December 31, 2009 — New figures for cancer mortality rates in Europe for 2000 to 2004 show "persistent favourable trends over the last years," according to a report published online in the November 30 Advance Access issue of the Annals of Oncology.
Overall cancer mortality rates in the European Union decreased by 9% in men and 8% in women from 1990 to 1994 and from 2000 to 2004.
These decreases are comparable in magnitude to those observed in the last decade in the United States (–0.8% per year in men, –0.4% per year in women) and are similar to those seen in Japan, say the study authors.
Led by Carlo La Vecchia, MD, head of epidemiology at the Mario Negri Institute for Pharmacological Research in Milan, Italy, the team of authors comments that the favorable trend of decreasing cancer mortality rates was seen in all European countries, with the sole exception of Romania.
However, there remains an approximately 2-fold difference in cancer mortality rate (as well as incidence) across European countries. For men, the highest mortality rates were seen in Hungary, the Czech Republic, and Poland, whereas the lowest rates were in Sweden, Finland, and Switzerland. For women, the highest mortality rates were seen in Denmark, Hungary, and Scotland, and the lowest were seen in Spain, Greece, and Portugal.
These differences between the sexes reflect, in part, the different spread of cigarette smoking among men and women across various European countries, the study authors comment. Smoking had declined substantially among men during the last few decades but has increased among women in several countries, they note.
Cancers Linked to Tobacco and Alcohol
These trends in smoking have influenced the patterns seen for several cancers, most noticeably lung cancer. In the European Union as a whole, the lung cancer mortality rate has been declining in men (decreasing by 17% from the late 1980s to the early 2000s), but has increased in women (by 27% during the same period).
A similar, though less pronounced, pattern was seen for oral cancer. Overall, the mortality rate from oral cancer declined by approximately 10% from 1990 to 1994 and from 2000 to 2004, but increased mortality rates were seen in women.
However, mortality rates from oral cancer have also been influenced by changing patterns of alcohol consumption. Together, tobacco and alcohol are associated with more than 80% of cases of cancer of the oral cavity and pharynx, the study authors point out.
Countries such as France and Italy, which had the highest rates of drinking up to the 1980s, have seen a substantial reduction in alcohol consumption in the last few decades. They have also seen a reduction in mortality rates from oral cancer since the mid to late 1980s.
In contrast, alcohol consumption has been increasing in most countries from northern Europe, and the trends for oral cancer here are less favorable, the study authors comment. In particular, the highest rates of mortality from oral cancer were seen in Hungary and Slovakia, and this trend may point to a specific role of fruit-based alcoholic drinks that are popular in these areas, they suggest.
These trends in alcohol consumption have also influenced patterns in mortality from liver cancer. France and Italy had some of the highest mortality rates from primary liver cancer, but these have been decreasing in recent years, mainly because of the reduction in alcohol consumption in these countries since the early 1980s, the authors note. In contrast, mortality rates for liver cancer have been increasing in several central and northern European countries, reflecting the recent increase in drinking there, they add.
Esophageal cancer is also strongly associated with tobacco and alcohol use, and the patterns for this cancer are similar to those for oral cancer, at least in part. As for oral cancer, in the last decade, mortality rates for esophageal cancer were substantially decreased in France, Italy, and Spain, following the decline in alcohol consumption in these countries and a decline in smoking among men. In contrast, the esophageal cancer mortality rate has increased in most northern, central, and eastern European countries.
However, part of the increase in northern Europe is because of an increase in esophageal adenocarcinoma, which is related to obesity, as well as to gastroesophageal reflux disease and tobacco (but not alcohol) use. "Therefore, at least part of the rise in esophageal cancer mortality in northern Europe can be attributed to increased prevalence of obesity," the authors comment.
Factors Influencing Mortality Rates
For several individual cancers, the authors highlight factors that have contributed to the decline seen in mortality rates.
Mortality rates for gastric cancer declined by approximately 30% in both sexes from 1990 to 1994 and from 2000 to 2004. This is attributed to improved diet, diet variety, and food conservation, as well as a decline in the prevalence of Helicobacter pylori infection in more recent generations.
Mortality rates for breast cancer declined by 13% from 1990 to 1994 and from 2000 to 2004, and the variation in rates across Europe was relatively limited. Breast cancer mortality rates have been declining substantially in the last 2 decades in western Europe, the authors note. Improved treatment through antiestrogens and chemotherapy has played a major role, but a favorable impact from screening mammography is also likely in recent years, they comment.
Mortality rates for prostate cancer showed a modest 4% decline from 1900 to 1994 and from 2000 to 2004. Both in western Europe and in the United States, peak mortality rates for prostate cancer were observed in the 1990s, with a levelling off thereafter, the authors comment. This trend likely reflects a favorable impact of advances in treatment, such as androgen deprivation therapy, wider adoption of radical prostatectomy in the elderly population, and radiotherapy for patients with locally advanced disease, they suggest. Less likely to have had an impact is the introduction of prostate-specific antigen testing, they add.
Testicular cancer mortality rates have declined steadily, with a decrease of 26% seen between 1990 and 1994 and 2000 and 2004. This follows a favorable trend observed since the 1970s, which was, however, delayed vs that observed in the United States, the authors comment. Adoption of standard therapeutic protocols has played a role, they suggest.
Testicular cancer is one of the most curable neoplasms if adequate treatment is adopted, they point out. However, such treatment involves platinum-derived chemotherapy and other expensive drugs, and the inadequate availability of these therapies accounts for the smaller decline seen in eastern European vs western European countries, and also in Latin America vs the United States.
"Widespread adoption of efficacious therapy is therefore a priority to avoid unnecessary deaths from testicular cancer worldwide," Dr. La Vecchia and colleagues comment.
The study authors have disclosed no relevant financial relationships.
Ann Oncol. Published online November 30, 2009. Abstract.
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