Cancer: Large Differences in Survival between European Countries

Photo: People

EUROCARE-5 comprises numbers about the survival of 10 millions cancer patients in 29 European countries; ©
Jean-Luc Cochonneau

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

The findings analyzed data from cancer registries covering all or part of 29 countries to compare 5-year survival from diagnosis for more than 9 million adults and 60 415 children diagnosed between 2000 and 2007.

“The good news is that the number of adults surviving for at least 5 years after diagnosis has risen steadily over time in all European regions, reflecting major advances in cancer management such as organized cancer screening programmes and improved treatments. But there continues to be big disparities between countries, and international survival differences are narrowing for only a few cancers such as breast, rectum, prostate, and melanoma of the skin”, explains study co-leader Dr Roberta De Angelis from the Istituto Superiore di Sanità in Rome.

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% vs. 57%), rectum (45% vs. 56%), non-Hodgkin’s lymphoma (NHL; 50% vs. 59%), and melanoma of the skin (74% vs. 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%).

Adults in the UK and Ireland continue to have shorter survival than the European average for many common cancers, particularly colon (52% vs. 57%), ovary (31% vs. 38%), and kidney (48% vs. 61%), but have about average survival rates for rectum, breast, prostate, melanoma of the skin, and lymphomas.

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 NHL (54% to 60%)—reflecting better cancer management.

According to Dr De Angelis, “The most likely reasons for improved survival for NHL and rectal cancer are more effective drugs and better surgical techniques, whilst earlier diagnosis, as well as detection of indolent cancers and over-diagnosis, owing to the increasing use of prostate-specific antigen (PSA) testing, explains the dramatic increase in numbers of patients surviving prostate cancer”.

In a second study of children aged 0–14 years, survival at 5 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”, explains study co-leader Dr Gemma Gatta from the Istituto Nazionale Tumori in Milan, Italy. “But we 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.”; Source: Universität zu Lübeck