Andreas Stang

Reliable characterization of infection dynamics is critical for managing endemic, epidemic, and pandemic outbreaks. A persistent challenge in epidemiology is the lack of a unified quantitative framework that allows wave patterns to be compared across outbreak scales and pathogens while accounting for possible ambiguities in wave definitions. This study presents a descriptive epidemiological framework to quantify epidemic wave characteristics using the Duty Cycle (DC), defined as the ratio between wave duration and the time to the next peak. Historical time-series data from viral outbreaks were analyzed, and combinatorics was applied to consider all valid interpretations (“perspectives”) of wave boundaries within the same incidence curves, thereby avoiding a perspective-selection bias. We calculated DC values, wave peak postdiction accuracy in days, wave heights relative to initial peaks, and subsequent wave frequencies. Distribution-based analyses show that DC values are generally higher in endemics and epidemics, indicating frequent overlapping waves, whereas pandemics tend to exhibit lower DC and fewer subsequent waves. Wave-peak postdiction accuracy varied across outbreak scales, with distributions reflecting perspective-dependent uncertainty. While subsequent waves of infection in endemics and epidemics are frequently higher than the first wave, pandemics typically peaked in the second wave and showed waning thereafter. The results provide a comparative, structurally grounded description of epidemic wave dynamics across outbreak types, supporting outbreak assessment and planning. Given the heterogeneity of reporting and outbreak dynamics, results should be interpreted as descriptive benchmarks rather than mechanistic postdictions.

Zusammenfassung: Die Krebsregistrierung in Nordrhein-Westfalen (NRW) begann 1974 und hatte 2024 ihr 50-jähriges Jubiläum. Das Ziel dieses Beitrags ist es, die Aufbauphasen der Krebsregistrierung in NRW der Jahre 1974 bis 2025 darzustellen. Nach einem internationalen Symposium in Düsseldorf 1973 und mit Unterstützung der Gesellschaft zur Bekämpfung der Krebskrankheiten (später: Krebsgesellschaft NRW) wurde 1974 in Münster unter Federführung von Prof. Ekkehard Grundmann ein Krebsregister zunächst mit dem Fokus auf die onkologische Nachsorge aufgebaut. Da Pathologen ohne direkten Patientenkontakt nicht direkt an das Register melden konnten, blieb die Erfassung zunächst eingeschränkt. Bundespolitische Debatten der Jahre 1978 bis 1981 förderten den Aufbau von Krebszentren und Krebsregistern. Mit dem Krebsregistergesetz NRW von 1985 wurde die rechtliche Grundlage der epidemiologischen Krebsregistrierung im Regierungsbezirk Münster geschaffen. Die Einbindung der Pathologie erfolgte erst Anfang der 2000er-Jahre durch die Etablierung eines elektronischen Verfahrens zur Übermittlung von Pathologieberichten unter Nutzung von Kontrollnummern. Damit konnte die für Krebsregister erforderliche Vollzähligkeit von 95 % erreicht werden. Im Jahr 2005 kam es aufgrund einer Gesetzesnovelle zur flächendeckenden Ausweitung der Krebsregistrierung in NRW. Meldungen konnten seither nur noch elektronisch erfolgen. Infolge des Krebsfrüherkennungs- und -registergesetzes (KFRG) von 2013 kam es im Jahr 2016 zur Novellierung des Krebsregistergesetzes in NRW. Seitdem vereint das Krebsregister epidemiologische und klinische Krebsregistrierung. Aktuell deckt es eine Bevölkerung von 18 Mio. Menschen ab und registriert pro Jahr 173.000 Krebsneuerkrankungen.

