Breast cancer mortality in Schleswig-Holstein administrative districts 1981-1995

The present descriptive study evaluates breast cancer mortality among women in the northernmost German Federal State of Schleswig-Holstein over the pe riod from 1981 to 1995 based on data provided by the Schleswig-Holstein Sta te Office for Statistics. Starting from the results of the second Cancer Atlas for the Federal Republ ic of Germany [11], covering the period 1976-1980, breast cancer mortality rates rose sharply until the beginning of our investigation. A moderate ris e in breast-cancer mortality in Schleswig-Holstein continuied until the thi rd period under investigation (1987-1989), while after that time breast can cer mortality decreased again towards the end of the investigation period. In Schleswig-Holstein as a whole, the mortality rate increased by approxima tely 12% during the last 20 years. When reviewing age-specific breast-cancer mortality for each rural district ('Kreis') or, respectively, for each self-administrative town (kreisfreie Stadt), different patterns were observed, particularly among younger women. In the 40- to 44-year and 45- to 49-year age group a rise in breast cancer mortality was observed in several, but not all districts. Mortality patterns do not tend to be representative for breast cancer incid ence because mortality reflects only a small proportion of the women actual ly suffering from breast cancer. The standardised incidence of breast cance r in Germany - calculated on the basis of data provided by the Saarland can cer registry - is currently over 60/100 000 and is thus 2-3 times the morta lity rate. However, presently it is not possible to evaluate the breast can cer incidence (Schleswig-Holstein) because the first population-based cance r registration was initiated only in 1999. In contrast to other German Fede ral States, notification of all cancer cases is compulsory in Schleswig-Hol stein. A valid analysis of breast cancer incidence should be possible in 5- 10 years conditional on a registration rate of at least 90 %. Further investigations into the causes of breast cancer should be carried o ut to test specific hypotheses on exposure to risk factors, including nutri tion and life style to clarify the regional differences observed in this st udy.