BACKGROUND: Information on cancer prevalence is of major importance for health planning and resource allocation. However, systematic information on cancer prevalence is largely unavailable. MATERIALS AND METHODS: Thirty-eight population-based cancer registries from 17 European countries, participating in EUROPREVAL, provided data on almost 3 million cancer patients diagnosed from 1970 to 1992. Standardised data collection and validation procedures were used and the whole data set was analysed using proven methodology. The prevalence of stomach, colon, rectum, lung, breast, cervix uteri, corpus uteri and prostate cancer, as well as of melanoma of skin, Hodgkin's disease, leukaemia and all malignant neoplasms combined, were estimated for the end of 1992. RESULTS: There were large differences between countries in the prevalence of all cancers combined; estimates ranged from 1170 per 100000 in the Polish cancer registration areas to 3050 per 100000 in southern Sweden. For most cancers, the Swedish, Swiss, German and Italian areas had high prevalence, and the Polish, Estonian, Slovakian and Slovenian areas had low prevalence. Of the total prevalent cases, 61% were women and 57% were 65 years of age or older. Cases diagnosed within 2 years of the reference date formed 22% of all prevalent cases. Breast cancer accounted for 34% of all prevalent cancers in females and colorectal cancer for 15% in males. Prevalence tended to be high where cancer incidence was high, but the prevalence was highest in countries where survival was also high. Prevalence was low where general mortality was high (correlation between general mortality and the prevalence of all cancers = -0.64) and high where gross domestic product was high (correlation = +0.79). Thus, the richer areas of Europe had higher prevalence, suggesting that prevalence will increase with economic development. CONCLUSIONS: EUROPREVAL is the largest project on prevalence conducted to date. It has provided complete and accurate estimates of cancer prevalence in Europe, constituting essential information for cancer management. The expected increases in prevalence with economic development will require more resources; allocation to primary prevention should therefore be prioritised.
Comment In: Ann Oncol. 2002 Jun;13(6):815-612123326
The EUROCARE project analysed cancer survival data from 45 population-based cancer registries in 17 European countries, revealing wide international differences in cancer survival. We calculated 5-year relative survival for 1836287 patients diagnosed with one of 13 cancers during the period 1978-1989. The data, from 20 cancer registries in 13 countries, were grouped into four regions: Finland, Sweden, Iceland (Northern Europe); Denmark, England and Scotland (UK and Denmark); France, The Netherlands, Germany, Italy and Switzerland (Western Europe); Estonia and Poland (Eastern Europe), and broken down into four periods (1978-1980, 1981-1983, 1984-1986, 1987-1989). For each cancer, mean European and regional survival was estimated as the weighted mean of 5-year relative survival in each country. Survival increased with time for all tumours, particularly for cancers of testis (12% increase, i.e. from 79.9 to 91.9%), breast, large bowel, skin melanoma (approximately 9-10%), and lymphomas (approximately 7%). For most solid tumours, survival was highest in Northern Europe and lowest in Eastern Europe, and also low in the UK and Denmark. Regional variation was less marked for the lymphomas. Survival improved more in Western than Northern Europe, and the differences between these regions fell for bowel cancer (from 8.0% for those diagnosed in 1978-1980 to 2% for those diagnosed in 1987-1989), breast cancer (from 7.4% to 3.9%), skin melanoma (from 13.4% to 11.0%) and Hodgkin's disease (from 7.2 to 0.6%). For potentially curable malignancies such as Hodgkin's disease, large bowel, breast and testicular cancers, there were substantial increases in survival, suggesting an earlier diagnosis and more effective treatment. The persisting regional differences suggest there are corresponding differences in the availability of diagnostic and therapeutic facilities, and in the effectiveness of healthcare systems.
OBJECTIVES: To describe and compare the consumption of dairy products in cohorts included in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: Data from single 24-hour dietary recall interviews collected through a highly standardised computer-based program (EPIC-SOFT) in 27 redefined centres in 10 European countries between 1995 and 2000. From a total random sample of 36 900, 22 924 women and 13 031 men were selected after exclusion of subjects under 35 and over 74 years of age. RESULTS: A high total consumption of dairy products was reported in most of the centres in Spain and in the UK cohort sampled from the general population, as well as in the Dutch, Swedish and Danish centres. A somewhat low consumption was reported in the Greek centre and in some of the Italian centres (Ragusa and Turin). In all centres and for both sexes, milk constituted the dairy sub-group with the largest proportion (in grams) of total dairy consumption, followed by yoghurt and other fermented milk products, and cheese. Still, there was a wide range in the contributions of the different dairy sub-groups between centres. The Spanish and Nordic centres generally reported a high consumption of milk, the Swedish and Dutch centres reported a high consumption of yoghurt and other fermented milk products, whereas the highest consumption of cheese was reported in the French centres. CONCLUSION: The results demonstrate both quantitative and qualitative disparities in dairy product consumption among the EPIC centres. This offers a sound starting point for analyses of associations between dairy intake and chronic diseases such as cancer.
