Potential for improvement in cancer management: reducing mortality in the European Union

Overall age-standardized cancer mortality rates in the European Union (EU) have declined by approximately 20% through 2010 (17% in women, 22% in men) since the peak value reached in 1988. This corresponds to the avoidance of more than 250,000 cancer deaths in 2010 alone and approximately 2.2 million deaths over the 1989-2010 22-year period. A more than twofold difference remains between the highest cancer mortality rates (in Hungary and other central European countries) and the lowest (in selected Nordic countries and Switzerland). Part of this gap is due to tobacco, alcohol, and other lifestyle and environmental exposures, and another part is attributable to differences in cancer diagnosis, treatment, and management. There are also appreciable differences in 5-year cancer survival across the EU, with lower survival rates in central and eastern Europe. If overall cancer survival in EU countries with low rates could be raised to the median, approximately 50,000 additional cancer deaths would be avoided per year, and more than 100,000 would be avoided if overall survival in all countries were at least that of the 75% percentile--4% and 8%, respectively, of the approximately 1.3 million cancer deaths registered in the EU in 2010. There is, however, substantial uncertainty about any such estimate because differences in cancer survival are partly or largely attributable to earlier diagnosis, in variable proportion for each cancer site and probably to different degrees in different countries, even in the absence of changes in the date of death or avoidance of death. Consequently, these approximations are the best available and may be used cautiously to compare countries, health care approaches, and changes that occur over time.