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@ARTICLE{Jansen:157708,
      author       = {L. Jansen$^*$ and B. Holleczek and K. Kraywinkel and J.
                      Weberpals$^*$ and C. C. Schröder$^*$ and A. Eberle and K.
                      Emrich and H. Kajüter and A. Katalinic and J. Kieschke and
                      A. Nennecke and E. Sirri and J. Heil and A. Schneeweiss and
                      H. Brenner$^*$},
      title        = {{D}ivergent {P}atterns and {T}rends in {B}reast {C}ancer
                      {I}ncidence, {M}ortality and {S}urvival {A}mong {O}lder
                      {W}omen in {G}ermany and the {U}nited {S}tates.},
      journal      = {Cancers},
      volume       = {12},
      number       = {9},
      issn         = {2072-6694},
      address      = {Basel},
      publisher    = {MDPI},
      reportid     = {DKFZ-2020-01763},
      pages        = {2419},
      year         = {2020},
      abstract     = {Breast cancer treatment has changed tremendously over the
                      last decades. In addition, the use of mammography screening
                      for early detection has increased strongly. To evaluate the
                      impact of these developments, long-term trends in incidence,
                      mortality, stage distribution and survival were investigated
                      for Germany and the United States (US).Using
                      population-based cancer registry data, long-term incidence
                      and mortality trends (1975-2015), shifts in stage
                      distributions (1998-2015), and trends in five-year relative
                      survival (1979-2015) were estimated. Additionally, trends in
                      five-year relative survival after standardization for stage
                      were explored (2004-2015).Age-standardized breast cancer
                      incidence rates were much higher in the US than in Germany
                      in all periods, whereas age-standardized mortality began to
                      lower in the US from the 1990s on. The largest and
                      increasing differences were observed for patients aged 70+
                      years with a $19\%$ lower incidence but $45\%$ higher
                      mortality in Germany in 2015. For this age group, large
                      differences in stage distributions were observed, with
                      $29\%$ (Germany) compared to $15\%$ (US) stage III and IV
                      patients. Age-standardized five-year relative survival
                      increased strongly between 1979-1983 and 2013-2015 in
                      Germany $(+17\%$ units) and the US $(+19\%$ units) but was
                      $9\%$ units lower in German patients aged 70+ years in
                      2013-2015. This difference was entirely explained by
                      differences in stage distributions.Overall, our results are
                      in line with a later uptake and less extensive utilization
                      of mammography screening in Germany. Further studies and
                      efforts are highly needed to further explore and overcome
                      the increased breast cancer mortality among elderly women in
                      Germany.},
      cin          = {C070 / C120 / HD01},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331 / I:(DE-He78)C120-20160331 /
                      I:(DE-He78)HD01-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:32858964},
      doi          = {10.3390/cancers12092419},
      url          = {https://inrepo02.dkfz.de/record/157708},
}