Primary prevention: a need for concerted action

Abstract

The burden of cancer is increasing worldwide, and Europe is no exception in this regard. Cancer incidence rate for men in 2018, excluding nonmelanoma skin cancers, averaged over the 40 UN-defined European countries has been estimated as 436/100 000. For women, the estimated incidence rate is 332.6/100 000. Although mortality rates are declining in most European countries, the total number of cancer deaths continues to rise due to an increase in the number of older people in the age range when the cancer typically occurs. The increase in incident cases and cancer deaths increases the pressure on healthcare infrastructure and related costs, thus presenting a challenge to health service sustainability in countries. In the general population, there remains a perception of an ever-increasing cancer risk. Hence, treatment alone is not a solution to address the cancer burden. At the same time, recent estimates of preventable fractions of cancer suggest that about half of all cancer cases could be prevented through rigorous implementation of successful prevention measures, among other actions, by following the cancer prevention recommendations of the European Code against Cancer. Smoking alone explains almost half of all preventable cancers, and the scattered way of implementing tobacco control in Europe with still increasing numbers of lung cancers in women demonstrates the gap between prevention potential and effectively implemented prevention. Cancer prevention clearly needs more resources, stronger support from decision-makers and society, and a solid network to better speak with one voice. The newly established 'Cancer Prevention Europe' (Forman et al., ) offers promising opportunities for the latter.

Keywords: Europe; cancer burden; cancer prevention; risk factors; tobacco control.

Figure 1

Estimated cancer incidence rates in European men (2018), age‐adjusted to European Standard Population (portion of prostate cancer shown in lighter colour).

Figure 2

Estimated cancer incidence rates in European women (2018), age‐adjusted to European Standard Population (portion of breast cancer shown in lighter colour).

Figure 3

Time trends in cancer mortality between 1994 and 2014 in selected European countries; (A) Cancer mortality rate, both sexes combined, in 1994, 2004 and 2014, age‐adjusted to World Standard Population; (B) Per cent change in total number of cancer deaths for 1994 to 2004 and for 1994 to 2014; (C) Per cent change in cancer mortality rates for 1994 to 2004 and for 1994 to 2014, age‐adjusted to World Standard Population; (B and C) Both sexes combined.

Figure 4

European Code against Cancer, 4th edition, 2014.

Figure 5

Attributable fractions of known causes of cancer, estimated for France ( http://gco.iarc.fr/resources/paf-france_en.php).

Figure 6

Time trends in incidence rates of lung cancer in Denmark and in Sweden, by sex, age‐adjusted to the World Standard Population, from 1965 to 2015 (produced with NORDCAN at http://www-dep.iarc.fr/;NORDCAN/english/frame.asp).