The cancer burden in the European Union and the European Region: the current situation and a way forward Presented by Zsuzsanna Jakab WHO Regional Director for Europe Informal Meeting of Health Ministers Brussels, Belgium, 4 5 July 2010
Added value of the European Union (EU) in cancer control The EU has experience in promoting joint initiatives; renewed leadership could give it the impulse needed really to make a difference in citizens lives.
Epidemiological situation of cancer in Europe Summary of main trends Cancer mortality accounts for nearly 20% of all deaths in the WHO European Region. After cardiovascular diseases (CVD), cancer is the second leading cause of death overall. Cancer is becoming the leading cause of premature death (before age 65) in many European countries (28 of the 53 in the Region). Although effective interventions exist, mortality from some forms of cancer is either increasing or remaining stable.
Epidemiological situation: lung cancer a special concern Lung cancer is the main cause of cancer deaths overall, followed by colon cancer, but breast cancer mortality is important among women. There is concern about rising trends in lung cancer mortality in EU-12 countries (those belonging to the EU before May 2004) and among women in the EU as a whole. Lung cancer mortality rates at regional level in the EU are higher in poorest areas (NUTS2 level nomenclature of territorial units for statistics level 2).
Epidemiological situation of cancer in Europe: incidence and survival An estimated 2.45 million new cancer cases occur in the EU every year. Incidence is increasing with ageing of the population. Increasing trends are particularly high in EU-12 countries, but data tend to be sparse. Five-year survival for breast, colon and cervical cancer is high (over 50%), and has improved, in contrast with that for lung cancer, which has remained low (around 10%).
700 600 500 400 300 200 100 0 Main causes of death in the EU EU 15 1980 EU 15 2007 EU 12 1980 EU 12 2007 Region Cardiovascular Cancers External causes Infectious disease Respiratory system Standardized SDR, mortality death by rate cause, (SDR) per by cause 100.000 per 100 000 population population
Mortality from cancer by sex and age groups in the European Region, around 2007 2000 Standardized rate (deaths per 100.000 population) SDR per 100 000 population 1800 1600 1400 1200 1000 800 600 400 200 0 0-14 15-29 30-44 45-59 60-74 75+ Age group (years) Total Male Female
Trends in mortality from cancer in Europe, all forms, 1980-2007 250 SDR per 100 000 population 200 150 European Region EU-15 EU-12 CIS Central Asian republics 100 1980 1990 2000 2010 Source: European Health for All database. WHO/Europe, 2010. Note. CIS = Commonwealth of Independent States.
500 Cancer incidence per 100 000 population 400 300 200 European Region EU-15 EU-12 CIS Central Asian republics 100 0 1980 1990 2000 2010 Source: European Health for All database. WHO/Europe, 2010.
Mortality from main types of cancer by European subregion, around 2007 50 SDR per 100 000 population Standardised rate (deaths per 100.000 population) 45 40 35 30 25 20 15 10 5 0 European Region EU-15 EU-12 CIS CARK Subregion Stomach Colon, rectum and anus Trachea, bronchus and lung Female breast Source: European Health for All database. WHO/Europe, 2010.
50 SDR, malignant neoplasm of trachea, bronchus and lung per 100000 40 30 European Region EU-15 EU-12 CIS Central Asian republics 20 10 1980 1990 2000 2010 Source: European Health for All database. WHO/Europe, 2010.
Mortality trends from lung cancer in EU countries, 1970 2007 120 100 EU-12 EU-15 Females SDR per 100 000, all ages 80 60 40 20 Males 1970 1975 1980 1985 1990 1995 2000 2005 1970 1975 1980 1985 1990 1995 2000 2005 Source: European Health for All database. WHO/Europe, 2010.
Lung cancer mortality rates in the EU and neighbouring countries around 2005 2007 Source: Inequalities in Health System Performance and Their Social Determinants in Europe Tools for Assessment and Information Sharing Project. WHO/Europe, 2010.
