Recent trends of cancer in Europe: A combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s

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Abstract

Introduction

We present a comprehensive overview of most recent European trends in population-based incidence of, mortality from and relative survival for patients with cancer since the mid 1990s.

Methods

Data on incidence, mortality and 5-year relative survival from the mid 1990s to early 2000 for the cancers of the oral cavity and pharynx, oesophagus, stomach, colorectum, pancreas, larynx, lung, skin melanoma, breast, cervix, corpus uteri, ovary, prostate, testis, kidney, bladder, and Hodgkin’s disease were obtained from cancer registries from 21 European countries. Estimated annual percentages change in incidence and mortality were calculated. Survival trends were analyzed by calculating the relative difference in 5-year relative survival between 1990–1994 and 2000–2002 using data from EUROCARE-3 and -4.

Results

Trends in incidence were generally favorable in the more prosperous countries from Northern and Western Europe, except for obesity related cancers. Whereas incidence of and mortality from tobacco-related cancers decreased for males in Northern, Western and Southern Europe, they increased for both sexes in Central Europe and for females nearly everywhere in Europe. Survival rates generally improved, mostly due to better access to specialized diagnostics, staging and treatment. Marked effects of organised or opportunistic screening became visible for breast, prostate and melanoma in the wealthier countries. Mortality trends were generally favourable, except for smoking related cancers.

Conclusion

Cancer prevention and management in Europe is moving in the right direction. Survival increased and mortality decreased through the combination of earlier detection, better access to care and improved treatment. Still, cancer prevention efforts have much to attain, especially in the domain of female smoking prevalence and the emerging obesity epidemic.

Introduction

Cancer has become a major public health problem in Europe with an estimated prevalence of about 3%, increasing to 15% at old age. Almost 50% of deaths at middle age is caused by cancer, partly resulting from lowering mortality from other causes of death. In 2002, 26% of all cancer cases in the world were diagnosed in Europe.1Fig. 1, Fig. 2 show the distribution of estimated cancer incidence and mortality for 2006; breast, colorectal, prostate and lung cancers were the most important cancer types in Europe.2

The progress against cancer is often focussed on survival of individual cancer patients. The recent paper on trends in survival of cancer across Europe up to 2002 by the EUROCARE group clearly showed that the most marked improvements occurred among patients with colorectal, breast, prostate and thyroid cancer and lymphomas, both Hodgkin’s and non-Hodgkin’s.3 Little explicit clarification was given for the observed differences between the countries. These differences may be due to variation in the baseline characteristics of the covered populations, e.g. selective areas in a country or state with large proportions of inhabitants having a high socio-economic status. Other explanations are the potentially selective incompleteness of cases at time of detection or diagnosis and during follow-up.

In the US, survival improvements were also revealed and largely determined by marked improvements in detection, thereby introducing lead-time and length bias, together with shifts in classification, subtype, and subsite resulting in pseudo-improvements of survival rates.4 To circumvent these problems, it is preferred to study simultaneously trends in cancer incidence and survival, also because both affect mortality.5, 6 Survival improvements are more often preceded by rises in incidence than followed by decreases in mortality. Table 1 summarises possible explanations for changes in incidence, survival, and mortality.

In this article we present the most recent trends in incidence, mortality, and survival over the last decade across Europe of 17 tumour sites, derived from cancer registries and mortality statistics.

Section snippets

Methods

Data of the following 17 tumour sites (and corresponding ICD-10 code) were collected: oral cavity and pharynx (C00-14), oesophagus (C15), stomach (C16), colorectal (C18-21), pancreas (C25), larynx (C32), lung (C33-34), skin melanoma (C43), female breast (C50), cervix (C53), corpus uteri (C54-55), ovary (C56), prostate (C61), testis (C62), kidney (C64-66/C68), bladder (C67), and Hodgkin’s disease (C81). They were derived from 21 European cancer registries, grouped into four regions: Northern

Results & comments

Results are presented in the accompanying tables, figures and text. Annual incidence and mortality rates per registry are provided on-line, and can be accessed at: http://www.eurocadet.org/documents/index.php?map=%2FEurocadet+publications%2FOnline+tables+trends+in+Europe+2008%2F.

Oral cavity and pharyngeal cancer (C00-14). Within Europe incidence among males in the most recent period varied substantially between 5.9 (Finland) and 32 (France) per 100,000. Mortality rates varied considerably less

General discussion

This study provides the most recent available overview of the burden of cancer in Europe. It is one of the few publications combining incidence, mortality and survival statistics of cancer. This combination is important in order to correctly interpret (trends in) cancer rates: has real progress been made or are we looking at artefacts? Observed increases in cancer incidence for example, might be real, i.e. that there are more cancer patients because of increasing risks, or they might be due to

Conclusions

The biggest achievement in cancer surveillance over the past 10 years, seems to have been the large reductions in smoking prevalence among males, hopefully soon to be followed by females.38 Lung cancer is still a very commonly diagnosed cancer, with a very poor survival, hence primary prevention by anti-smoking measures remains of utmost importance. Obesity, an upcoming problem, should be the target for prevention of oesophageal, breast, corpus uteri, cervical, prostate, and kidney cancer.74

Conflict of interest statement

None declared.

Acknowledgements

The authors thank M. Dalmas (Malta National Cancer Registry), A. Znaor (Croatian National Cancer Registry), J. Borras (Institut Catala d’Oncologia) for the information that they provided. Some of the data used in this paper were taken from the EUROCIM database of the European Network of Cancer Registries.75 We thank the individual cancer registries for making their data publicly available; their work on collecting and presenting the data is gratefully acknowledged.

The work on this research was

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