5.3.4 Mortality and incidence data discussion

 

All cancers (ICD-9 140 - 239)

This category includes all malignant tumours except non-melanoma skin cancers (specifically ICD-9 codes 140-172 and 174-208) and is mainly a proxy of the overall cancer care performance. In 2006, 3,200,000 new cases and 1,700,000 deaths were estimated for all cancers all around Europe (Ferlay et al, 2007). Maximum incidence rates (Figures 5.3.1) were estimated in Hungary for men (599 new cases per 100,000) and in Denmark for women (414 new cases per 100,000). Maximum mortality rates (Figures 5.3.3) were estimated in Hungary for men (364 deaths per 100,000) and in Denmark for women (196 deaths per 100,000). The highest incidence rates in 2006 were in Western Europe for men (482 new cases per 100,000, Figure 5.3.2a) and in Northern Europe for women (351 new cases per 100,000, Figure 5.3.2b), while the highest mortality rates were reported in Eastern Europe for men (287 deaths per 100,000, Figure 5.3.4a) and again in Northern Europe for women (155 deaths per 100,000, Figure 5.3.4b).

Figures 5.3.2 show that incidence rates are increasing both in men and in women for all macro-areas. On the contrary, Figures 5.3.4 show that mortality is decreasing for men with the exception of Eastern Europe and is decreasing or constant for women.

 

Figure 5.3.1a.            All cancer (ICD9 140-172, 174-208) standardized incidence estimated rates (European standard) by sex in 2006 A) Men

Figure 5.3.1b.            All cancer (ICD9 140-172, 174-208) standardized incidence estimated rates (European standard) by sex in 2006 B) Women

 

Figure 5.3.2a.            Trends of all cancer (ICD9 140-172, 174-208) standardized incidence estimated rates (European standard) by sex A) Men

Figure 5.3.2b.            Trends of all cancer (ICD9 140-172, 174-208) standardized incidence estimated rates (European standard) by sex B) Women

 

 

Figure 5.3.3a.            All cancer (ICD9 140-172, 174-208) standardized mortality rates (European standard) by sex in 2006 A) Men

Figure 5.3.3b.            All cancer (ICD9 140-172, 174-208) standardized mortality rates (European standard) by sex in 2006 B) Women

 

Figure 5.3.4a.            Trends of all cancer (ICD9 140-172, 174-208) standardized mortality rates (European standard) by sex A) Men

Figure 5.3.4b.            Trends of all cancer (ICD9 140-172, 174-208) standardized mortality rates (European standard) by sex B) Women

 

Stomach Cancer (ICD-9 151)

In 2006 Europe saw, 160,000 new cases and 118,000 deaths estimated for stomach cancer (Ferlay et al, 2007). In 2006 maximum levels of incidence rates (Figures 5.3.5) were estimated in Macedonia for men (37 new cases per 100,000) and in Lithuania for women (18 new cases per 100,000); while maximum levels of mortality rates (Figures 5.3.7) were estimated in Lithuania for men (29 deaths per 100,000) and in Estonia for women (12 deaths per 100,000). Incidence and mortality levels seem to be negatively associated with GDP levels, both for men and women (Figures 5.3.5 and Figures 5.3.7). Stomach cancer incidence (Figures 6) and mortality trends (Figures 5.3.8) are decreasing both for men and women in all macro-areas taken into account (with the exception of male incidence in Eastern Europe). Moreover, Eastern Europe maintains higher levels (in respect with other macro-areas) both for male incidence and mortality.

 

Figure 5.3.5a.            Stomach cancer (ICD9 151) standardized incidence estimated rates (European standard) by sex in 2006 A) Men

Figure 5.3.5b.            Stomach cancer (ICD9 151) standardized incidence estimated rates (European standard) by sex in 2006 B) Women

 

Figure 5.3.6a.            Trends of stomach cancer (ICD9 151) standardized incidence estimated rates (European standard) by sex A) Men

Figure 5.3.6b.            Trends of stomach cancer (ICD9 151) standardized incidence estimated rates (European standard) by sex B) Women

 

Figure 5.3.7a.            Stomach cancer (ICD9 151) standardized mortality rates (European standard) by sex in 2006 A) Men

Figure 5.3.7b.            Stomach cancer (ICD9 151) standardized mortality rates (European standard) by sex in 2006 B) Women

 

Figure 5.3.8a.            Trends of stomach cancer (ICD9 151) standardized mortality rates (European standard) by sex A) Men

