Fall in European Colorectal Cancer Deaths a 'Major Success'

Liam Davenport

March 19, 2018

Mortality rates among patients with cancer from across the European Union (EU) have decreased since 2012, with colorectal cancer a particular success story, although the picture remains mixed for other major cancer types, say Swiss and Italian researchers.

The research, published online in Annals of Oncology on March 19, is the eighth annual report on current-year estimates of cancer mortality.

The calculated age-standardized death rates for 2018 show that despite the aging population, overall mortality rates for the most common forms of cancer have fallen 10% in men and 5% in women since 2012.

The report also notes that for colorectal cancer, death rates have fallen by over 6% in men and more than 7% in women since 2012.

Author Carlo La Vecchia, MD, professor on the faculty of medicine at the University of Milan, Italy, said in a release that although the disease remains the most common cause of cancer death in nonsmokers, the fall in mortality predicted for 2018 is "one of the major success stories in clinical oncology."

"This improvement in death rates in Europe comes in the absence of a single major breakthrough and is due to improved diagnosis and management of the disease," he said.

However, coauthor Fabio Levi, MD, emeritus professor on the Faculty of Biology and Medicine, University of Lausanne, Switzerland, pointed out that the outlook for mortality rates in 2018 among women with cancer is mixed.

"The overall pattern is characterized by continuous improvement in breast cancer due to better management and screening, and in ovarian cancer due to the use of oral contraceptives and better treatment, but an increase in the tobacco-related lung cancer epidemic."

Fabrice André, professor in the Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France, and editor-in-chief of Annals of Oncology, also pointed out that the improvements in cancer survival do not mask the huge overall loss of life to the disease across Europe.

"While this study suggests that improving cancer detection and quality of care translates into better outcome," he said, "it also reminds everyone that 1.4 million patients in Europe will die because of cancer in 2018 and that research efforts need to be amplified."

Study Details

To estimate cancer mortality in 2018, the team obtained official death certificate data from the World Health Organization (WHO) databases for all cancers combined and for the most common cancer sites (stomach, intestines, pancreas, lung, breast, uterus [including cervix], ovary, prostate, and bladder), as well as leukemias.

They also gathered resident population estimates from the WHO and Eurostat databases for the EU as a whole for the period 1970 to 2012, along with the most recent data for the six most populous EU countries: France, Germany, Italy, Poland, Spain, and the United Kingdom.

It was estimated that, overall, the number of people dying of cancer in 2018 will reach 765,000 in men and 617,000 in women, or a total of 1,382,000 deaths. This compares to 1,333,362 cancer deaths in 2012, representing an increase of 3.6%.

However, taking into account population changes, the team determined that the age-standardized death rate in 2018 will be 130 per 100,000 men and 84 per 100,000 women, representing a decrease compared with 2012 of 10.3% and 5.0%, respectively.

Compared with the 1980s, the period with the highest age-standardized death rates, the authors estimated that on an annual basis, approximately 392,300 cancer deaths will be avoided in 2018, yielding a total of 3.3 million deaths in men and 1.6 million deaths in women avoided in the years since 1988.

Focus on Colorectal Cancer

The researchers focused in particular on colorectal cancer because evidence suggests that the incidence of and mortality from the disease are increasing outside the EU in people younger than age 50 years, which is contrary to the trends seen in older individuals.

The team found that in 2018, colorectal cancer will account for the second highest number of cancer deaths, at 98,000 deaths in men and 79,400 in women.

While the total number of colorectal deaths has risen since 2012 because of the aging population, the age-standardized death rate has fallen in comparison with 2012, by 6.7% in men and 7.5% in women, to 15.8 per 100,000 and 9.2 per 100,000, respectively.

"In the EU, deaths from colorectal cancer have been declining since 1993 in men, and over the whole period since 1970 in women," said La Vecchia, pointing out that factors associated with colorectal cancer include tobacco, alcohol, obesity, diabetes, a sedentary lifestyle, and an unhealthy diet.

"However, in women, the use of oral contraceptives and hormone replacement therapy may partly explain their decreased risk. In both men and women, the use of aspirin, mainly taken to prevent heart attacks and strokes, and effective screening are likely to have contributed to a decrease in the incidence of the disease," he added.

In addition, the "availability of colonoscopy for investigating bleeding and other early symptoms has improved early diagnosis across Europe," he said.

Biggest Toll Is Still Lung Cancer

The largest toll in terms of cancer deaths continues to come from lung cancer.

In 2018 across the EU, approximately 183,100 deaths in men and 94,500 deaths in women are predicted to be from lung cancer, with age-standardized death rates of 32.4 per 100,000 and 14.7 per 100,000, respectively.

This represents a 13.0% fall in rates of death from lung cancer among men since 2012; for women, however, mortality rates have increased over the same period, by 5.8%.

Breast cancer is predicted to have the second highest death rate among women in 2018, at 92,700 deaths or an age-standardized death rate of 13.7 per 100,000, representing a 9.5% decrease since 2012.

Among men, prostate cancer is the third biggest killer, at an age-standardized death rate of 10.1 per 100,000. However, death rates have, again, decreased since 2012, by 8.5%.

Mortality rates for pancreatic cancer have stabilized since 2012 in men, at an estimated age-standardized death rate in 2018 of 7.9 per 100,000. However, the age-standardized death rate among women increased by 2.8% over the same period, to 5.6 per 100,000.

La Vecchia commented: "In 2018, deaths from pancreatic cancer will be close to 90,000. This is close to the figure for breast cancer, where there will be 92,000 deaths, and lower only to lung and colorectal cancers for both sexes."

Discussing the findings, the team points out that caution is required in interpreting the predictions.

They note that there are likely to be minor inconsistencies with previous reports due to changes in how the mortality data were aggregated, and that the 6-year projection period is "relatively large" and therefore "at the limit" of reliability.

This work was conducted with the contribution of the Italian Association for Cancer Research, Ministero dell' Istruzione, dell'Universit à e della Ricerca, with an Scientific Independence of Young Researchers 2014 grant. The authors have disclosed no relevant financial relationships.

Ann Oncol. Published online March 19, 2018.   Full text

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