Avoidable cancer in Europe: a study of 11 major cancers amenable to lifestyle change

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Avoidable cancer in Europe a study of 11 major
cancers amenable to lifestyle change

• Isabelle Soerjomataram
• Esther de Vries
• Eero Pukkala
• Jan Willem Coebergh (coordinator)

Amsterdam, October 20 2006
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International variation in cancer

• Cross country incidence of cancer is diverging
• varies by 10-fold
• International variation is caused by differences
  in external (rather than genetic) factors
• Doll and Peto 81 80 of cancer incidence
  might be avoidable

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Aim

• To estimate the potential in avoidable cancer in
  Europe
• assuming that the lowest rate is feasible
  throughout Europe

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Following approach

• Incidence rates 2002 GLOBOCAN 2002
• Gender 4 age groups (15-44, 45-54, 55-64, 65)
• 28 European countries
• Lowest aggregated rate (of 3 countries) in 2002
• Difference is assumed avoidable

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Selected Cancers(? 60 of total number of
incident)

• Oral cavity
• Larynx
• Lung
• Oesophagus
• Stomach
• Pancreas

• Colon rectum
• Bladder
• Kidney
• Breast
• Endometrium

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Methods

• Proportion of avoidable cancer (P)
• Numbers of avoidable cancer (A)

I Incidence rate in the country of
interest I ref, Lowest incidence rate
(aggregated rate of 3 countries) N
Population in the country of interest .
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Results of this exercise

• Males
• Females
• Soon published in Int J cancer

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Avoidable (9) cancers in European men
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Avoidable (11) cancers in European females
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An example on application
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Lung cancer smoking male
1st
2nd
3rd
4th
20 years latency time
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Lung cancer smoking female
1st
2nd 3rd
4th
20 years latency time
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Conclusions I

• About 50 of cancers in Europe in 2002 was
  potentially avoidable
• - Males 363,000 cases (59)
• - Females 326,000 cases (45)
• The largest reduction in cancer
• - Preventing lung, breast and colorectal
  cancer.
• Prevention in the past should have been !
• - higher in Central Eastern Europe
• - and in some countries in the West

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Conclusions II

• Priorities for future also to be determined by
  expected incidence up till 2020 and beyond
• Work in progress
• Registry data are indispensable

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Limitations

• Overestimation of effects of prevention
• But also underestimation

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Limitations

• Overestimation.
• - Not all causes of cancers are known ?
  eliminating known causes will reduce cancer by
  25-35
• - Screening activities (breast, prostate)
  may increase cancer incidence
• ? artificial cross country differences in rates

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Limitations

• Underestimation!
• - Reference used was the lowest incidence
  rate in Europe
• not necessarily based on lowest (optimal)
  exposure

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Future of Eurocadet

• Include data on
• - Changes of exposure, in the past and the
  future
• - Prediction of future cancer incidence, with
  and without prevention
• Eurocadet aims to estimate the potential effects
  of successful prevention on future incidence
  across Europe
• Prevent model made available to everybody
• End in 2009 with regional workshops in
• London, Copenhagen, Heidelberg, Barcelona, Warsaw

? www.eurocadet.org
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www.eurocadet.org