Experts had calculated that EU cancer deaths would rise from just over 850,000 in 1985 to over 1.03 million in 2000 due to demographic reasons, but the new research shows that when final statistics are available, the figure is likely to be nearer to 940,500.
Although the EU's Europe Against Cancer Programme failed to meet the ambitious target it set in the mid 1980s of cutting deaths by 15% by the year 2000, the programme does appear to have been associated with the avoidance of 92,500 deaths, said lead researcher Professor Peter Boyle, Director of the Division of Epidemiology and Biostatistics at the European Institute of Oncology in Milan, Italy.
Only Austria and Finland actually hit the 15% target for men and for women although the UK, Italy and Luxembourg came close with the UK and Luxembourg meeting the target among men. Overall in the EU there was a 10% reduction in the number of deaths expected among men and an 8% reduction among women. Portugal and Greece had the poorest performances with increases above the expected number of deaths among both men and women. The relative risk of death [the ratio of the standardised mortality rate in 2000 compared to 1985][2] fell overall in the EU by 11% in men and 10% in women.
"Although we fell short of our ambitious target the reductions are noteworthy and about half of the expected increase in cancer deaths was avoided," said Professor Boyle. "With few exceptions most countries are experiencing declining trends in cancer death rates, which seem set to continue, at least in the near future."
However, he warned against complacency. Over the fifteen year period the number of deaths from cancer rose by 12% in men and 9% in women, which meant that the there were over 90,000 more in 2000 than in 1985. The good news was that this rise was only about half the projected increased based on demographic factors.
The report assembled all mortality data from member states in 1985 plus the three then applicant states, Sweden, Austria and Finland, which also took up the Europe Against Cancer Programme. It also looked in detail at trends among the five most common cancers – lung, stomach, colorectal, breast and prostate.
Some key findings:
Women: numbers of deaths from all forms of cancer
Lung cancer – men
Lung cancer – women
Stomach cancer – men
Stomach cancer – women
Colorectal cancer – men
Colorectal cancer – women
Breast cancer
Prostate cancer
Commenting on the figures, Professor Boyle drew attention to the large impact that smoking made on the figures – for good in the case of men, but for ill in the case of women, and the part that tobacco contributed towards the Europe Against Cancer programme missing its 15% target.
He said: "Aside from Luxembourg where the small population makes calculations and comparisons statistically fraught, the countries that experience large declines of all forms of cancer in men also experience large declines in lung cancer. Successful tobacco control activities have made a major contribution to the declines in cancer death rates in men and the UK is a good example of this. As the risk of cancer at several sites other than the lung is associated with tobacco smoking those countries that experience declines in lung cancer also experience declines in all forms of cancer combined.
"In women the situation is, in many respects, the exact opposite. Nine out of 15 countries experienced declines of more than 10% in risk of death from all forms of cancer when lung cancer was excluded. However, the risk of dying from lung cancer in women increased substantially in every country (although it appears to be stabilising in the UK). The failure of tobacco control in women is a great disappointment. The fact that women are increasingly smoking, and smoking more, represents a great failure of public health in the recent past and is a major challenge for the near future. If women in each country had experienced the same decline in lung cancer as men, then the target may have been achieved in women and also overall.
"What this research tells us is that tobacco control must continue to be a number one priority, and women, alongside deprived populations of both sexes, must be a priority target."
He said that Finland, Austria, the UK, Luxembourg and Italy had the most effective overall programmes for reducing cancer mortality, whether directly or indirectly associated with the Europe Against Cancer programme. In contrast, cancer control seemed to be failing in Spain, Portugal and Greece and needed a boost in Denmark and Ireland.
An optimistic message was that there were strong suggestions that the risk of death from cancer is set to continue to fall in many countries into the foreseeable future, although Spain and Portugal currently posed significant cause for concern.
Professor Boyle concluded: "The reversal of a continually increasing trend has been a success that has been associated with the activities of the programme. Its major achievement has been the emphasis on prevention and the increased awareness of the importance of this aspect in wide-ranging cancer control programmes. The impact will hopefully continue to grow and continue to reduce the death rates from cancer in Europe." (ends)
[1] Measuring progress against cancer in Europe: has the 15% decline targeted for 2000 come about? Annals of Oncology 14, Pp 1312-1325. Annals of Oncology is the monthly journal of the European Society for Medical Oncology. Please acknowledge the journal as the source in any reports.
[2] Relative risk of death is calculated by taking into account the impact background changes e.g. screening, improvement in treatments, changes in smoking habits etc., would have had on the death rates in the population in 2000 as compared to the population in 1985.
Note: The 14-page research paper, with graphs giving a detailed breakdown for all countries, is available in html format from a special website: http://www.ntrac.org.uk/restrictedArea/AnnalsOfOncology/Overview.asp
Because this is a large file with many graphs it is split into sections. In case of difficulty accessing the website a PDF is available on request from Margaret Willson, but please note, even as a compressed file it is very large so you may prefer a faxed copy.
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Professor David Kerr, editor-in-chief, Annals of Oncology
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Professor Peter Boyle
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Annals of Oncology