ZEBra-MSP
Evaluation of breast cancer mortality in the German mammography screening program
In the period between 2005 and 2009, the quality-assured and population-based mammography screening program (MSP) was implemented nationwide and comprehensively. As part of this organized early detection program for breast cancer, women between the ages of 50 and 69 (eligibility up to age 75 from July 2024) receive a written invitation to an X-ray-based mammography examination every two years.
Since no scientific evaluation of the German MSP has been carried out to date and the assessment is only based on international study results, this study is intended to evaluate the early detection examination in Germany with the primary endpoint of breast cancer mortality. Due to the complexity of the German MSP, it is necessary to bring together data from various sources. Therefore, the actual mortality evaluation was preceded by two feasibility studies in the period between 2012 and 2017. In these studies, data protection compliant and practicable concepts for merging the various data sources (epidemiological and clinical cancer registers, Kassenärztliche Vereinigungen and health insurance companies) were developed. Subsequently the developed technical-organizational models for continuous data collection and storage were implemented in routine operation in the main study I (2018 - 2021). In addition, the implementation of the evaluation concepts developed until then have begun using the strategy of converging evidence. In the second phase of the main study, which started in December 2021 and will run for three years, the databases will be finalized at first. Finally, the combined data will be evaluated using various complementary analysis methods in order to complete the scientifically comprehensive evaluation of the German MSP on breast cancer-related mortality.
Buschmann L, Wellmann I, Bonberg N, Hense H-W, Karch A, Minnerup H. Isolating the effect of confounding from the observed survival benefit of screening participants — a methodological approach illustrated by data from the German mammography screening programme. BMC Medicine 2024; 22 (43). doi:10.1186/s12916-024-03258-6
Braitmaier M, Kollhorst B, Heinig M, Langner I, Czwikla J, Heinze F, Buschmann L, Minnerup H, García-Albéniz X, Hense HW, Karch A, Zeeb H, Haug U, Didelez V. Effectiveness of Mammography Screening on Breast Cancer Mortality – A Study Protocol for Emulation of Target Trials Using German Health Claims Data. Clin Epidemiol. 2022;14:1293-1303. doi:10.2147/CLEP.S376107
Bartholomäus S, Siegert Y, Hense HW, Heidinger O. Secure linking of data from population-based cancer registries with healthcare data to evaluate screening programs. Gesundheitswesen. 2019. doi: 10.1055/a-1031-9526
Langner I, Ohlmeier C, Haug U, Hense HW, Czwikla J, Zeeb H. Implementation of an algorithm for the identification of breast cancer deaths in German health insurance claims data: a validation study based on a record linkage with administrative mortality data. BMJ Open. 2019;9(7):e026834. doi: 10.1136/bmjopen-2018-026834.
Hense HW. [The development of early cancer detection in Germany]. Bundesgesundheitsblatt. 2018;61(12):1484-1490. doi: 10.1007/s00103-018-2828-6. Review.
Braun B, Khil L, Tio J, Krause-Bergmann B, Fuhs A, Heidinger O, Hense HW. Differences in breast cancer characteristics by mammography screening participation or non-participation. Dtsch Arztebl Int. 2018;115(31-32):520-527.
Czwikla J, Giersiepen K, Langner I, Enders D, Heinze F, Rothgang H, Haug U, Zeeb H, Hense HW. A cohort study of mammography screening finds that comorbidity measures are insufficient for controlling selection bias. J Clin Epidemiol. 2018;104:1-7. doi: 10.1016/j.jclinepi.2018.07.014
Simbrich A, Wellmann I, Heidrich J, Heidinger O, Hense HW. Trends in advanced breast cancer incidence rates after implementation of a mammography screening program in a German population. Cancer Epidemiol. 2016;44:44-51. doi: 10.1016/j.canep.2016.07.006
Berkemeyer S, Lemke D, Hense HW. Incidence and mortality trends in German women with breast cancer using age, period and cohort 1999 to 2008. PLoS One. 2016;11(3):e0150723. doi: 10.1371/journal.pone.0150723.
