisted at a high level. The reversal, however, does not mean that the situation is no longer a cause for concern. In fact, for the most common cause of death, namely the cardiovascular diseases, a much greater decrease in mortality has been observed for many years now. If this trend continues, cancer could become the largest killer in another 15 to 20 years.
On the other hand, we have been aware since the end of the 1960s that the majority of cancers are caused by environmental influences and are thus, in principle, avoidable. In the present contribution we present (a) the fundamental arguments to support the thesis that a large proportion of cancers, and of cancer deaths, could be avoided and (b) an estimate for Germany of both the theoretical potential of primary cancer prevention and also the practically attainable potential. The estimates are based on very conservative assumptions. They yield, for the theoretical potential, values in the range 43 – 65 % and for the reduction actually obtainable in the medium term due to primary prevention, values of 18 – 31 % (1).

Secondary Prevention

Secondary prevention and screening measures in particular, offer a further level of cancer prevention for tumors which have not or could not be targeted by primary prevention.
In the area of high quality screening, which has the potential to account for the earliest effects in mortality reduction, Germany lacks far behind in international comparison. Therefore this working group puts strong emphasis on the implementation of established screening measures in Germany, the quality control of their effectiveness and research into new screening approaches.


Etiologic Studies

Even if the main risk factors or factor groups are roughly understood, and their contribution to cancer causation is quantified at least in its magnitude, the search for unknown factors or the investigation of poorly understood factors continues. Work focuses especially on complex interactions as, e.g., between viruses or other immunogenic agents and the immune system, or environmental factors and genetic predisposition.
This area comprises also a number of occupational cancer studies. Since various of the examined agents play a role in the environment, this research is also of interest for environmental cancer epidemiology.


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