Europe
Breast, prostate, lung, and colorectal cancers represent over half of all cancer diagnoses in Europe.
There were an estimated 3.9 million new cancer cases and 1.9 million cancer deaths in Europe in 2018. Cancers of the female breast (523,000 new cases, 13% of all cancer cases), colorectum (500,000, 13%), lung (470,000, 12%), and prostate (450,000, 12%) were the most common cancers on the continent, and combined they represented almost half of the overall cancer burden. (Figure 1)
Figure 1. Estimated number of new cancer cases vs. deaths and distribution (%) by type (excludes non-melanoma skin cancer) in Europe, both sexes, 2018. There were an estimated 3.9 million cancer cases. The leading cancer cases are breast (13%), colorectum (13%), lung (12%), prostate (12%), bladder (5%), melanoma of skin (4%), kidney (4%), and other cancers (38%). There were an estimated 1.9 million cancer deaths. The leading cancer deaths are lung (20%), colorectum (13%), breast (7%), pancreas (7%), prostate (6%), stomach (5%), liver (4%), and other cancers (39%).
For men, prostate cancer was the most commonly diagnosed cancer in almost all northern and western European countries, and lung cancer was the most commonly diagnosed in most Eastern European countries. For women, breast cancer is the most commonly diagnosed cancer in all European countries. (Map 1) These cancers were also the leading causes of cancer death in Europe: lung (388,000 deaths, 20%), colorectum (242,000, 13%), female breast (138,000, 7%), and pancreas (128,000, 7%).
Substantial variation in incidence and mortality rates are observed at the national level, where cancer incidence rates in males vary from 430 per 100,000 in Ireland to 239 in Montenegro. The lifetime risk of a cancer diagnosis ranges from 35% in Ireland—indicating that 1 in 3 persons in Ireland will be diagnosed with cancer over the course of their lifetime—to 25%, or 1 in 4 persons, in Montenegro. (Figure 2) Similarly, a twofold difference in rates is seen for mortality, with the highest and lowest mortality rates observed in Hungary and Sweden, respectively. The risk of dying from cancer in men varied from 22% in the Republic of Moldova to 10% in Iceland, and in women from 13% in Hungary to 7% in Spain.
Figure 2. Lifetime risk (%) of a cancer diagnosis in selected European countries, by sex. In Hungary, lifetime risk in males is 39% and lifetime risk in females is 30%. In Ireland, lifetime risk in males is 36% and lifetime risk in females is 28%. In Latvia, lifetime risk in males is 36% and lifetime risk in females is 26%. In Slovakia, lifetime risk in males is 35% and lifetime risk in females is 25%. In Czech Republic, lifetime risk in males is 34% and lifetime risk in females is 25%. In Belgium, lifetime risk in males is 34% and lifetime risk in females is 30%. In Lithuania, lifetime risk in males is 34% and lifetime risk in females is 24%. In Greece, lifetime risk in males is 32% and lifetime risk in females is 22%. In Spain, lifetime risk in males is 32% and lifetime risk in females is 21%. In Moldova, lifetime risk in males is 32% and lifetime risk in females is 22%. In Germany, lifetime risk in males is 31% and lifetime risk in females is 26%. In Sweden, lifetime risk in males is 30% and lifetime risk in females is 26%. In Italy, lifetime risk in males is 30% and lifetime risk in females is 25%. In Bulgaria, lifetime risk in males is 29% and lifetime risk in females is 21%. In Romania, lifetime risk in males is 28% and lifetime risk in females is 20%. In Ukraine, lifetime risk in males is 27% and lifetime risk in females is 20%. In Bosnia Herzegovina, lifetime risk in males is 27% and lifetime risk in females is 20%. In Iceland, lifetime risk in males is 26% and lifetime risk in females is 25%. In Montenegro, lifetime risk in males is 25% and lifetime risk in females is 21%. In Albania, lifetime risk in males is 20% and lifetime risk in females is 14%.
Incidence trends for all cancer sites combined have continued to rise in many countries, although at a slower pace in recent years. This slower increase partly results from a stabilization or decline in breast and prostate cancers, countered by an increase in colorectal cancer. (Figure 3) On the other hand, overall cancer death rates are steadily decreasing in Europe, mainly due to decreasing death rates from breast and prostate cancers as well as lung (male only, particularly in Northern and Western Europe). In Central and Eastern European men, lung cancer incidence and mortality rates are beginning to stabilize or decline. But in women across Europe, who for the most part acquired the smoking habit several decades after men, lung cancer rates are still rising, though there are early signs of stabilization in recent years in some countries, notably in the highest-risk countries of Northern Europe.
Figure 3. Trends in all cancer sites combined (excluding non-melanoma skin cancer) in Denmark and the United Kingdom, 1960–2014. (Incidence rates are for UK, England only.) All-sites cancer incidence rates have increased in both males and females in Denmark and the United Kingdom between 1960 and 2014. Mortality rates in both countries remained flat from 1960 to around 1990 before declining gradually.
The diverging health trends (including cancer) in Europe are a testimony to both the successes and failures of health policy in Europe.
Quote:
Successes and failures of health policy in Europe. Four decades of divergent trends and converging challenges (2013). Mackenbach and Mckee, eds. Open University Press, 2013.
Disproportionate cancer representation among Europeans:
Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today. Lyon, France: IARC. Available from: https://gco.iarc.fr/today.
Text:
Arnold M, Karim-Kos HE, Coebergh JW, et al. Recent trends in incidence of five common cancers in 26 European countries since 1988: Analysis of the European Cancer Observatory. Eur J Cancer. 2015;51(9): 1164–87.
Ferlay J, Colombet M, Soerjomataram I, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer. 2018 Nov;103:356–387.
Lortet-Tieulent J, Renteria E, Sharp L, et al. Convergence of decreasing male and increasing female incidence rates in major tobacco-related cancers in Europe in 1988–2010. Eur J Cancer. 2015; 51(9):1144–63.
Map and Figures 1–2:
Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today. Lyon, France: IARC. Available from: https://gco.iarc.fr/today.
Figure 3:
Rates have been smoothed using 5 years average.
Danckert B, Ferlay J, Engholm G , et al. NORDCAN: Cancer Incidence, Mortality, Prevalence and Survival in the Nordic Countries, Version 8.2 (26.03.2019). Association of the Nordic Cancer Registries. Danish Cancer Society. Available from http://www.ancr.nu.
Ferlay J, Colombet M and Bray F. Cancer Incidence in Five Continents, CI5plus: IARC CancerBase No. 9 [Internet]. Lyon, France: International Agency for Research on Cancer; 2018. Available from: http://ci5.iarc.fr.
World Health Organization Cancer Mortality Database, http://www-dep.iarc.fr/WHOdb/WHOdb.htm.