Cancer mortality in the United States and Germany

Purpose: The USA and Germany are currently two of the world's leading industrial nations with comparable standards of living and considerable similarities in lifestyle. Fifty years ago, i.e., in the years following the Second World War, the living conditions in the two countries were completely different. If it is true that the major part of cancer occurrence is lifestyle-related, we should see corresponding discrepancies and assimilations on the level of cancer occurrence. Methods: As an exercise in descriptive epidemiology, we compare the time trends in German and US cancer mortality in order to examine whether they parallel indeed the differences and changes in lifestyle factors of the two countries. Results: Overall, we found the cancer mortality of the two countries converging to rather similar rates. However, in detail, the data indicate various inconsistencies between the patterns of lifestyle factors and cancer mortality in the two countries: similar lung cancer rates, despite rather different patterns of cigarette consumption, or decreasing rectal cancer mortality, despite increasing prevalence of risk factors, are examples. Conclusions: Promising changes with regard to relevant risk factors indicate that the recent decline of cancer mortality in both countries will continue. Nevertheless, vigorous action towards primary prevention in Germany and more effective screening programs in both countries appear recommendable.