Nearly 1.3 million Europeans will die from cancer this year, according to epidemiologists who predict that age-standardized death rates for most cancers will have dropped or remained flat since 2007 with the exception of lung cancer in women.
Based on a close analysis of continuing trends in the European Union, an estimated 1,281,436 E.U. residents – 721,252 men and 560,184 women of all ages – will die of cancer in 2011, they said. Overall, E.U. cancer deaths have will have dropped 7% in men and 6% in women over 5 years, from 153.8 per 100,000 to 142.8 per 100,000 in men, and from 90.7 to 85.3 in women, they say – a continuation of longer-term patterns of decline.
For their research, published Feb. 9 in Annals of Oncology (Annals Oncol. 2011 Feb. 9 [doi:10.1093/annonc/mdq774]), epidemiologist Dr. Carlo La Vecchia of the University of Milan, along with Dr. Fabio Levi of Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland, and colleagues, examined World Health Organization mortality records to identify deaths from stomach, colorectal, pancreatic, lung, breast, uterine, cervical, and prostate cancers, along with leukemia deaths and total cancer deaths, for all EU countries besides Cyprus between 1970 and 2007.
They also used the most recent national cancer-death data available (the oldest from 2005 and the newest from 2008) for France, Germany, Italy, Poland, Spain, and the United Kingdom, Europe’s six most populous countries.
Dr. La Vecchia, Dr. Levi, and colleagues identified a downward trend in mortality for all cancers studied, except for pancreatic cancer, which was predicted to remain flat for men and increase very slightly among women in 2011, they said. They also noted that the one former Eastern bloc country, Poland, among the six populous countries studied, had higher overall death rates and less impressive declines than did the others. For example, estimated mortality rates for uterine cancer in Poland were three times higher than those projected for Germany: 7.9 and 2.6 per 100,000 women, respectively.
The European patterns reported stand in contrast to new global trends published in a Feb 4 report by the American Cancer Society (Global Cancer Facts & Figures 2nd Edition), which highlights an increasing portion of cancer deaths in developing countries attributable to lifestyle changes such as smoking, unhealthy diet, and physical inactivity as opposed to infections such as hepatitis B virus (HBV), human immunodeficiency virus, human papillomavirus, and helicobacter pylori. For example, male lung cancer mortality, which is declining in Europe, has been increasing in China and other countries in Asia and Africa. And breast cancer (likely reflective of changes in reproductive patterns, obesity, physical inactivity, and delayed breast cancer screening) now leads in cancer deaths among women in developing countries, as opposed to cervical cancer, according to the ACS report.
Yet even within Europe, divides persist along national and economic lines. In a report presented to the European Parliament Feb. 9 by the European Society for Pediatric Oncology, investigators found that Eastern European countries with a heavy oncology burden tended not to collaborate in research with countries with better-developed research structures, and that pediatric cancer patients suffered as a result.
Dr. La Vecchia said in an interview that Poland’s high mortality, related to drug access and quality of treatment, was representative of other former Eastern bloc countries in the European Union. "It’s a complex problem of medical culture and organization," he said. "All central and eastern Europe countries have this problem, but there is room of improvement even in the wealthier countries."
Female lung cancer was one area that needed desperate attention throughout the European Union, Dr. La Vecchia said. While deaths from breast cancer in women are likely to continue to fall, the trend in female lung cancer deaths is rising everywhere but the United Kingdom, which at 20.33 per 100,000 women still has the highest female lung cancer mortality in the European Union, followed by Poland at 16.6 per 100,000. In both countries, more women will die from lung cancer than from breast cancer in 2011, the investigators predicted.
Overall, lung cancer deaths among E.U. women will increase from 12.55 per 100,000 in 2007 to 13.12 in 2011, the investigators predicted, while rates among men have fallen. "This suggests that the lung cancer epidemic in European women is still expanding, and the rate may ultimately approach 14 to 15 per 100,000 in 2015," the investigators wrote.
"This is essentially attributable to smoking," Dr. La Vecchia said. Bans on indoor smoking are now widespread in Western Europe, but "these have only been adopted over the last 5 years, so while you see some impact on cardiovascular disease, you don’t see any important change in cancer yet in the short term." Women, he said, are simply not quitting fast enough: "We need to concentrate on convincing women to stop smoking."