Tuesday, July 29, 2003

Cancer death rates falling in Europe

That's the headline being given to a report in Annals of Oncology. In fact, deaths from cancer are actually rising. But because death from cancer is associated with age, the age-adjusted cancer rates are falling - not surprising given that treatment for cancer continues to improve, smoking is decling overall (but going up among women), and people lead relatively easier, wealthier lives.

The report is, however, a piece of self-justification. 'Cancer deaths in the EU were expected to rise from 850 194 in 1985 to 1 033 083 in 2000. It is estimated that there will be 940 510 cancer deaths that year, due to the decline in risk observed since 1985. The Europe Against Cancer programme appears to have been associated with the avoidance of 92 573 cancer deaths in the year 2000. With few exceptions, most countries are experiencing declining trends in cancer death rates, which seem set to continue, at least in the near future. Renewed tobacco control efforts are clearly needed for women, and there is a strong case for the introduction of organized breast and cervix screening programmes in all member states. Continuing to emphasize prevention within cancer control will help to promote the continuing decline in death rates in the future.'

It is hard to see here any evidence that Europe Against Cancer, a inter-governmental initiative started in 1985, has necessarily had any effect at all. Certainly, it is rather cheeky to ascribe the entire fall in expected deaths to this initiative. Would smoking rates have remained the same without public health warnings? It may well be that their decline has as much to do with changing fashions as anything else. Breast and cervical cancer screening have been criticised elsewhere as a pointless and frequently distressing waste of money.

Measuring progress against cancer in Europe: has the 15% decline targeted for 2000 come about?, Annals of Oncology, May 2003


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