BackgroundLong-term cancer survivors constitute a growing population with characteristic health care needs. Survey-based studies are essential to understanding this population, yet low participation raises questions about potential non-response bias. This study analysed response and non-response in a registry-based cross-sectional survey among long-term cancer survivors in North Rhine-Westphalia, Germany.MethodsA sample of 24 291 adult long-term cancer survivors was drawn from the North Rhine-Westphalian Cancer Registry (diagnosed between 2008 – 2018, ≥5 years post-diagnosis, aged 18–74 at diagnosis). Survivors were contacted by postal letters and asked for consent. Those consenting received a questionnaire. Survey participation was defined as returning a questionnaire (paper-based or online). Age, sex and clinical data (calendar period of diagnosis, tumour stage and ICD-10 group) were available for all invitees and used to compare responders with non-responders.ResultsOf 24 291 invited survivors, 3 297 (13.6%) consented and 2 355 (9.7%) answered the questionnaire; 71.4% of those who consented participated. The contact proportion was 85.8% and the cooperation proportion 11.3%. Non-response patterns differed across subgroups: younger survivors were more difficult to contact, whereas older survivors were more likely to refuse participation. Contactability decreased with increasing time since diagnosis. Lower response was observed among survivors with advanced tumour stage and lung cancer, while higher consent was seen among prostate cancer and leukemia survivors. Among consenting survivors, non-participation was mainly due to non-return of the questionnaire, with reported reasons including fatigue and lack of time.ConclusionsOverall response in this registry-based survey was low and primarily driven by non-consent, whereas participation among those who consented was high. This indicates selection arises predominantly at the initial contact stage, with implications for potential non-response bias. Future survivorship studies should prioritise recruitment strategies at first contact, including multimodal approaches and timely follow-up. Weighting approaches might mitigate selection bias and improve representativeness.

In many countries the incidence of squamous cell carcinoma (SCC) on the esophagus has fallen, whereas the incidence of adenocarcinoma (AC) of the esophagus has increased. Furthermore, an increase in adenocarcinoma of the esophagogastric junction has...

Background and Objectives: Aspects of social relationships, like isolation and low social support, have been linked to type 2 diabetes onset, though evidence is inconsistent. We investigated whether social relationships mediate the association between socioeconomic status (SES) and diabetes or interact with SES in relation to diabetes. Materials and Methods: The study included 3642 participants (mean age 58.9 ± 7.6 years, 47.9% male) from the Heinz Nixdorf Recall Study, a population-based cohort in Germany. Baseline examinations took place in 2000–2003 with two 5-year follow-ups. Adjusted relative risks (RRs) were estimated for social relationships (isolation, partnership, instrumental, financial, emotional support) and incident diabetes using Poisson regression with robust variance. We performed causal mediation analyses and estimated relative excess risks due to interaction (RERI). Results: Associations between measures of social integration and diabetes incidence were weak (e.g., RR = 1.09 (95% CI: 0.86, 1.39) for lack of partnership). Limited financial support was associated with higher diabetes risk (RR = 1.33 (1.09, 1.62)), whereas instrumental or emotional support was not. Some evidence of mediation was found for limited financial support (14% (95% CI: −7%, 35%) for the income–diabetes association). There was hardly any excess risk of diabetes in persons with poor education, and poor income, respectively, and low social support (RERI = −0.33 to 0.27). Conclusions: In this prospective study, limited financial support emerged as a social risk factor for type 2 diabetes and explained a small proportion of socioeconomic inequalities in diabetes incidence. Other dimensions of social relationships showed little evidence of independent, mediating, or interaction effects. The findings regarding financial support require confirmation in further studies.

Zusammenfassung: Hintergrund: Primäre kutane Lymphome ( primary cutaneous lymphomas , PCL) bestehen hauptsächlich aus kutanen T‐Zell‐Lymphomen ( cutaneous T‐cell lymphomas , CTCL), gefolgt von kutanen B‐Zell‐Lymphomen ( cutaneous B‐cell lymphomas , CBCL). Ziel dieser Studie war es, die Inzidenz und Überlebensraten von PCL in Deutschland zu ermitteln. Methoden: Wir analysierten Daten des nordrhein‐westfälischen Krebsregisters (2008–2021), das eine Bevölkerung von 18 Millionen Menschen umfasst. Es wurden altersstandardisierte Inzidenzraten und relative Überlebensraten berechnet. Ergebnisse: Die Analyse umfasste 3853 Patienten mit neu diagnostizierten PCL. Bei 69,5% dieser Patienten handelte es sich um CTCL und bei 24,9% um CBCL. Die altersstandardisierte Inzidenz von PCL betrug 10,8 pro Million Personenjahre. Die Inzidenz sowohl von CTCL als auch von CBCL nahm im Laufe der Zeit zu. PCL‐Fälle wurden auch bei Kindern festgestellt. Die relative Fünf‐Jahres‐Gesamtüberlebensrate für PCL betrug 89% (95% CI: 87–92%), wobei die Überlebensrate bei CTCL‐Patienten 91% (95% CI: 88–94%) und bei CBCL‐Patienten 86% (95% CI: 81–91%) betrug. Bei den Patienten mit Sézary‐Syndrom lag die relative Fünfjahresüberlebensrate bei 53% (95%: CI:29–77%). Schlussfolgerungen: Diese Studie ist bisher die größte bevölkerungsbasierte Analyse der PCL in Deutschland, die sowohl Erwachsene als auch Kinder umfasst. Die Inzidenz der PCL war höher als bisher berichtet. Darüber hinaus präsentieren wir die ersten Überlebensdaten für PCL in Deutschland, die unter anderem eine deutlich höhere Überlebenswahrscheinlichkeit für Patienten mit Sézary‐Syndrom zeigen.

