Results from first five years of the Europe Against Cancer Programme

There are likely to have been over 92,500 fewer cancer deaths than expected in the European Union in the year 2000, according to research published today[1] (Tuesday 29 July) in Annals of Oncology – and at least part of the credit will be due to the Europe Against Cancer Programme.

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 five 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:

Men: numbers of deaths from all forms of cancer
* 55,738 deaths avoided [estimated 526,427 deaths in 2000 instead of expected 582,165 – down 10%]
* Biggest reductions: Luxembourg (-24%), Finland (-17%), UK (-16%), Austria (-15%), The Netherlands (-14%), Italy (-13%)
* Increases: Portugal (+17%), Spain (+11%)
* Little change: Greece (+1%), Ireland (no change), Denmark (-2%).

Women: numbers of deaths from all forms of cancer
* 33,835 deaths avoided [estimated 414,083 deaths in 2000 instead of expected 450,918 – down 8%]
* Biggest reductions: Austria (-15%), Finland (-15%), Luxembourg (-13%), UK (-10%), Italy, France, Germany (-9%)
* Increases: Greece (+2%), Portugal (+3%)
* No change: Denmark, Spain

Lung cancer – men
* 23,922 deaths avoided [estimated 139,838 deaths in 2000 instead of expected 163,760 – down 15%]
* Biggest reductions: UK (-38%), Finland (-36%), The Netherlands (-29%), Luxembourg (-24%), Austria (-23%), Ireland (-22%).
* Increases: Portugal (+34%), Spain (+23%), France (+2%), Greece (+1%)
* Favourable downward trends in the risk of lung cancer death in all EU countries except France, Greece, Spain, Portugal

Lung cancer – women
* 10,613 more deaths[estimated 33,533 deaths in 2000 but actual total 44,146 – up 32%]
* Increase in each country, ranging from +8% (UK) to +84% (Netherlands)
* Risk of dying from lung cancer rose 29% overall with increases ranging up to 95% in The Netherlands
* Only country where there are indications of a near future favourable trend is the UK

Stomach cancer – men
* 22,021 deaths avoided [estimated 30,879 in 2000 instead of expected 52,900 – down 42%]
* Decline in risk of dying from stomach cancer in every member state

Stomach cancer – women
* 18,166 deaths avoided [estimated 22,169 in 2000 instead of expected 40,335 – down 45%]
* Decline in risk of dying from stomach cancer in every member state

Colorectal cancer – men
* 3,535 deaths avoided [estimated 63,672 in 2000 instead of expected 67,297 – down 5%]
* Favourable downward trends in risk in most member states
* Strongly increasing trends in risk in Spain, Portugal, Greece

Colorectal cancer – women
* 12,153 deaths avoided [estimated 61,704 in 2000 instead of expected 73,857 – down 16%]
* Favourable downward trends in risk in nearly all countries
* Upward trend in Greece, Portugal

Breast cancer
* 2,666 deaths avoided [estimated 79,608 in 2000 instead of expected 76,942 – down 3%]
* Risk of dying from breast cancer fell overall by 5%
* Biggest reductions in risk of dying were in Luxembourg (-42%), UK (-24%), Sweden (-9%)
* Biggest increases in risk of dying were in Spain (+15%), Portugal (+11%), Greece (+7%)

Prostate cancer
* 4,200 more deaths [estimated 58,800 in 2000 but actual total 60,000 – up 7%]
* Risk of dying from prostate cancer rose by 5% overall
* Risk rising in all countries except France, Italy, Luxembourg, Germany
* Trend in risk also increasing except for Austria, France, Germany, Italy, Luxembourg, UK

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.”

Contact:

Professor David Kerr, editor-in-chief, Annals of Oncology
Tel: +44 – 1865 224482
Fax: +44 – 1865 791712
Email: david.kerr@clinpharm.ox.ac.uk