Cancer Epidemiology

In the PROBASE study (Risk-adapted prostate cancer early detection study based on a ‘baseline’ PSA value in young men - a prospective multicenter randomised trial), a modern concept for PSA screening is being investigated. In this risk-adapted strategy, PSA tests are carried out depending on the individual risk of the man, which is determined using a baseline PSA value at the age of 45 or 50.

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SOLACE aims to develop, test and disseminate tools to overcome identified bottlenecks and target health inequalities in different European countries. It will provide a toolbox for individualised approaches to lung cancer screening at national or regional level.

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The German National Cohort (“NAKO Gesundheitsstudie”) is an interdisciplinary, population-based cohort study that will follow the long-term medical histories of 200,000 participants over 25-30 years. As Germany’s largest health study, the overarching aim of the National Cohort is to inform more effective disease prevention strategies, with a focus on seven major disease groups: cancer, diabetes, and cardiovascular, neurologic and psychiatric, infectious, respiratory and musculoskeletal diseases. It will provide a major, central resource for population-based epidemiology in Germany, and will help to identify new and tailored strategies for early detection, prediction, and primary prevention of major diseases.

The main objectives of the study are:

1. to identify etiologic pathways linking lifestyle and environmental risk factors to chronic diseases and functional impairments;
2. to study the causes of regional and socio-economic disparities in health status and disease risk in Germany; and
3. to develop risk prediction models for the identification of individuals at increased risk of major chronic diseases; and (iv) to identify and validate markers for early detection of disease and pre-disease phenotypes.

The study participants are recruited through a network of 18 local recruitment centres, in 8 regional clusters throughout Germany, which cover both urban, strongly industrialized and rural regions (Figure V.1). Each centre recruits a minimum of 10,000 cohort participants, men and women aged 20-69 who are randomly selected from municipal population registers. At baseline, the participants are invited to visit their local study centre, where they have a face-to-face interview, fill out computer-aided questionnaires, provide biological samples, and take part in an extensive series of medical examinations.

The Division of Cancer Epidemiology is responsible for one of the 18 recruitment centres of the German National Cohort, which is located in Mannheim (PI: Rudolf Kaaks, together with Co-PIs from the University of Heidelberg) In addition, the MRI centre in Mannheim conducts 6,000 MRIs for study participants from the study centres Mannheim, Saarbrücken and Freiburg under the joint responsibility of the DKFZ and the University Hospital Heidelberg.

As part of the Competence Network Secondary and Registry Data, the division also has responsibility for the administrative and scientific organization of record linkages to epidemiological and clinical cancer registries throughout Germany.

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The MARIE study is a population-based case-control study on breast cancer with more than 11,000 women. In the years 2001-2005, histologically confirmed patients with breast cancer or carcinoma in situ (age range 50-74 years) and, as controls, women without breast cancer were included. The study took place in the two regions of Hamburg and Rhine-Neckar-Karlsruhe. There were three follow-up studies.

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Approximately half of all cancer patients receive radiotherapy as part of their cancer treatment. Patients react differently to radiotherapy. Some are particularly sensitive, making them more at risk than others of developing side effects that can occur years after radiotherapy.

The aim of the international REQUITE project (www.requite.eu) with more than 4000 breast, prostate and lung cancer patients and the ISE study with more than 400 breast cancer patients is to develop prediction models and biological tests to identify those patients who are particularly sensitive before the start of treatment. This should reduce side effects in patients, improve their quality of life and potentially increase the number of successfully treated cancer patients.

The ISE study also participates in the international Breast Cancer Association Consortium (BCAC). Pseudonymised data (such as genetic data, lifestyle factors and tumour-related data) will be used to address disease-related research questions that deal with the investigation of genetic risk factors for breast cancer as well as survival, second tumours and pharmacogenomics.