Death rates from lung cancer will fall overall in the EU and UK in 2023, but rise among women in France, Italy and Spain

A total of 1,261,990 people will die from cancer in 2023 in the EU (EU-27). A further 172,314 people will die from the disease in the UK, according to new research published in the leading cancer journal Annals of Oncology [1].

Researchers led by Carlo La Vecchia (MD), a professor at the University of Milan (Italy), estimate there will be a 6.5% fall in cancer death rates in men and a 3.7% fall in women between 2018 and 2023.

They predict that death rates from the ten most common cancers will continue to fall in most European countries in 2023, although the numbers of people dying will go up due to aging populations. A greater proportion of elderly people in the population means there is a greater number at the age where they are more likely to develop and die from cancer.

Compared to a peak in cancer death rates in 1988, the researchers calculate that nearly 5.9 million deaths will have been avoided in the 35 years between 1989 and 2023 in the EU-27. In the UK, 1.24 million deaths will have been avoided.

Prof. La Vecchia said: “If the current trajectory of declining cancer death rates continues, then it is possible there could be a further 35% reduction by 2035. More smokers quitting contribute to these favourable trends. In addition, greater efforts need to be made to control the growing epidemic in overweight, obesity and diabetes, alcohol consumption and infections, together with improvements in screening, early diagnosis and treatments.

“The advances in tobacco control are reflected in the favourable lung cancer trends but more could be done in this respect, particularly among women, as lung cancer death rates continue to rise among them. No deaths from lung cancer have been avoided in women, both in the EU-27 and the UK, during the period between 1989 and 2023.

“Pancreatic cancer is also a cause for concern, as death rates from this disease will not fall among men and will rise by 3.4% in women in the EU, although they will fall by 3.2% in women in the UK. Smoking can explain between about a quarter to a third of these deaths, and women, particularly in the middle and older age groups, did not give up smoking as early as men.”

The researchers analysed cancer death rates in the EU 27 Member States [2] as a whole and separately in the UK. They also looked at the five most populous EU countries (France, Germany, Italy, Poland and Spain) and, individually, for stomach, intestines, pancreas, lung, breast, uterus (including cervix), ovary, prostate, bladder and leukaemias for men and women [3]. Prof La Vecchia and his colleagues collected data on deaths from the World Health Organization and Eurostat databases from 1970 to 2018 for most of the EU-27 and the UK. This is the thirteenth consecutive year the researchers have published these predictions.

In the EU-27 countries the researchers predict that will be an age standardised rate (ASR) [4] of 123.8 deaths per 100,000 men by the end of 2023. In women, the age standardised death rate will be 79.3 per 100,000. In the UK, the death rates will be 106.5 and 83.5 per 100,000 for men and women, respectively.

Cancer death rates will fall for all cancers in men in the EU-27 and the UK. They will also fall for women in the UK. Among EU women, death rates will rise by 3.4% to nearly six per 100,000 for pancreatic cancer, and to just over 1% to 13.6 per 100,00 for lung cancer. Although there will be a 13.8% drop in lung cancer death rates among women in the UK, the death rate of 16.2 per 100,000 is still higher than among EU women because more UK women started smoking earlier than those in the EU. Lung cancer now kills more women in the UK than breast cancer, which has a death rate of 13.5 per 100,000.

When the researchers looked specifically at lung cancer death rates in five EU countries as well as the UK, they found that, although death rates are predicted to fall in men for all six countries, for women they will rise by nearly 14% in France, 5.6% in Italy and 5% in Spain. Among women in different age groups, the researchers found a decrease in predicted death rates from lung cancer among those aged 25 to 64, but an increase in those aged 65 to over 75 years, and consequently an increase overall.

“This is because women now aged 45 to 65, born in the 1960s and 1970s, have smoked less and stopped earlier than those born in the 1950s, who were in their twenties in the 1970s when smoking among young women was most prevalent,” said Prof. Eva Negri from the University of Bologna (Italy), co-leader of the research.

Colorectal (bowel) cancer will be the third biggest killer for women in both the EU and the UK: eight and ten per 100,000, respectively. Prostate cancer will be the third biggest killer for men: 9.5 and 11.2 per 100,000 in the EU and UK, respectively.

The researchers say that organised screening programmes using low dose computed tomography (CT scans) could reduce deaths from lung cancer by up to 20%. However, there are no such organised programmes in Europe, and it is too early to evaluate the impact of screening in the UK, following the Lung Cancer Screening trial.

The researchers highlight the role that overweight and obesity plays in cancers such as post-menopausal breast, endometrial (womb) cancer, stomach and colorectal cancer. Although death rates from stomach cancer are falling overall, mainly because of improved methods of food preservation, healthier diets and a decline in Helicobacter pylori infection, approximately a third of stomach cancers now occur in the cardia, the entrance to the stomach, and are associated with overweight and obesity and, hence, reflux, which is a risk factor for the development of cancer at this site. For colorectal cancer, death rates are falling in the EU but the decline has slowed in the UK.

“This is concerning as increases in both incidence and mortality from colorectal cancer in young women have been recorded in the UK. This can be partly explained by the prevalence of overweight and obesity, and alcohol and tobacco consumption,” said Prof. Negri.

The researchers caution that their estimates do not take account of the COVID pandemic, which occurred after the dates when data were available on cancer deaths. “The COVID-19 pandemic may have an effect on cancer mortality in 2023 as a result of delayed visits and procedures, influencing both secondary prevention and treatment, and disease management for cancer,” they write.

(ends)

Notes:

[1] “European cancer mortality predictions for the year 2023 with focus on lung cancer”, by M. Malvezzi et al. Annals of Oncology, doi: 10.1016/j.annonc.2023.01.010

[2] At the time of this analysis, the EU had 27 member states, with the UK leaving in 2020. Cyprus was excluded from the analysis due to excessive missing data.

[3] The paper contains individual tables of cancer death rates for each of the six countries.

[4] Age-standardised rates per 100,000 of the population reflect the annual probability of dying adjusted to reflect the age distribution of a population.

The project was supported by the Associazione Italiana per la Ricerca sul Cancro (AIRC, Italian Foundation for Cancer Research).