Recent trends in incidence of five common cancers in 26 European countries since 1988: Analysis of the European Cancer Observatory
Introduction
Cancer has emerged as a leading cause of morbidity and mortality in European populations [1]. This development has made population-based, accurate and near-term information on cancer occurrence extremely valuable in order to identify trends, and risk factors driving those trends. Such data are also the foundation for adequate and purposeful cancer prevention, which needs to be continuously adapted according to the best available scientific evidence and knowledge [2]. Several initiatives at the European level have led to the formation of a network of cancer registries, allowing for comparisons across countries that provide insights into the impact of different risk factors, detection methods and treatment practices on the variation in cancer incidence and survival [3], [74].
Smoking, dietary habits and reproductive factors have been identified as the main (modifiable) risk factors for cancer in populations in industrialised countries, with different magnitudes and implications across countries and regions [4], [5]. Parallels between changes in the prevalence of those risk factors in the past and cancer incidence today highlight and confirm associations known for years. While smoking prevalence is still increasing in women in some countries in southern and central Europe [6], [7], it has decreased in men in Europe since the 1960s, leading to declines in lung cancer incidence since the 1980s or 1990s, first in northern and western Europe and later in eastern and southern Europe [8], [74]. At least 3–6% of all cancers in Europe have been related to high body mass index (BMI) and currently observed increases in BMI across all European countries [9], [10]. Although the impact of these recent changes in risk factor prevalence will only be fully reflected in cancer burden in the next 20–30 years [11], monitoring current trends may enable us to anticipate future increases in cancer burden.
Progress in cancer control has recently been measured using trends in incidence, mortality and survival based on data from 21 European cancer registries [12]. While improvements in early detection as well as treatment options have translated into an ongoing increase in survival and decrease in mortality, cancer prevention efforts have so far yielded only moderate successes. In this study, we aim to describe recent trends in incidence of the most common cancers in Europe in the past two decades, complementing the study of [74] on trends in incidence of smoking-related cancers. Population-based incidence data from cancer registries in 26 countries from the European Cancer Observatory [13] and Cancer Incidence in Five Continents (CI5) [14] were used to assess trends across European regions, age groups and sex. Where possible, incidence trends were assessed in the light of the changing prevalence of several known risk factors in European populations. This approach will shed light on the potential for improvement in cancer prevention.
Section snippets
Methods
Cancer incidence data by age and sex and corresponding population figures were obtained from the EUREG database (http://eu-cancer.iarc.fr/EUREG/Default.aspx), which has been developed in the framework of the EUROCOURSE project and is part of the European Cancer Observatory (ECO) website [13]. Annual country- and sex-specific age-standardised incidence rates (ASR), using the European Standard population, were calculated for 26 European countries between 1988 and 2008. Average annual percentage
Results and discussion
Trends in incidence of five major cancers in Europe since 1988 are presented by sex and region in Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7, Fig. 8, Fig. 9, Fig. 10. Table 1 lists the corresponding absolute numbers of cancer cases at the beginning and at the end of the study period. The AAPC plotted against the incidence in the most recent year are displayed by cancer site and sex in Fig. 11, Fig. 12, Fig. 13, Fig. 14, Fig. 15, Fig. 16, Fig. 17, Fig. 18, Fig. 19, Fig. 20 and by sex
Conclusion
Increasing trends in incidence of the most common cancers in Europe are of concern, in particular those at younger ages, as observed for colorectal cancer in some central and eastern European countries, where incidence is high and still continues to increase. Although incidence rates have decreased for some cancers in some countries, e.g. corpus uteri cancer in western Europe, the absolute number of cases remained relatively stable (or even increased) during the study period due to ageing of
Authors’ contributions
M.A. contributed to study design, data analysis, data interpretation and wrote the first draft of the manuscript. H.K.K., J.W.C., G.B., A.A., J.F., A.R., D.F. and I.S. contributed to data interpretation, writing and reviewing the manuscript. I.S. additionally contributed to study design and supervised the study.
Role of the funding source
The sponsor of the study had no role in study design, data collection, data analysis or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Conflict of interest statement
None declared.
Acknowledgements
M.A. is supported by the World Cancer Research Fund, Grant number SG 2012/619. I.S. is funded through the Marie Curie Action Intra-European Fellowship, contract number 302050. EUROCOURSE (EUROpe against Cancer: Optimisation of the Use of Registries for Scientific Excellence in research), an EC 7th Framework Programme of DG Research and Innovation under Grant agreement number LSSH-CT-2008-219453 provided logistic support and time of J.W.C. through Workpackage 8. We thank Joannie Lortet-Tieulent
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