Figure 5.3.8b.            Trends of stomach cancer (ICD9 151) standardized mortality rates (European standard) by sex B) Women

 

Colorectal Cancer (ICD-9 153, 154)

In 2006, 413,000 new cases and 207,000 deaths were estimated for colorectal cancer in Europe (Ferlay et al, 2007). Figures 5.3.9 show that maximum incidence rates were estimated in Hungary for men (106 new cases per 100,000) and Switzerland for women (56 new cases per 100,000). Finland had lower male incidence rate compared to other countries with a similar GDP. In 2006 Western Europe had maximum levels of incidence estimated rates (in respect with all the other macro-areas) both for men and women (Figures 5.3.10) (65 new cases in men and 41 new cases per 100,000 in women). Figures 5.3.11 show that Hungary, Czech Republic and Slovakia had higher mortality rates than the rest of Europe both for men (over 40 deaths per 100,000) and for women (over 24 deaths per 100,000).

Colorectal cancer incidence rates are increasing rather rapidly in Western and Eastern Europe mainly for men (Figure 5.3.10a). Male mortality rates (Figure 5.3.12a) are declining in Western and Northern Europe, while they are increasing in Eastern and Southern Europe.

 

Figure 5.3.9a.            Colorectal cancer (ICD9 153, 154) standardized incidence estimated rates (European standard) by sex in 2006 A) Men

Figure 5.3.9b.            Colorectal cancer (ICD9 153, 154) standardized incidence estimated rates (European standard) by sex in 2006 B) Women

 

Figure 5.3.10a.          Trends of colorectal cancer (ICD9 153, 154) standardized incidence estimated rates (European standard) by sex A) Men

Figure 5.3.10b.          Trends of colorectal cancer (ICD9 153, 154) standardized incidence estimated rates (European standard) by sex B) Women

 

Figure 5.3.11a.          Colorectal cancer (ICD9 153, 154) standardized mortality rates (European standard) by sex in 2006 A) Men

Figure 5.3.11b.          Colorectal cancer (ICD9 153, 154) standardized mortality rates (European standard) by sex in 2006 B) Women

 

Figure 5.3.12a.          Trends of colorectal cancer (ICD9 153, 154) standardized mortality rates (European standard) by sex A) Men

Figure 5.3.12b.          Trends of colorectal cancer (ICD9 153, 154) standardized mortality rates (European standard) by sex B) Women

 

 

Lung Cancer (ICD-9 162)

In 2006, in Europe there were 386,000 new cases and 335,000 estimated deaths (Ferlay et al, 2007). Worldwide, it is by far the most common cancer of men, while in women incidence rates are lower.

Figures 5.3.13a and 5.3.15a show that Hungary had the worst performance in men (119 new cases and 110 deaths per 100,000) against Sweden with minimum rates (29 new cases and 29 deaths per 100,000). Sweden had a lower male incidence rate compared to other countries with a similar GDP. In 2006 Iceland was the only country in which the female incidence estimated rate was higher than that of males (46 vs 41 new cases per 100,000). Eastern Europe had maximum levels of incidence (Figure 5.3.14a) and mortality (Figure 5.3.16a) rates (in respect of other macro-areas) for men in 2006 (92 new cases and 85 deaths per 100,000). While Northern Europe had the maximum incidence (Figure 5.3.14b) and mortality (Figure 5.3.16b) rates for women (31 new cases and 27 deaths per 100,000 in 2006).

Most European countries have experienced the peak of the lung cancer epidemic in men, although incidence and mortality rates are now declining for all macro-areas considered as shown in Figures 5.3.14a and 5.3.16a. In contrast, incidence and mortality are increasing for women (Figure 5.3.14b and 5.3.16b).

 

Figure 5.3.13a.          Lung cancer (ICD9 162) standardized incidence estimated rates (European standard) by sex in 2006 A) Men

Figure 5.3.13b.          Lung cancer (ICD9 162) standardized incidence estimated rates (European standard) by sex in 2006 B) Women

 

Figure 5.3.14a.          Trends of lung cancer (ICD9 162) standardized incidence estimated rates (European standard) by sex A) Men

Figure 5.3.14b.          Trends of lung cancer (ICD9 162) standardized incidence estimated rates (European standard) by sex B) Women

 

Figure 5.3.15a.          Lung cancer (ICD9 162) standardized mortality rates (European standard) by sex in 2006 A) Men

Figure 5.3.15b.          Lung cancer (ICD9 162) standardized mortality rates (European standard) by sex in 2006 B) Women

