[Fight against cancer in the Netherlands: current state of affairs]

To give insight into the fight against cancer in the Netherlands.

Nationwide observational cohort study.

Data from the Netherlands Cancer Registry on standardized incidence rates and relative survival were analysed. Mortality data was obtained from Statistics Netherlands.

Between 1989 and 2017 the number of newly-diagnosed cancers doubled to 111,582. The standardized incidence (ESR) increased from 377 per 100,000 inhabitants in 1989 to 481 in 2011, and stabilized thereafter (459 in 2017). In 2018 the five most common types of cancer were skin cancer (excl. basal cell carcinoma, n = 21,000), breast cancer (n = 15,000), colorectal cancer (n = 14,000), lung cancer (n = 13,000) and prostate cancer (n = 13,000). The incidence of skin cancer rose the fastest (melanoma from 11 to 32 per 100,000; squamous cell carcinoma from 14 to 49 per 100,000). The largest shift to local disease (T1-T2 according to the TNM) was seen in breast cancer (from 50% to 75%). The 5-year survival improved from 50% in patients diagnosed with cancer in 1991-1996 to 65% in 2011-2016. Of the most common cancer types, survival of acute myeloid leukaemia increased the most (from 10% to 25%). The absolute number of deaths increased (from 35,000 in 1989 to 45,000 in 2017), but after standardization this decreased from 234 to 169.

The incidence of cancer in absolute numbers is still increasing due to the ageing population. However, taking population demographics into account, the standardized incidence has not increased since 2011. This is related to the decrease in smoking-related cancers, amongst other things. The increase in survival is related to early detection and improved treatment. The decrease in mortality is mainly related to the decrease in lung cancer mortality in men.