Background: Melanoma of unknown primary (MUP) accounts for up to 10% of all cases of metastatic melanoma. The origin of MUP is unclear, and previous studies on the clinical course in comparison with cutaneous melanoma have reported varying results. Objectives: The study was conducted to assess the oncogenic pattern of MUP and to compare the clinical course with that of melanoma of known cutaneous primary (MKP). Methods: Patients with MUP diagnosed between 1999 and 2022 were included in this cohort study from the prospective multicentre real-world DeCOG (German Dermatologic Cooperative Oncology Group) registry ADOREG and from the tumour database of the University Hospital Essen. For comparison, a cohort of consecutive patients with MKP with stage III or IV disease from the skin cancer centre Essen between 1999 and 2022 was used. The median follow-up was 3.5 years. Available tumour samples were genetically analysed using next-generation sequencing. Survival outcome adjusted for age, sex and tumour stage was compared between patients with MUP and those with MKP, using the Kaplan–Meier method. Results: In total, 727 patients with MUP and 587 with MKP were identified. Median age at first diagnosis was 62 years [interquartile range (IQR) 53–73] for MUP and 63 years (IQR 52–75) for MKP. Most patients were male, 448 (61.6%) with MUP and 330 (56.2%) with MKP. Of the 727 patients with MUP, 337 (46.4%) had stage III disease at first diagnosis. Overall survival (OS) at 48 months was 65% [95% confidence interval (CI) 61–69] for all patients with MUP and 68% (95% CI 64–72) for all patients with MKP. Survival analyses adjusted for age, sex and tumour stage showed comparable OS rates for patients with MUP and MKP. Genetic analyses of tumours from 110 patients with MUP detected C>T and CC→TT mutations as the most common nucleotide variations. Median tumour mutational burden was 5 mutations per Mb (95% CI 4–5). Activating BRAF V600E (c.620T>A) mutations were detected in 43 patients (39.1%), activating NRAS mutations in 37 (33.6%), RAC1 P29S mutations in 7 (6.3%) and TERT promoter mutations in 73 (66.4%) of the analysed tumour samples. No activating KIT mutations were detected. Conclusions: The oncogenic pattern of MUP showed an ultraviolet mutation signature, suggesting an origin in sun-exposed areas. OS of MUP is comparable with that of MKP.

Introduction: Thoracic angiosarcoma is a very rare and malignant disease. This study examined the incidence and survival of thoracic angiosarcomas with special focus on primary and secondary angiosarcomas. Methods: Data from the population-based North Rhine-Westphalia (NRW) cancer registry in Germany covering the years 2008–2023 were analyzed, including primary and secondary thoracic angiosarcoma (ICD-O-3: morphology 9120/3, topography C34, C38, C44.51, C49.3, C50), and reported age-standardized incidence rates (using the Old European Standard population) and survival analyses (Kaplan–Meier curves). Results: A total of 421 cases of thoracic angiosarcoma were analyzed, and 90.0% of the patients were female (n = 379). Age-standardized incidence rates of thoracic angiosarcoma were 0.25 per million per year for male patients (SE 0.0) and 1.5 per million per year for female patients (SE 0.1). All male patients had primary angiosarcoma (n = 42). Among female patients, the majority of cases were second primary tumors (n = 262, 69.1%). The 5-year overall survival (OS) for the cohort study was 38.5% (SE 2.6). Stratified by sex, OS was 41.1% (SE 2.8) for women and 12.0% (SE 5.4) for men. Among female patients, OS was 40.9% (SE 4.1) for primary and 41.8% (SE 3.8) for second primary angiosarcoma. The worst OS occurred among patients with angiosarcoma of the lung (men 20.0% (SE 12.7)) and of the mediastinum, heart and pleura (men 4.7% (SE 4.5)) The OS for women was 0%; all females died within 2.2 years after diagnosis of angiosarcoma with these topographies. Conclusions: Thoracic angiosarcoma is a rare condition with a poor prognosis. Irrespective of whether their disease is classified as primary or second primary, women with angiosarcoma have a better prognosis than men. Topography seems to be the most determining prognostic factor in this disease.