EUROCARE-3 analysed the survival of 1815584 adult cancer patients diagnosed from 1990 to 1994 in 22 European countries. The results are reported in tables, one per cancer site, coded according to the International Classification of Diseases (ICD)-9 classification. The main findings of the tables are summarised and commented on in this article. For most solid cancers, wide differences in survival between different European populations were found, as also reported by EUROCARE-1 and EUROCARE-2, despite a remarkable (10%) overall increase in cancer survival from 1985 to 1994. Survival was highest in northern Europe (Sweden, Norway, Finland and Iceland), and fairly good in central-southern Europe (France, Switzerland, Austria and Spain). Survival was particularly low in eastern Europe, low in Denmark and the UK, and fairly low in Portugal and Malta. The mix of tumour stage at diagnosis explains much of the survival differences for cancers of the digestive tract, female reproductive system, breast, thyroid, and also skin melanoma. For tumours of the urinary tract and prostate, the differences were explained mainly by differences in diagnostic criteria and procedures. The case mix by anatomic subsite largely explains differences in survival for head and neck cancers. For oesophagus, pancreas, liver and brain cancer, with poor prognoses, survival differences were limited. Tumours, for which highly effective treatments are available, such as testicular cancer, Hodgkin's lymphoma and some haematological malignancies, had fairly uniform survival across Europe. Survival for all tumours combined (an indicator of the overall cancer care performance of a nation's health system) was better in young than old patients, and better in women than men. The affluence of countries influenced overall cancer survival through the availability of adequate diagnostic and treatment procedures, and screening programmes.
Breast cancer is the most frequent malignancy among women in developed countries. Prognosis is better than for other major cancers, and an improvement in survival has been reported for several populations in recent decades. Within the framework of EUROCARE, a population-based project concerned with the survival and care of cancer patients in Europe, we analysed data from 119,139 women diagnosed with breast cancer between 1978 and 1985 in 12 countries and followed for at least 6 years. Multiple regression models of relative survival, which take mortality from all other causes in each area into account, were used to estimate the effect of age, period of diagnosis and country on survival. For the comparison between countries, survival rates were age-standardised to the age structure of the entire study population. Women aged 40-49 years at diagnosis had the best prognosis in all countries and throughout the study period. Women younger than 30 years at diagnosis had a worse prognosis than those aged 30-39. The highest relative survival at 5 years was in Finland and Switzerland (about 74%), intermediate levels were found for Italy, France, The Netherlands, Denmark and Germany (about 70%) and the lowest rates were in Spain, the United Kingdom, Estonia and Poland (55-64%). During the 6 months following diagnosis, survival was highly dependent on age and was sharply lower in women older than 49 years. For women surviving more than 6 months after diagnosis, survival was similar for all ages, although women aged 40-49 still had the better prognosis. The average rate of death from breast cancer fell by about 2.5% for each year of diagnosis between 1978 and 1985. This improvement manifested mainly in younger and older women, for whom survival was initially less good. The largest improvement was seen in Poland (-15% death risk per year). We suggest that the better survival of women aged 40-49 at diagnosis is related to lower levels of circulating sex hormones, resulting in reduced stimulation of tumour cell growth. Early diagnosis may also be important in the peri-menopausal period due to increased diagnostic attention. Low survival in the United Kingdom may be due to inadequate adherence to consensus treatment guidelines and greater variation in treatment.