 

Figure 5.3.16a.          Trends of lung cancer (ICD9 162) standardized mortality rates (European standard) by sex A) Men

Figure 5.3.16b.          Trends of lung cancer (ICD9 162) standardized mortality rates (European standard) by sex B) Women

 

Female Breast Cancer (ICD-9 174)

Breast cancer is by far the most frequent type of cancer in women with an estimated 430,000 new cases and 132,000 deaths in 2006 for the entire Europe (Ferlay et al, 2007). The high incidence rates in recent years in the more affluent world areas as for Europe could also depend by the different introduction of screening programs in various countries that anticipate incidence detecting early invasive cancers (Parkin et al, 2005). The screening effect on the incidence trends is in fact an anticipation of the incidence in the years following full screening implementation.

Figure 5.3.17 shows that the maximum incidence rate in 2006 was estimated in Belgium (138 new cases per 100,000). Breast cancer incidence seems to be associated with GDP.

Figure 5.3.19 shows that in 2007 mortality rates varied by 17 deaths (in Iceland) to 34 deaths per 100,000 (in Denmark). Mortality trends (Figure 5.3.20) are decreasing in Northern Europe, Western Europe and Southern Europe, whilst they are constant in Eastern Europe.

 

Figure 5.3.17.            Female breast cancer (ICD9 174) standardized incidence estimated rates (European standard) in 2006

Figure 5.3.18. Trends of female breast cancer (ICD9 174) standardized incidence rates (European standard)

Figure 5.3.19. Female breast cancer (ICD9 174) standardized mortality rates (European standard) in 2006

Figure 5.3.20. Trends of female breast cancer (ICD9 174) standardized mortality rates (European standard)

 

Cervical Cancer (ICD-9 180)

Cervical cancer estimates were about 60,000 new cases and 30,000 deaths in 2002 for the entire Europe (Parkin et al, 2005). The risk of developing cervical cancer is mainly related to the HPV (Human Papilloma Virus) infection (Stewart and Kleihues, 2003). Cervical cancer incidence rates can be influenced by screening programmes. In this case, screening detects cervical lesions caused by HPV infection before becoming cervical cancer. If two countries have similar HPV infection exposure and the organised screening is implemented in the second, the cervical cancer incidence rate in the latter country should be lower than the incidence rate in the former one.

Cervical cancer incidence seems to be negatively associated with GDP (Figure 5.3.21). This could be caused by different HPV exposure and by the different introduction of screening programmes in various countries. Countries with lower GDP may have difficulties to implement cervical screening programs. There have been quite substantial declines in cervical cancer incidence and mortality, most clearly observed in Western, Southern and Northern Europe (Figure 5.3.22 and Figure 5.3.24) where there are well-developed screening programs.

 

Figure 5.3.21.            Cervical cancer (ICD9 180) standardized incidence estimated rates (European standard) in 2002

Figure 5.3.22.            Trends of cervical cancer (ICD9 180) standardized incidence estimated rates (European standard)

Figure 5.3.23.            Uterus cancer standardized mortality rates (European standard) in the age class 20-44 in 1996-2001

Figure 5.3.24.            Trends of uterus cancer standardized mortality rates (European standard) in the age class 20-44

 

Prostate Cancer (ICD-9 185)

In 2006, 346,000 new cases and 87,000 deaths were estimated for prostate cancer in Europe (Ferlay et al, 2007). Comparison of prostate cancer rates in European populations should take into account the geographical and temporal spread of PSA (Prostate-Specific Antigen) testing, which resulted in increased early detection (incidence) of positive prostate cancers prognosis.

Prostate cancer incidence seems to be positively associated with GDP (Figure 5.3.25) possibly due to the diffusion of PSA test in more affluent countries. In fact, the increase of incidence rates in Western, Northern and Southern Europe (Figure 5.3.26) reflects the PSA test diffusion. Mortality rates by years (Figure 5.3.28) are constant in Northern Europe, slightly decreasing in Western and Southern Europe, and increasing in Eastern Europe.

 

Figure 5.3.25.            Prostate cancer (ICD9 185) standardized incidence estimated rates (European standard) in 2006

Figure 5.3.26.            Trends of prostate cancer (ICD9 185) standardized incidence estimated rates (European standard)

Figure 5.3.27.            Prostate cancer (ICD9 185) standardized mortality rates (European standard) in 2006

Figure 5.3.28.            Trends of prostate cancer (ICD9 185) standardized mortality rates (European standard)