gms | German Medical Science

Introduction: Most cancers are more prevalent in people above 50 years of age. However, empirical evidence indicates a worldwide increase in the early-onset cancer incidence and mortality between 1990 and 2019 with notable variances between countries, sex and cancer types [1], [2]. In particular, the more developed a country, the higher its observed incidence of early-onset cancer. However, with regard to Germany, a highly developed country, epidemiological information on early-onset cancer is scarce. Therefore, to contribute to the cancer disease surveillance, we estimated the temporal trend in the incidence and mortality of early-onset cancer in Germany between 1999 and 2019.

Methods: The data on early onset cancer were obtained from the Center for Cancer Registry Data (Zentrum für Krebsregisterdaten, ZfKD) [3]. The analysis comprised all ages, from 0 to 50 years, and all types of cancer classified by the International Classification of Diseases (ICD-10)-codes C00-C97 (excl. C44). Temporal trends were estimated using negative binomial regression, differentiated by sex and cancer type.

Results: We found large variations in the incidence and mortality trends with regard to different cancer types as well as sex. Particularly regarding the incidence, our results indicate heterogenous developments. Between 1999 and 2019 in Germany, we observed stable or slightly increasing overall trends (0% and 1%) in the incidence for all early-onset cancers combined (C00-C97, excl. C44) for men and women, respectively, and strict declines in the mortality for both sexes (-2% and -3%). In addition, irrespective of sex, there is a significant age-specific trend showing an increase in both the incidence and mortality as individuals age, with only a few exceptions.

Discussion: Our findings demonstrate that cancer among younger ages is rare compared to later onset cancer and that the incidence increases with age. Considering the temporal development of the disease-related rates, early-onset cancer should be closely monitored to see whether decreasing trends in the incidence and mortality continue. Despite decreasing incidence, the prevalence of a disease can rise due to the interplay with mortality. Consequently, we recommend to maintain precise surveillance, efforts in prevention and early detection, as well as appropriate investments into healthcare resources, research and development.

Conclusion: The incidence and mortality of early-onset cancer in Germany slightly decreased in the last decade (since about 2011). Primary prevention strategies and treatment strategies that are based on the characteristics of the specific early-onset cancers, the sex and the age of diseased individuals, are pivotal to maintain the trends. Likewise, it is key to educate both, the population and healthcare professionals, about the possibility of developing cancer in child- and younger adulthood and to encourage healthy lifestyles as well as complying with early screening recommendations.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.