60 Trachea, bronchus and lung cancer incidence per 100 000 50 40 30 European Region EU-15 EU-12 CIS Central Asian republics 20 10 0 1980 1990 2000 2010 Source: European Health for All database, WHO/Europe, 2010.
Lung cancer incidence and deaths * Hungary (2005) Denmark (2001) Croatia (2005) Italy (2002) United Kingdom (2003) Czech Republic (2004) Slovenia (2004) Netherlands (2003) Germany (2002) Poland (2004) Serbia (2004) Belgium (1997) Estonia (2004) Norway (2005) Austria (2004) France (2000) Latvia (2006) Lithuania (2005) Bulgaria (2004) Ireland (2005) Slovakia (2003) Finland (2005) Belarus (2005) TFYR Macedonia (2003) Russian Federation Ukraine (2006) Sweden (2004) Luxembourg (2004) Romania (2005) Iceland (2002) Portugal (2000) Malta (2005) Armenia (2003) Kazakhstan (2006) Israel (2003) Moldova (2006) Cyprus (2004) Georgia (2001) Albania (2002) Kyrgyzstan (2005) Azerbaijan (2004) Uzbekistan (2005) Turkmenistan (1997) Tajikistan (2005) 75.1 64.3 59.4 56.5 56.1 55.7 52.1 54.6 47.4 55.5 59.2 67.0 48.6 42.5 41.4 42.2 50.5 40.3 40.6 37.8 37.2 37.2 35.8 31.6 36.9 33.4 36.9 41.9 41.8 34.1 28.1 30.2 27.8 21.5 20.7 23.7 22.5 17.9 19.4 7.8 11.3 4.0 5.3 2.5 68.2 67.5 65.0 62.4 61.3 60.8 55.6 54.6 53.3 51.8 51.3 49.1 48.7 47.3 47.1 46.8 46.2 45.8 44.6 42.4 41.7 41.6 41.0 40.3 38.4 36.9 35.7 33.9 31.3 30.5 30.5 29.7 23.8 23.6 21.7 19.8 16.0 12.8 8.5 8.3 4.5 3.8 1.8 100.7 125 75 25 25 75 125 Crude death rate per 100 000 population New cases per 100 000 population Source: Atlas of health in Europe. WHO/Europe, 2008. * The former Yugoslav Republic of Macedonia.
40 SDR, females, malignant neoplasm of breast, per 100 000 30 20 European Region EU-15 EU-12 CIS Central Asian republics 10 0 1980 1990 2000 2010 Source: European Health for All database. WHO/Europe, 2010.
Female breast cancer incidence and deaths * Sweden (2004) Luxembourg (2004) Finland (2005) Denmark (2001) United Kingdom (2003) Netherlands (2003) Hungary (2005) Malta (2005) France (2000) Germany (2002) Italy (2002) Norway (2005) Iceland (2002) Austria (2004) Ireland (2005) Belgium (1997) Israel (2003) Czech Republic (2004) Slovenia (2004) Croatia (2005) Cyprus (2004) Bulgaria (2004) Estonia (2004) Portugal (2000) Latvia (2006) Lithuania (2005) Slovakia (2003) Serbia (2004) Russian Federation TFYR Macedonia (2003) Belarus (2005) Poland (2004) Ukraine (2006) Romania (2005) Armenia (2003) Moldova (2006) Georgia (2001) Kazakhstan (2006) Azerbaijan (2004) Albania (2002) Kyrgyzstan (2005) Uzbekistan (2005) Turkmenistan (1997) Tajikistan (2005) 34.6 30.9 30.9 49.2 41.5 41.0 39.4 34.9 36.2 42.2 38.4 29.8 25.7 36.4 32.7 46.5 27.5 38.2 36.7 40.0 23.5 28.6 32.2 28.8 36.1 31.9 26.0 40.3 29.4 23.8 24.0 24.8 31.3 28.6 26.8 24.8 23.1 17.4 12.2 6.8 7.7 6.1 4.5 3.2 152.6 151.3 150.1 147.9 143.6 142.6 142.6 140.1 138.2 130.8 124.3 119.3 117.6 114.9 113.5 110.4 107.9 107.5 106.3 100.0 99.2 85.4 84.2 82.4 81.4 72.6 72.4 70.2 64.6 63.6 62.2 61.2 60.4 52.1 49.0 47.7 39.2 37.7 23.0 20.4 19.8 12.5 9.4 6.7 100 50 0 50 100 150 200 250 Crude death rate per 100 000 population New cases per 100 000 population Source: Atlas of health in Europe. WHO/Europe, 2008. * The former Yugoslav Republic of Macedonia.
