Europe moves in right direction

The first research to examine recent trends in European cancer incidence, mortality and survival together has shown that cancer prevention and management in Europe is moving in the right direction. However, the work reveals that variations between countries in policies for mass screening, access to healthcare and treatment are reflected in the different cancer rates. The research, consisting of ten papers, has been published in a special July edition of the European Journal of Cancer and coincides with the start of work by the EC to draw up a new EU Cancer Action Plan.

In one study (2008;44:1345-1389), scientists from the Erasmus Medical Centre obtained data on incidence, mortality and five-year survival from the mid-1990s to the mid-2000s from cancer registries in 21 European countries, and used it to analyse trends. The researchers found that generally in the more prosperous countries of Northern and Western Europe the trend was downwards for cancer incidence; the exceptions were for obesity-related cancers, such as colorectal and postmenopausal breast cancer (BC), and for tobacco-related cancers in women, such as lung cancer.

Incidence and mortality from tobacco-related cancer decreased for men in Northern, Western and Southern Europe, they increased for both sexes in Central Europe and for women nearly everywhere in Europe. With the exception of smoking-related cancers, mortality trends generally in most cancers were moving downwards for the majority of Europe.

Survival rates for most cancers generally improved. The investigators state that this is due to better access to specialised diagnostics, staging and treatment. For instance, although the incidence of BC continues to rise in most countries, deaths are declining and survival is improving. The rising incidence and survival rates are partly influenced by the presence of organised BC screening programmes and even opportunistic screening that increases the detection of smaller and less aggressive tumours. Survival and mortality is also influenced by improved staging and treatment, such as the use of tamoxifen in postmenopausal patients and chemotherapy in premenopausal patients.

The impact of mass screening is investigated in greater depth in another paper (2008;44:1404-1413), and in a further paper (2008;44:1425-1437), on the potential ways of closing the gap between Central and Eastern Europe through changes in lifestyles, which could reduce the incidence of some cancers. Another report (2008;44:1451-1456), by scientists from the Institute of Public Health of the Republic of Slovenia, outlines some of the issues for Europe, including the identification of five groups of key stakeholders: patients, health policy, reimbursement and financing agencies, research and finally, pharmaceutical and medical technology industries. Four key resources are identified as the most relevant to successful cancer management: human resources, physical resources, knowledge resources and social resources.

The paper concludes that Europe must focus on four types of interventions: primary prevention and health promotion; secondary prevention with proven screening programmes; more equitable access to optimal treatment and integration of all cancer care services; and sustained and consistent support for advanced independent research. All of those involved in the oncology field will hope that the EC listens to its experts and outlines a plan that will tackle these important issues.

Matthew Dennis - Editor, Cancer Drug News