Bartholomäus S, Hense HW, Heidinger O. Blinded anonymization: a method for evaluating cancer prevention programs under restrictive data protection regulations. Stud Health Technol Inform. 2015;210:424-8. PubMed PMID: 25991179.
Fuhs A, Bartholomäus S, Heidinger O, Hense HW. [Evaluation of the impact of the mammography screening program on breast cancer mortality: feasibility study on linking several data sources in North Rhine-Westphalia]. Bundesgesundheitsblatt. 2014;57(1):60-7. doi: 10.1007/s00103-013-1870-7.
Project details
Responsible persons
Project period
Dec 2021 - Dez 2024
Cooperation partners
Landeskrebsregister NRW gGmbH
Universität Bremen - SOCIUM Forschungszentrum Ungleichheit und Sozialpolitik
Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS GmbH, Bremen
Funding
German Federal Ministry for the Environment, Nature Conservation, Nuclear Safety and Consumer Protection
German Federal Ministry of Health
Cooperation Community Mammography
Contracting authority: Federal Office for Radiation Protection
Buschmann L, Wellmann I, Bonberg N, Hense H-W, Karch A, Minnerup H. Isolating the effect of confounding from the observed survival benefit of screening participants — a methodological approach illustrated by data from the German mammography screening programme. BMC Medicine 2024; 22 (43). doi:10.1186/s12916-024-03258-6
Braitmaier M, Kollhorst B, Heinig M, Langner I, Czwikla J, Heinze F, Buschmann L, Minnerup H, García-Albéniz X, Hense HW, Karch A, Zeeb H, Haug U, Didelez V. Effectiveness of Mammography Screening on Breast Cancer Mortality – A Study Protocol for Emulation of Target Trials Using German Health Claims Data. Clin Epidemiol. 2022;14:1293-1303. doi:10.2147/CLEP.S376107
Bartholomäus S, Siegert Y, Hense HW, Heidinger O. Secure linking of data from population-based cancer registries with healthcare data to evaluate screening programs. Gesundheitswesen. 2019. doi: 10.1055/a-1031-9526
Langner I, Ohlmeier C, Haug U, Hense HW, Czwikla J, Zeeb H. Implementation of an algorithm for the identification of breast cancer deaths in German health insurance claims data: a validation study based on a record linkage with administrative mortality data. BMJ Open. 2019;9(7):e026834. doi: 10.1136/bmjopen-2018-026834.
Hense HW. [The development of early cancer detection in Germany]. Bundesgesundheitsblatt. 2018;61(12):1484-1490. doi: 10.1007/s00103-018-2828-6. Review.
Braun B, Khil L, Tio J, Krause-Bergmann B, Fuhs A, Heidinger O, Hense HW. Differences in breast cancer characteristics by mammography screening participation or non-participation. Dtsch Arztebl Int. 2018;115(31-32):520-527.
Czwikla J, Giersiepen K, Langner I, Enders D, Heinze F, Rothgang H, Haug U, Zeeb H, Hense HW. A cohort study of mammography screening finds that comorbidity measures are insufficient for controlling selection bias. J Clin Epidemiol. 2018;104:1-7. doi: 10.1016/j.jclinepi.2018.07.014
Simbrich A, Wellmann I, Heidrich J, Heidinger O, Hense HW. Trends in advanced breast cancer incidence rates after implementation of a mammography screening program in a German population. Cancer Epidemiol. 2016;44:44-51. doi: 10.1016/j.canep.2016.07.006
Berkemeyer S, Lemke D, Hense HW. Incidence and mortality trends in German women with breast cancer using age, period and cohort 1999 to 2008. PLoS One. 2016;11(3):e0150723. doi: 10.1371/journal.pone.0150723.
Bartholomäus S, Hense HW, Heidinger O. Blinded anonymization: a method for evaluating cancer prevention programs under restrictive data protection regulations. Stud Health Technol Inform. 2015;210:424-8. PubMed PMID: 25991179.
Fuhs A, Bartholomäus S, Heidinger O, Hense HW. [Evaluation of the impact of the mammography screening program on breast cancer mortality: feasibility study on linking several data sources in North Rhine-Westphalia]. Bundesgesundheitsblatt. 2014;57(1):60-7. doi: 10.1007/s00103-013-1870-7.