London School of Hygiene & Tropical Medicine

Cancer survival still varies widely between European countries despite major improvements in cancer diagnosis and treatment during the first decade of the 21^st century, according to the latest EUROCARE-5 reports covering over 50% of the adult and 77% of the childhood population of Europe.

The findings, published in The Lancet Oncology,analysed data from cancer registries in 29 countries to compare five-year survival from diagnosis for more than 9 million adults and 60,415 children diagnosed between 2000 and 2007.

The number of adults surviving for at least five years after diagnosis has risen steadily over time in all European regions, reflecting major advances in cancer management such as organised cancer screening programmes and improved treatments.  However, there continues to be big disparities between countries.

Michel Coleman, Professor of Epidemiology and Vital Statistics at the London School of Hygiene & Tropical Medicine and co-author on the adult study said: “EUROCARE-5 updates what we know about survival for cancer patients in Europe. Cancer survival still varies widely across Europe, despite widespread improvements in the first decade of this century. The trends are likely to reflect improvements in screening, treatment and post-operative care.

“The international differences have narrowed for cancers of the breast, rectum and prostate, and skin melanoma, but the differences remain wide for most other cancers. Survival in the four UK nations and Ireland is lower than the European average for most but not all cancers. The results will help drive health policy for cancer control in many countries, including the UK.”

According to the EUROCARE-5 study, survival in England was comparable to the European average for cancers of the breast, prostate, rectum, melanoma of the skin, and lymphomas, but lower than the average for many common cancers, particularly kidney (48% v 61%), ovary (31% v 38%) and colon (52% v 57%).

Countries with lowest survival for most cancers (Bulgaria, Estonia, Latvia, Lithuania, Poland, and Slovakia) are in eastern Europe. Here survival is below the European average, particularly for cancers with a better prognosis. For example: colon (49% v 57%), rectum (45% v 56%), non-Hodgkin’s lymphoma (50% v 59%), and melanoma of the skin (74% v 83%).

But the gulf in survival between east and west is closing, with evidence that some eastern European countries with previously poorer survival are catching up. For example, improvements in breast cancer survival in eastern Europe between 1999 and 2007 (70% to 75%) have reduced the gap with the best performing countries (northern Europe) over the same time periods (82% to 85%).

Nordic countries (with the exception of Denmark), central European countries such as Austria, Belgium, France, Germany, Switzerland, and Netherlands, and some countries in southern Europe, particularly Italy, Portugal, and Spain, have the best survival for most cancers.

Some cancers showed particularly large increases in survival between 1999 and 2007— prostate (73% to 82%), rectum (52% to 58%), and non-Hodgkin’s lymphoma (54% to 60%)—reflecting better cancer management.

Researchers believe that the most likely reasons for improved survival for lymphoma and rectal cancer are more effective drugs and better surgical techniques.  The dramatic increase in numbers of patients surviving prostate cancer are most likely due to earlier diagnosis, the detection of cancers that develop slowly, and over-diagnosis due to the increasing use of prostate-specific antigen testing.

The second study, which the School was not involved in, looked at survival among children aged 0-14 years. It found survival at five years from diagnosis for all cancers combined is generally good, with 79% now surviving (2005–2007), up from 76% in 1999–2001. The most striking increases in childhood cancer survival have been in eastern Europe where survival rose from 65% in 1999–2001 to 70% in 2005–2007. But the study still found large survival differences within European areas, ranging from a low of 70% in eastern Europe to 80% or more in northern, central, and southern Europe.

The authors note that interpreting cancer survival differences is complex. Longer survival may be due to better treatments or to earlier diagnosis that improves the effectiveness of existing treatments.

However other factors such as tumour biology, lifestyle, presence of other diseases, and tests that detect slow growing tumours can influence survival.  The researchers say better clinical records are needed to further assess cancer care and that adequate legislation is needed to enable this.

Publication:

• Roberta De Angelis, Milena Sant, Michel Coleman et al. Cancer survival in Europe 1999—2007 by country and age: results of EUROCARE-5—a population-based study. The Lancet Oncology. DOI: 10.1016/S1470-2045(13)70546-1

Image: Mammogram. Credit: iStock