Childhood Cancer Registry of Piedmont -- Cancer Epidemiology Unit of the Centre for Cancer Epidemiology and Prevention (CPO-Piemonte), ASO S.Giovanni, V.Santena 7, 10126 Turin, Italy. firstname.lastname@example.org
EUROCARE is a population-based survival study including data from European Cancer Registries. The present paper analyses survival after a malignant neoplasm of the central nervous system (CNS) in childhood (aged 0--14 years at diagnosis). The database includes 6130 cases from 34 population-based registries in 17 countries: 1558 were primitive neuroectodermal tumours (PNET) and 4087 astrocytoma, ependymoma or other gliomas: these morphologies were grouped in the analyses in order to reduce the diagnostic variability among the registries. 87% of cases were microscopically diagnosed (range among registries 71--100%) and losses to follow-up were limited to 2% (range 0--14%). Actuarial analyses indicate that the European (weighted) average of 5 years cumulative survival for cases diagnosed in 1978--1989 was 53% (95% confidence interval (CI) 49--57) for CNS neoplasms, 44% (95% CI 37--50) for PNET and 60% (95% CI 55--65) for the glioma-related types. Analysis of the sub-set of cases diagnosed in 1985--1989 revealed better results: cumulative survival at 5 years was 61% (95% CI: 55--65) for all CNS neoplasms; 48% (95% CI 41--56) for PNET and 68% (95% CI 62--73) for glioma-related types. Compared with older children, infants showed poorer prognosis: in 1978--1989 the 5-year survival rate was 33% (95% CI 23--45) and in 1985--1989 it was 46% (95% CI 34--59). Variability among countries was very large, with 5-year survival for CNS tumours diagnosed in 1985--1989 ranging from 28% in Estonia (95% CI 17--43) to 73% Sweden (95% CI 59--83) and 75% in Iceland (95% CI 35--95) and 73% in Finland (95% CI 66--79). Time trends were studied in a multivariate analysis observing a reduction in the risk of death in periods of diagnosis 1982--1985 (hazard ratio (HR)=0.85; 95% CI 0.78--0.93) and 1986--1989 (HR=0.70; 95% CI 0.64--0.77) compared with 1978--1981. The analysis were extended to 1990--1992 for the countries whose registries provided data for that period did not indicate any further progress. Results of this study confirm the large variability in European countries and indicate a positive trend in the survival probability for cases diagnosed in the 1980s.
The study describes the prognosis of head and neck cancer in Europe on the basis of information available to population-based cancer registries collaborating in the EUROCARE II project. Variation in survival in relation to country and the anatomical site/sub-site of origin of the tumours was examined. Survival analysis was carried out on 35,004 head and neck cancer cases (ICD 141, 143-148 and 161) diagnosed between 1985 and 1989 in 17 European countries. Prognosis varied considerably according to anatomical site: the best 5-year survival rates were seen for cancer of the larynx (63% in men) and the worst for cancer of the hypopharynx (22% in men). Five-year relative survival of male patients with cancer of the tongue, mouth and pharynx (ICD 141, 143-148) was 34% and ranged from over 45% in Iceland, Sweden, The Netherlands and Austria to less than 25% in Eastern European countries. Survival for larynx cancer ranged from over 70% in Iceland, Sweden, The Netherlands and Germany to less than 50% in Slovakia, Poland and Estonia. Apparently, France had the lowest survival (relative risk (RR) of dying versus Finland = 1.29) in Western Europe; after adjustment for ICD 3-digit anatomical sites the difference disappeared (RR = 1.04). Eastern European countries remained at the bottom of the survival range (RR > 1.4). The analyses adjusting by sub-site (ICD fourth digit) were confined to registries for which the proportion of unspecified sub-sites was less than 20%. Geographical differences in survival between Western European countries were largely due to a difference in case mix of anatomical sub-sites. However, after correcting for different sub-site distribution, differences persisted between Eastern and Western European countries. This is likely to be due to late diagnosis and to late referral or poor access of patients to adequately equipped treatment centres.
OBJECTIVES: To analyze cervical cancer survival trends in 10 European countries using models that estimate the proportion of cured patients (having the same life expectancy as the general population) and the survival of fatal cases (who die from cervical cancer). METHODS: We considered 40,906 cases diagnosed over 12 years (1978-89) collected from cancer registries participating in EUROCARE. RESULTS: From 1978 to 1989, 5-year relative survival in Europe improved (60%-->63%). The proportion of cured patients increased slightly but significantly (53%-->55%, p = 0.05). For countries with poorer survival at the end of the 1970s the proportion of cured patients increased faster than average, particularly evident in England (49%-->56%) and Scotland (44%-->53%). By contrast, in Finland, Sweden and Germany with organized screening, 5-year survival and cure rate did not improve, but incidence declined to very low levels. CONCLUSIONS: Cervical screening can explain the trends in cervical cancer survival: this identifies premalignant lesions, reduces incidence and selectively prevents less aggressive cancers. The decreased proportion of the latter means that survival does not improve in countries with low incidence of cervical cancer. The increased proportion of cured patients with time shows that survival improvement was not due simply to earlier diagnosis with no patient advantage.