Lung cancer is likely to overtake breast cancer as the main cause of cancer death among European women by the middle of this decade, according to new research published in the cancer journal Annals of Oncology on February 13. In the UK and Poland it has already overtaken breast cancer as the main cause of cancer deaths in women.
The study by researchers in Italy and Switzerland predicts that just over 1.3 million people will die from cancer (737,747 men and 576,489 women) in the 27 countries of the European Union in 2013. Although the actual numbers have increased when compared with 2009 (the year for which there are World Health Organization mortality data for most EU countries), the rate (age-standardised per 100,000 population) of people who die from the disease has declined. Since 2009 there has been 6% fall among men and 4% fall among women.
However, despite the decline in cancer deaths overall, lung cancer death rates continue to rise among women in all countries, while breast cancer rates fall. In 2013 there will be an estimated 88,886 deaths (14.6 per 100,000 women) from breast cancer and 82,640 deaths (14 per 100,000 women) from lung cancer. Lung cancer deaths have risen by 7% among women since 2009.
One of the study's authors, Professor Carlo La Vecchia (MD), head of the Department of Epidemiology at the Mario Negri Institute and professor at the Faculty of Medicine, University of Milan (Italy), said: "If these opposite trends in breast and lung cancer rates continue, then in 2015 lung cancer is going to become the first cause of cancer mortality in Europe. This is already true in the UK and Poland, the two countries with the highest rates: 21.2 and 17.5 per 100,000 women respectively.
"This predicted rise of female lung cancer in the UK may reflect the increased prevalence of young women starting smoking in the late 1960s and 1970s, possibly due to changing socio-cultural attitudes at that time. However, fewer young women nowadays in the UK and elsewhere in Europe are smoking and, therefore, deaths from lung cancer may start to level off after 2020 at around 15 per 100,000 women."
Deaths from breast cancer have been declining steadily, with a 7% fall in rates since 2009 in the EU. "This reflects the important and accumulating advances in the treatment, as well as screening and early diagnosis, of the disease," said Prof La Vecchia.
Although lung cancer is still the main cause of cancer death among men, with nearly 187,000 deaths predicted for 2013, giving a death rate of 37.2 per 100,000 men, this represents a 6% fall since 2009.
The study looked at cancer rates in the whole of the EU (27 member states as at 2007) and also in six individual countries -- France, Germany, Italy, Poland, Spain and the UK -- for all cancers, and, individually, for stomach, intestine, pancreas, lung, prostate, breast, uterus (including cervix) and leukemias. This is the third consecutive year the researchers have published predicted EU cancer deaths. Last year they predicted deaths for 2012.
The researchers focused on intestinal cancers, particularly colorectal cancers, for their 2013 predictions. They found that, overall, there has been a decline in rates of deaths from colorectal cancers in the EU. They predict there will be 87,818 deaths (16.7 per 100,000) in men and 75,059 (9.5 per 100,000) in women in 2013; this represents a fall when compared with actual death rates of 17.6 for men and 10.5 for women for the period 2005-2009.
Prof La Vecchia said: "The main reasons for the decline are improved screening and diagnosis, and improved management and treatment."
However, there are large variations between European countries. Poland and Spain have the highest rates of colorectal cancer deaths among men, with rates well above the EU average at 21.5 and 18.6 per 100,000 men respectively. Death rates among Polish women are also higher than the EU average, at 10.8; Spanish women have death rates from colorectal cancers that are lower than the EU average at 9 per 100,000 women.
"Smaller improvements in diagnosis and treatment partly or largely explain the less favourable trends in Poland and Spain," said Prof La Vecchia. "Tobacco and diet are other possible reasons, since they have evolved less favourably in these countries than in most other European countries."
Pancreatic cancer is the only cancer for which death rates are not predicted to decline in both sexes and, in fact, may rise in 2013. There will be a predicted 40,069 deaths (8 per 100,000) in men and 40,197 deaths (5.5 per 100,000) in women in 2013. These rates are higher than those recorded for 2009 of 7.9 per 100,000 in men and 5.4 per 100,000 in women. Among women in Germany the death rate will be higher (6.3 per 100,000), while it will be lower among Spanish women (4.1 per 100,000) compared to the EU average. Men in France have the highest predicted rate (8.7 per 100,000), while the other countries in the study had more stable rates among men, with Spain and the UK having lower rates (6.6 per 100,000) than the EU average.
Prof La Vecchia said: "The best ways of preventing pancreatic cancer is to avoid tobacco, and to avoid being overweight and the consequent onset of diabetes that this can bring. This could prevent about a third of pancreatic cancers in the EU. No other major risk factor is known, and there is nothing happening with regard to diagnosis and treatment that could materially influence national death rates."
Co-author Professor Fabio Levi (MD), Head of the Cancer Epidemiology Unit at the Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, (Switzerland), said: "The key message for EU national governments from this study is tobacco control, particularly among middle-aged men and women, i.e. the European generations most heavily exposed to smoking. If more people could be helped and encouraged to give up smoking, or not to take it up in the first place, hundreds of thousands of deaths from cancer could be avoided each year in Europe. Other measures that could help to prevent cancer deaths include controlling overweight and alcohol abuse, as well as optimising cancer diagnosis and treatment. Most of these measures are applicable to all EU countries, and, in particular, the delay in improvements in cancer diagnosis and management is difficult to justify in central and eastern Europe, particularly in the light of the recent progress in countries such as Brazil or Argentina, which now have similar GDPs to several central European countries."
- M. Malvezzi, P. Bertuccio, F. Levi, C. La Vecchia, E. Negri. European cancer mortality predictions for the year 2013. Annals of Oncology, 2013 DOI: 10.1093/annonc/mdt010
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