International Agency for Research on Cancer, Lyon, France
* Correspondence to: Professor P. Boyle, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France. Tel: +33-4-7273-8577; Fax: +33-4-7273-8575; Email: director{at}iarc.fr
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Abstract |
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Methods: The most recent sources of incidence and mortality data available in the Descriptive Epidemiology Group at IARC were applied to population projections to derive the best estimates of the burden of cancer, in terms of incidence and mortality, for Europe in 2004.
Results: In 2004 in Europe, there were an estimated 2 886 800 incident cases of cancer diagnosed and 1 711 000 cancer deaths. The most common incident form of cancer was lung cancer (13.3% of all incident cases), followed by colorectal cancer (13.2%) and breast cancer (13%). Lung cancer was also the most common cause of cancer death (341 800 deaths), followed by colorectal (203 700), stomach (137 900) and breast (129 900).
Conclusions: With an estimated 2.9 million new cases (54% occurring in men, 46% in women) and 1.7 million deaths (56% in men, 44% in women) each year, cancer remains an important public health problem in Europe, and the ageing of the European population will cause these numbers to continue to increase even if age-specific rates remain constant. To make great progress quickly against cancer in Europe, the need is evident to make a concerted attack on the big killers: lung, colorectal, breast and stomach cancer. Stomach cancer rates are falling everywhere in Europe and public health measures are available to reduce the incidence and mortality of lung cancer, colorectal cancer and breast cancer.
Key words: cancer, deaths, Europe, European Union, incidence
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Introduction |
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An attempt has been made to monitor the evolution of cancer mortality in the European Union, where it was observed that the expected number of cancer deaths in the 15 Member State European Union fell by over 9% between 1985 and 2000 [4]. During the lifetime of the Europe Against Cancer programme, favourable trends in cancer mortality were established for several common forms of cancer death in many countries [4
], which appear likely to continue in the near future [5
], although there were notable exceptions including lung cancer in women and most forms of cancer in Spain and Portugal [4
].
In the year 2000, there were 1 122 000 deaths from cancer recorded in the 25 Member States that now constitute the European Union [5]. Even if the age-specific cancer mortality rates remain constant at year 2000 levels, there will be large increases in the absolute numbers of cancer cases and deaths into the foreseeable future. Although the total population will remain fairly constant, compared with 2000, by 2015 there will be a 22% increase in the population aged >65 years and a 50% increase in the number of persons aged >80 years. Given the strong association between cancer risk and age, this will lead to a major increase in the cancer burden. Using population projections, if the age-specific death rates remain constant, the absolute numbers of cancer deaths in 2015 will increase to 1 405 000. Even if the forecast trends are taken into account, it is still expected that there will be an increase, but this will be smaller and result in an estimated figure of 1 249 000 cancer deaths [5
].
Estimates of the numbers of cancer cases and deaths in Europe for 2004 have been calculated to provide information on the cancer burden in Europe and to allow monitoring of the evolution of the impact of the ageing of the European population.
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Materials and methods |
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Mortality data
WHO mortality data [7] are available by sex and cancer site up to 2002 for all countries in Europe, except Cyprus, Liechtenstein, and Bosnia and Herzegovina. For some Eastern European countries (Belarus, Russian Federation, Serbia and Montenegro, and Ukraine), mortality statistics are only available by an ICD-9 Special Coding List.
We estimated mortality in Cyprus using incidence and survival [8] (pooled European survival from the EUROCARE-3 study), and as the simple average of the mortality rates of neighbouring countries for Bosnia and Herzegovina, and for Liechtenstein (Table 1). For Albania, mortality rates are known to be under-estimates of the true mortality, so the rates have been corrected (multiplied by the estimated percentage of under-registration).
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Population data
Estimates of the population of country (by age and sex) for the years 2000 and 2005 were taken from the United Nations population division (the 2002 revision). The 2004 population figures were estimated by calculating the annual percentage change by sex and age between the year 2000 and 2005.
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Results |
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Prostate cancer was the most common form of cancer in men (202 100 incident cases, 18.1% of all incident cases), closely followed by lung cancer (196 100, 17.6%). Colorectal cancer ranked third (149 400 cases, 13.4%), followed by bladder cancer, the fourth most common, with 91 000 (8.2%) new cases. However, due to differences in coding practices between European countries, the rubric bladder cancer includes non-invasive tumours. Stomach cancer (53 800 cases) was slightly more common than oral cavity cancer (52 500) (Table 4A). In women, with an 8% lifetime risk, breast cancer was the most common incident form of cancer (275 100 cases, 29% of all incident cases), while colorectal cancer was second (129 800, 13.7%). There were 81 500 (8.6%) cases of uterus cancer and 62 000 (6.5%) incident cases of lung cancer (Table 4B).
Lung cancer continued to be the most common cause of cancer death in men in the European Union, with 178 400 deaths estimated in 2004 (27.3% of all cancer deaths), and the lifetime risk of dying of 5.5%. Colorectal cancer ranked second (72 300 deaths, 11.1%), followed by prostate cancer (68 200, 10.4%). In women, breast cancer is the leading cause of death in the European Union (88 400 deaths, 17.4% of total). Colorectal cancer was the second most common cause of cancer death (67 000, 13.2%), with lung cancer clearly established as the third most frequent cause of cancer deaths in women (55 900 deaths, 11%) (Table 5B).
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Discussion |
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The estimates provided herein give a good indication of the burden of cancer incidence and death throughout Europe, and help clarify the priorities for cancer control action. The overwhelming majority of lung cancer is caused by tobacco smoking [11, 12
] and tobacco control is clearly a number one priority in Europe, aimed not only at men, but increasingly targeted towards women.
Although there have been recent declines in breast cancer mortality rates in some European Union countries [4], breast cancer remains of key importance to public health in Europe. Prospects for primary prevention are unclear at present and tamoxifen no longer appears to be a candidate for chemoprevention in the general population of women [13
]. Population screening with mammography is effective at reducing mortality when quality control procedures are in place [14
] and there are slow but continual increases taking place in treatment outcome [15
], reflected by the very high ratio of the lifetime risk of getting the disease (7.8%) to that of dying from the disease (2%) observed in the European Union. However, there is still a clear need to accelerate prospects for preventing women getting breast cancer as well as dying from the disease.
Colorectal cancer is the third most common form of cancer in men and the second most common form of cancer in women in Europe, but it ranked second in frequency of deaths in both men and women. The potential to avoid many deaths from colorectal cancer has been available for several years [16, 17
], although progress in implementing what is known has been remarkably slow.
What is very clear is that if we wish to make great progress quickly against cancer in Europe, then the need is evident to make a concerted attack on the big killers: lung, colorectal, breast and stomach cancer.
Thankfully, stomach cancer incidence and mortality are declining throughout Europe, in both men and women [4]. Lung cancer incidence and mortality will be reduced by effective tobacco control, and while there has been substantial progress in men in Europe, the situation in women, particularly young women, is cause for concern. Furthermore, the situation differs greatly between Northern Europe and Central and Eastern Europe (Figure 3) and the latter region should be a special target for tobacco control.
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These are among the key recommendations of the recently revised European Code Against Cancer, which provides a public health roadmap for cancer risk reduction in Europe [18].
Received for publication December 7, 2004. Accepted for publication December 9, 2004.
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References |
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