1 Cancer Epidemiology Unit and Cancer Registries of Vaud and Neuchâtel, Institut Universitaire de Médecine Sociale et Préventive, Lausanne, Switzerland; 2 Laboratory of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; 3 Department of Cancer Epidemiology and Prevention, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland; 4 International Agency for Research on Cancer, Lyon, France; 5 Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, Milan, Italy
* Correspondence to: Dr F. Levi, Cancer Epidemiology Unit and Cancer Registries of Vaud and Neuchâtel, Institut Universitaire de Médecine Sociale et Préventive, CHUV-Falaises 1, 1011 Lausanne, Switzerland. Tel: +41-21-314-73-11; Fax: +41-21-323-03-03; Email: fabio.levi{at}inst.hospvd.ch
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Abstract |
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Key words: cancer, Europe, mortality, time trends
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Introduction |
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In May 2004, 10 additional countries joined the EU, which include a total of 75 million inhabitants. Of these, eight are central and eastern European countries (the Czech Republic, 10.3 million; Estonia, 1.4 million; Hungary, 10.2 million; Latvia, 2.4 million; Lithuania, 3.5 million; Poland, 38.6 million; Slovakia, 5.4 million; Slovenia, 7 million), and two are mediterranean countries (Cyprus, 0.8 million; Malta, 0.4 million). Since cancer rates in most central and eastern European countries are comparatively high, the inclusion of these countries may unfavourably and appreciably influence future trends in cancer mortality in the EU [11
13
]. It is therefore important that recent trends in mortality from major cancer sites in accession countries are considered [1
, 14
].
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Materials and methods |
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During the calendar period considered (19802000), four different revisions of the International Classification of Diseases (ICD) were used. Classification of cancer deaths was re-coded, for all calendar periods and countries, according to the Ninth Revision (for further details see [1]). To improve validity and comparability of data throughout different countries, we pooled together all intestinal sites including rectum, all uterine cancers (cervix and endometrium) and all non-Hodgkin's lymphomas.
Estimates of the resident population, generally based on official censuses, were obtained from the same WHO database. From the matrices of certified deaths and resident populations, age-specific rates for each 5-year age group (04 to 8084 and 85 years) and calendar period were computed. Age-standardised rates per 100 000 population, at all ages and truncated 3564 years, were computed using the direct method, on the basis of the world standard population.
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Results |
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Discussion |
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The overall analyses by groups of countries, defined essentially on historical and political grounds, are necessarily simplistic in order to convey the message of overall disparity between EU and accession countries, since important variations in cancer mortality rates and trends are observed in both groups of countries, as addressed in detail in a separate paper [1].
It is unlikely that cancer mortality data for the major sites considered have substantial problems in terms of reliability and validity that may have falsely given rise to any appreciable trends over time in any of the countries considered, although minor influences due to changes in classification and coding remain possible [1, 16
18
].
Most of the unfavourable patterns and trends in cancer mortality are due to recognised, and hence largely avoidable, causes of cancer. These include the exceedingly high rates of lung and other tobacco-related cancersfor Hungarian men probably the highest ever registered in any developed country [1, 2
, 19
]but also the high rates of gastric and intestinal cancer, related to poorer and unfavourable dietary patterns [1
, 20
, 21
].
Alcohol drinking is also responsible for the gross excess and the consequent unfavourable trends in oral cavity, oesophageal and laryngeal cancers, mostly in Hungary but also in other central European countries. While the role of type of alcoholic beverage in cancer risk remains open to discussion, with a possibly higher risk of fruit-derived ethanol in Hungary [2224
], the control of alcohol consumption as a whole in these areas of the continent remains a public health priority for cancer as well as for several other major diseases [22
, 25
].
The elevated liver cancer rates seen were largely due to high hepatitis B and C prevalence [2629
]. Alcohol and tobacco consumption, however, may also contribute to the high mortality from liver cancer in Hungary, the Czech Republic and other countries of central and eastern Europe [30
].
Furthermore, there are high mortality rates for neoplasms related to inadequate screening, diagnosis and treatment, mainly uterine cervical cancer, with the lack of adoption of effective screening programs [6, 31
], but also breast [5
] and ovarian [32
] cancers, as well as testicular cancer [9
, 10
], Hodgkin's disease [8
] and leukaemias [7
]. Mortality for these neoplasms in western European countries has been substantially influenced by advancements in integrated chemo- and radiotherapy approaches [7
]. The excess mortality from these same neoplasms in eastern European accession countries could therefore be reduced if adequate ressources, training and logistics to deliver adequate diagnosis and treatment were implemented [9
, 10
, 12
, 14
].
Thus, application of available knowledge on prevention, diagnosis and treatment of several cancers may substantially reduce, over the next few years, the major disadvantages now evident in cancer mortality rates and trends in central and eastern European accession countries, compared with those in the 15 EU countries as of 2003 [33].
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Acknowledgements |
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Received for publication January 31, 2004. Revision received April 20, 2004. Accepted for publication April 28, 2004.
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References |
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