A European effort to monitor the impact of cancer in Europe
The EUROCARE project involves 45 European cancer registries in 17 countries. The aim is to estimate and compare survival of cancer patients in European populations and to identify the reasons for geographical differences and time trends. It is funded by the Biomed programme of the European Union
Improved survival since 1985
This study is published today by the International Agency for Research on Cancer and analyses the most recent available data concerning patients diagnosed between 1985 and 1989 in 17 European countries and followed up until 1994. Compared with the results for patients diagnosed between 1978 and 1985, the five-year survival rate increased from 40 to 50% for colorectal cancer, from 69 to 77% for melanoma, from 68 to 75% for breast cancer, from 80 to 92% for testicular cancer, from 64 to 72% for Hodgkin's disease, and from 44 to 54% for non-Hodgkin's lymphomas. Cancer, however, still includes highly lethal diseases: survival is still uniformly low across Europe for several common cancer sites, such as lung, pancreas and oesophagus, for which five-year survival is less than 10%. For these, practically no significant improvement in survival was seen.
Almost half of all cancer patients are still alive five years after diagnosis
Overall in Europe, 43% of patients diagnosed in the late 80's with any cancer (excluding non-melanoma skin cancer) survived at least five years after diagnosis (35% for male patients and 50% for females). For most cancers, however, five-year survival does not mean cure: even 10 years after diagnosis, there is still some excess mortality due to cancer. One may speculate, nevertheless, that today more than one third of European patients are cured of their cancer.
In general, survival is markedly lower in eastern European countries than in western Europe. One of the major results of EUROCARE, however, is that in western Europe, too, there is still room for improvement. For many cancer sites, especially those for which early diagnosis is a major determinant of favourable prognosis, survival was higher in northern countries (Finland, Iceland, Sweden), intermediate in continental Europe (Austria, France, Germany, Italy, The Netherlands, Spain and Switzerland), and lower in Denmark and the UK. The highest survival rates were usually recorded in Iceland, Sweden (South Sweden cancer registry), Switzerland (Geneva and Basel cancer registries) or The Netherlands (Eindhoven cancer registry). The survival of patients with melanoma was higher in Nordic countries and the UK than in southern European countries.
With a few exceptions, survival increased in all these countries but this pattern of differences persisted. By 1989, the survival differences between continental and northern European countries were diminishing for colorectal and breast cancer, melanoma of the skin and Hodgkin's disease.
Survival for Hodgkin's disease and testicular cancer, that respond to medical treatment, was rather similar across western European countries.
Better survival correlates with socio-economic conditions
Comparison of the geographical variation with demographic, sociological and health economic indicators shows that in general, cancer patients' survival is higher where overall life-expectancy is higher. Significant factors associated with a favorable prognosis include: proportion of Gross National Product spent on health, level of employment, number of hospital beds and number of CT scanners per million population. Within Western Europe, such factors appear to be responsible for over 70% of the intercountry variability of survival for prostate cancer, 65% for breast, 60% for rectum and 50% for stomach cancer. A sizable fraction of within-country differences is also likely to be due to socio-economic differences, as has been shown for the UK.
Age and sex major determinants for survival
Other major determinants of survival include age (survival is inversely related to age at diagnosis for practically all tumours in all countries) and sex: for most tumours women survive longer than men, and this difference is more marked in younger age groups.
The reasons for survival differences between countries, between socio-demographic groups and over time, however, are complex. Improved survival may be due to greater awareness in the population, earlier diagnosis, or more effective treatment. In its next phase, the EUROCARE project is focusing on determining the extent to which differences and improvements in survival are the result of better treatment, and to what extent the improved effectiveness of treatment is due to earlier diagnosis. This will help health authorities to make informed decisions regarding the most effective investment of resources.
Survival of Cancer Patients in Europe : The EUROCARE-2 Study, Eds : F. Berrino, R. Capocaccia, J. Estève, G. Gatta, T. Hakulinen, A. Micheli, M. Sant and A. Verdecchia, IARC Scientific Publications No.151, 1999 ; 550 pages. ISBN 92 832 2151 6, US$ 68. To order, contact IARCPress, address below, or E-mail at