The study by researchers in Italy and Switzerland predicts that although the actual number of deaths from all cancers in the European Union will continue to rise due to growing populations and numbers of elderly people, the rate of cancer deaths will continue to decline overall, with some notable exceptions: lung cancer in women and pancreatic cancer in both sexes. In women, the predicted age standardised rate of deaths from lung cancer will increase by 9% from 2009 to 14.24 per 100,000 of the population, while the death rates from breast cancer are predicted to be 14.22 per 100,000, which represents a fall of 10.2% since 2009. However, the total number of deaths will remain slightly higher for breast cancer (90,800) than for lung (87,500).
Professor Carlo La Vecchia (MD), professor at the Faculty of Medicine, University of Milan (Italy), one of the study authors, said: “We still have to be cautious about the lung cancer rates in women since these are predictions. The data for real death rates in 2015 in the EU as a whole will be available in three to four years. Further caution is required due to the fact that the absolute numbers of deaths in 2015 remains higher for breast than for lung. However, the 2015 predictions confirm our projections on long-term trends made two years ago that lung cancer death rates would overtake breast cancer in women around 2015.”
The overall death rate for lung cancer among women is being driven by women in the UK and Poland, with predicted rates of 21 and 17 per 100,000 in the UK and Poland respectively. These rates are more than double those in Spain, which has a lung cancer death rate among women of just over eight per 100,000.
“UK and Polish women, particularly UK women, have long had much higher lung cancer rates than most other European countries (except Denmark, which is not considered separately in this study). This is due to the fact that British women started smoking during the Second World War, while in most other EU countries women started to smoke after 1968. It is worrying that female lung cancer rates are not decreasing in the UK, but this probably reflects the fact that there was an additional rise in smoking prevalence in the UK as well in the post-1968 generation — those born after 1950,” said Prof La Vecchia. “However, despite the relatively lower rates of women dying from lung cancer in other EU countries, the trends are less favourable in some countries, particularly in France and Spain.”
The study predicts that there will be a total of 1,359,100 deaths from cancer in the 28 member states of the EU in 2015 (766,200 men and 592,900 women), corresponding to an age standardised rate of 138.4 per 100,0000 men and 83.9 per 100,000 women. This represents a fall of 7.5% and 6% in men and women respectively since 2009, and an overall fall of 26% in men and 21% in women since the peak of cancer death rates in 1988. Over 325,000 deaths will be avoided in 2015 compared with the 1988 peak rate.
The study looked at cancer rates in the EU 28 member states as a whole and also in the six largest countries — France, Germany, Italy, Poland, Spain and the UK — for all cancers, and, individually, for stomach, intestines, pancreas, lung, prostate, breast, uterus (including cervix) and leukemias. This is the fifth consecutive year the researchers have published these predictions.
In men, predicted rates for the three major cancers (lung, colorectal and prostate) are lower than in 2009, falling 9%, 5% and 12% respectively. In women, breast and colorectal cancer death rates will fall by 10% and 9% since 2009. “The favourable predictions for breast and colorectal cancer are largely due to improved detection and management of these common cancers,” said Prof La Vecchia. “The key feature of prostate cancer deaths is that it is likely to decline further across the EU, and in all age groups, including the elderly. Since this is essentially due to better treatment — including surgery, radiotherapy, and medical treatments such as newer anti-androgens — one would have expected that these favourable trends to be much larger below the ages of 70 or 75, but the data suggest that the improvement is extended to the elderly too. Earlier diagnosis and PSA [prostate-specific antigen] screening may also play a role.”
Death rates from pancreatic cancer are predicted to rise since 2009 by 4% in men and 5% in women. Tobacco, obesity, diabetes, high alcohol intake and a family history of pancreatic cancer are all recognised risk factors for the disease, but explain less than 40% of cases and important causes of the increasing trends yet have to be identified.
Co-author, Fabio Levi (MD), Emeritus Professor at the Faculty of Biology and Medicine, University of Lausanne, (Switzerland), said: “While the downward trends in overall cancer death rates is good news, smoking still remains the greatest cause of cancer deaths in the EU. For instance, smoking probably accounts for 15 to 25 percent of all pancreatic cancers, 85 to 90 percent of all lung cancers, and is implicated in a number of other cancers too. The differences in death rates between European countries remains a concern, with higher rates in the member states that joined most recently, such as the central and eastern European countries.”
Professor Paolo Boffetta (MD), the Annals of Oncology associate editor for epidemiology and Director of the Institute of Translational Epidemiology at the Icahn School of Medicine at Mount Sinai in New York (USA), commented: “The decrease in overall cancer mortality rates among European men and women which started in the 1990s does not seem to slow down: this is the major favourable conclusion of the 2015 report. On the other hand, the continuing increase in lung cancer mortality among European women represents a challenge for cancer control, and the steady increase in pancreatic cancer deserves high priority for research.”