11 SDR, females, malignant neoplasm of cervix uteri, per 100 000 10 9 8 7 6 European Region EU-15 EU-12 CIS Central Asian republics 5 4 3 2 1980 1990 2000 2010 Source: European Health for All database. WHO/Europe, 2010.
Trends in premature mortality from cervical cancer in EU countries, 1970 2007 12 EU-12 EU-15 SDR per 100 000 females aged 0 64 years 10 8 6 4 2 0 1970 1975 1980 1985 1990 1995 2000 2005 Source: European Health for All database. WHO/Europe, 2010.
Female cervical cancer incidence and deaths * Romania (2005) Lithuania (2005) Bulgaria (2004) Serbia (2004) Estonia (2004) TFYR Macedonia (2003) Hungary (2005) Slovakia (2003) Czech Republic (2004) Slovenia (2004) Ukraine (2006) Portugal (2000) Latvia (2006) Moldova (2006) Poland (2004) Belarus (2005) Russian Federation Kazakhstan (2006) Germany (2002) Denmark (2001) Armenia (2003) Croatia (2005) Kyrgyzstan (2005) Norway (2005) Ireland (2005) Iceland (2002) Italy (2002) Luxembourg (2004) France (2000) Austria (2004) Georgia (2001) Malta (2005) Belgium (1997) Sweden (2004) United Kingdom (2003) Uzbekistan (2005) Netherlands (2003) Turkmenistan (1997) Cyprus (2004) Israel (2003) Azerbaijan (2004) Tajikistan (2005) Finland (2005) Albania (2002) 16.2 11.8 9.1 11.9 8.0 4.4 7.9 6.6 7.5 4.7 8.6 4.3 8.8 11.4 9.2 7.0 7.8 7.4 4.2 5.5 6.1 4.6 5.8 3.1 3.7 2.1 1.3 1.3 2.3 3.9 6.0 1.0 4.3 3.5 3.6 3.1 292.6 4 3.4 2.1 1.9 1.1 1.5 2.2 1.3 20.7 19.8 19.7 19.1 19.0 18.1 17.8 17.6 17.0 16.9 16.9 15.8 15.4 15.3 14.5 13.8 13.6 12.5 12.2 11.8 11.6 11.3 11.2 10.9 10.5 9.8 9.8 9.6 9.2 7.4 7.1 5.7 5.6 5.5 5.1 4.9 4.7 4.2 28.9 27.4 26.9 25.2 24.9 24.6 20 15 10 5 0 5 10 15 20 25 30 Crude death rate per 100 000 population New cases per 100 000 population Source: Atlas of health in Europe. WHO/Europe, 2008. * The former Yugoslav Republic of Macedonia.
Integrated action plan on noncommunicable diseases (NCDs) Population-wide health promotion to tackle the main NCD risk factors: Tobacco Poor diet Excessive alcohol intake Physical inactivity
Early detection Mammography Cervical cancer screening already introduced in all countries, although target populations and recommended frequency vary considerably Colorectal cancer screening introduced in only a few countries in the European Region
Cancer research across Europe Need for coordinated and comprehensive cancer registries across the EU, covering (a representative sample of) all populations Latest data on EU-wide cancer incidence and mortality are incomplete and outdated Thorough review of European directives on research and data protection
Regional leadership, technical excellence and synergistic collaboration among partners With political leadership from the EU and Member States, and technical leadership from WHO, cancer control can make real progress in the coming years.
Thank you Merci beaucoup Dank u wel