5.3.1 Introduction

Cancer is a highly complex disease as demonstrated by the fact that about 100 cancer sites are considered in ICD-X. Cancer incidence has been increasing since the first cancer statistics became available, partly because increased occurrence and importance of cancer risk factors and also due to increased life expectancy at birth (LE). In fact, cancer is mainly a disease of older age. The LE of European countries is still increasing, and in these countries a cancer epidemic is currently ongoing or is expected in the near future (WHO, 2003; Micheli, Baili et al, 2003).

Main indicators to describe the evolution of cancer in a particular population are:

-         Incidence: the frequency with which cancer appears in a population or area over a given timeframe. Cancer incidence rate is the number of new cancers in a year over the population at risk. It is usually expressed as the number of new cancer cases per 100,000 population at risk;

-         Mortality: cancer mortality rates show the number of deaths where cancer is the underlying cause of death in a year over the population at risk. It is usually expressed as the number of deaths for cancer per 100,000 population at risk;

-         Relative survival: reflects the survival experience of cancer patients, after removing the effects of non cancer-related cause of death. It is typically expressed at some point subsequent to the cancer diagnosis (i.e. 1-year, 3-years, 5-years after diagnosis);

-         Prevalence: reflects the total cancer burden in a population and is a useful indicator for planning and allocation of resources. It is the proportion of subjects living in the population at a given date with a past diagnosis of cancer.

As there are several indications that cancer outcomes are related to macro-social indicators and lifestyles (Micheli, Capocaccia et al, 2003), in this chapter cancer outcome indicators are ordered by country specific Gross Domestic Product (GDP) and their trends are subdivided by geographical macro-area. Moreover, information is provided on all cancers combined and on a selection of major cancer sites: lung cancer, still being the major cancer killer in Europe; cancers of female breast, colorectal and uterine cervix, for their implication in screening activity; prostate and stomach cancers for their public health relevance. Table 5.3.1 shows the burden of these cancer sites in EU25 as estimated in 2006.

Table 5.3.1. Estimated incident cases and deaths by selected cancer sites in EU25 (2006).