New research on deaths from cancer in Europe concludes that the key priority for continuing to reduce mortality is cutting tobacco smoking. The study shows that, while deaths for men from lung cancer in the EU have declined overall, by 17 % from 1995 to 2004, they rose by 27% for women over the same period. It also reveals other significant differences in the mortality between different EU countries and genders, and a steady decline in cancer deaths overall between the early 1990s and 2004.

The gender 'splits' reflect how the spread of cigarette smoking among men and women across Europe has changed in the past. For example, the lowest death rates for women in the early 2000s were in Spain, Greece and Portugal, the highest being in Denmark, Hungary and Scotland. For men there is a contrasting country 'split', the lowest rates for men being in Sweden, Finland and Switzerland while the worst affected were Hungary, the Czech Republic, and Poland.

Despite the impact of smoking, the deaths from all cancers in the EU between the early nineties and early 2000s fell by nine per cent in men and eight per cent in women, with a large drop among the middle aged. This is the key favourable message from the research team led by Professor Carlo La Vecchia (MD) at the Mario Negri Institute, University of Milan, and Professor Fabio Levi (MD) at the Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne.

The reasons for the favourable trend are summed up by Dr Cristina Bosetti of the Mario Negri Institute: 'Falls in lung and other tobacco related cancers in men, the persistent decline in gastric cancer, and appreciable falls in colorectal cancer are the main causes. Screening and early diagnosis have contributed to the decline in cervical and breast cancer, although the fall in breast cancer deaths is mainly due to improved treatment. Therapeutic advancements have also played a role in the reduced mortality from testicular cancer, Hodgkin lymphoma and leukaemias, although the declines have been delayed and are smaller in Eastern Europe.'

Further falls in cancer deaths in the EU will be influenced by more than just reduced smoking. The research team highlights the need for interventions in, for example, alcohol drinking and aspects of nutrition - including overweight and obesity. More widespread adoption of screening, and early diagnosis and therapeutic advancements for treatable cancers would also contribute.

An example of the research findings is the impact of tobacco and alcohol on cancer incidence for the mouth, pharynx and oesophagus. The substantial decline in alcohol consumption in Spain, France and Italy, for example, is related to a big fall in deaths from cancer of the oesophagus in these countries. In contrast such deaths have increased in most northern, central and eastern European countries.

A continued rise in prostate cancer deaths in Russia, the Baltic countries, Poland and other eastern European countries was shown by the study. But, in the EU as a whole, there was a modest decline of about four per cent over the period researched. The results for breast cancer showed a 13% decline over all ages.

Source:  Annals of Oncology (30 November 2009); DOI:10.1093/annonc/mdp530

'Cancer mortality in Europe, 2000 - 2004, an overview of trends since 1975'