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.
Highlights
In 2015, there were an estimated number of 247.5 million migrants worldwide [1]
We found lower incidence of all malignant neoplasms combined among resettlers compared to the Münster population
While mortality of all malignant neoplasms combined was lower among resettler women as well, no difference was observed among men
Summary
In 2015, there were an estimated number of 247.5 million migrants worldwide [1]. Research on migrants is important, since it contributes to the knowledge of disease etiology and reveals differences in the health status between migrants and host populations. It was observed that migrants from non-Western countries showed a higher risk of infectious-related cancer-sites than the host populations of Western European countries, including stomach, liver and cervix uteri cancer. A lower risk of cancer-sites related to a Western lifestyle was observed, including breast and colorectal cancer [8] These results reflect findings from studies in the US and in Australia, which found a lower breast cancer risk and a higher incidence risk of stomach and liver cancer among migrants compared to host populations [9,10,11]. The development of cancer incidence and mortality will be investigated over 20 years after immigration to Germany and cancer stage at diagnosis will be compared between resettlers and the Münster population
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