Cancer Incidence and Mortality Among Ethnic German Migrants From the Former Soviet Union

Abstract

Germany is a country known for immigration. In 2015, 21% of the general population in Germany consisted of individuals with a migration background. This article focuses on cancer-specific incidence and mortality among one of the biggest migrant groups in Germany: the resettlers. Resettlers are ethnic Germans who mainly immigrated from the Russian federation and other countries of the former Soviet Union after its collapse in 1989. We investigated differences between resettlers and the general German population, regarding (i) incidence and mortality of malignant neoplasms, (ii) time trends of the corresponding incidence and mortality, and (iii) cancer stage at diagnosis. We provide data from two resettler cohorts covering an observation time of 20 years: one cohort on cancer incidence (N = 32,972), and another cohort on mortality (N = 59,390). Cancer-specific standardized incidence ratios (SIR) and standardized mortality ratios (SMR) for all malignant neoplasms combined and the most common cancer-sites were calculated between resettlers and the general German population. Time trend analyses using Poisson regression were performed to investigate the developments of SIRs and SMRs. To investigate differences in stage at diagnosis, logistic regression was performed, calculating Odds Ratios for condensed cancer stages. We observed higher incidence and mortality of stomach cancer [SIR (men) 1.62, 95%CI 1.17–2.19; SMR (men) 1.62, 95%CI 1.31–2.01; SIR (women) 1.32, 95%CI 0.86–1.94; SMR (women) 1.52, 95%CI 1.19–1.93] and higher mortality of lung cancer [SMR (men) 1.34, 95%CI 1.20–1.50] among resettlers compared to the general German population, but lower incidence and mortality of colorectal (both sexes), lung (women), prostate and female breast cancer. However, time trend analyses showed converging incidence risks of cause-specific incidence over time, whereas differences of mortality did not show changes over time. Results from logistic regression suggest that resettler men were more often diagnosed with advanced cancer stages compared to the Münster population. Our findings suggest that risk factor patterns of the most common cancer-sites among resettlers are similar to those observed within the Russian population. Such increases in prostate, colorectal and breast cancer incidence may be the consequence of improved detection measures, and/or the adaptation of resettlers to the German lifestyle.

Increased Incidence and Mortality of Gastric Cancer in Immigrant Populations from High to Low Regions of Incidence: A Systematic Review and Meta-Analysis

“…One of these 7 studies did not report a statistically significant increased SMR in the FSU immigrant population to Germany, 25 but the other 6 did report statistically significant increases when migrating to Germany, Canada, and Israel; sex-specific rates varied from 1.44 to 1.91 among males, 1.40 to 2.56 among females, and 1.40 to 2.56 for combined sexes ( Table 2). [26][27][28][29][30][31] Two studies reported increased SMR for first-generation Japanese immigrants to Brazil. One study reported ranges of 61-88 and 49-72 for men and women from 1980 to 2000, respectively (Japanese mortality in Japan used as a reference, with the rates listed found to be statistically significant when compared with the Brazilian born population).…”

Breast cancer incidence and mammography screening among resettlers in Germany

“…The AMIN study (Aussiedler in Münster -Incidence Cohort Study, N = 32,972 [19]) is a retrospective, register-based cohort study that provides information on breast cancer incidence among resettlers from the FSU and the general German population. The study was conducted in the administrative district (AD) of Münster in cooperation with the federal cancer registry of NRW.…”

“…However, sensitivity analyses showed negligible differences in the results. A detailed discussion of the strengths and weaknesses of the AMIN study has been published elsewhere [19].…”

“…Previous studies showed lower rates of breast cancer incidence and mortality; but a higher proportion of advanced breast cancer stages among resettlers compared to the general German population [18,19]. In addition, it was shown that the incidence ratio of breast cancer between resettlers and the general population converged over time [19]. Explanations pertaining to rising breast cancer incidence among resettlers have not yet been determined, and data regarding participation levels in MSP among resettlers were not available so far.…”

A cross-national perspective of migration and cancer: incidence of five major cancer types among resettlers from the former Soviet Union in Germany and ethnic Germans in Russia

“…However, mortality ratios showed site-specific cancer differences [7]. Focusing on cancer incidence in comparison to the respective regional populations in Germany, female resettlers had lowered overall, colorectal, lung and breast cancer incidence, while male resettlers showed lowered overall and prostate cancer incidence, but elevated stomach cancer incidence [8, 9]. Furthermore, overall cancer incidence converged since 1994 reaching levels of the general German population in 2013 [8].…”