Oncology Landscape in Germany
The goal of this section is to contextualise where genomic sequencing demand is most likely to concentrate at the healthcare delivery level, using Germany as a case study. Germany combines a large (aging) population, broad access to advanced oncology care, and a decentralised hospital system, making it a useful reference for understanding regional variation in sequencing demand across Europe.
Incidence per State
Initially, it is useful to examine cancer incidence across federal states using two complementary views:
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Absolute cases which can be a proxy for throughput and workflow volume (diagnosis, pathology, molecular routing)
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Incidence per 100,000 inhabitants separates population size from geographic variation and might help explain how routine and well-established diagnostic workflows are in a given region
The following information refers to 2022 data obtained from the Zentrum für Krebsregisterdaten (ZfKD):
Incidence by tumour type (absolute + per 100k)
Incidence at Hospital Level
Genomic testing is ultimately performed within specific hospitals and laboratory networks, and oncology care is unevenly distributed across institutions. To examine sequencing demand at the hospital level, I combined incidence case estimates with information from the German Hospital Directory, which lists hospitals and their oncology-related case volumes. This enables an approximate allocation of cancer cases across hospitals, helping identify institutions where genomic testing demand is likely to be highest.
The panels below show, for Berlin, Bavaria, and North Rhine-Westphalia, distribution of cases by the top 5 hospitals vs “Other”, and absolute case number for the same top 5 hospitals:
State-level hospital concentration (top 5 hospitals)
Full distribution of hospital data across all of Germany’s federal states
This visualisation is useful because it distinguishes centralization (high concentration into one or two institutions) from more distributed care structures where demand is spread across several centres. It is also suggestive of direct operational implications, as centralised settings favour in-house molecular pathology and sequencing, while distributed settings typically rely on shared or networked testing workflows.
Cancer Subtypes at Hospital Level
Looking at cancer subtypes at the hospital level makes it possible to assess not only where oncology activity is concentrated, but also which diagnostic and molecular workflows are most likely frequently used within individual centres: