Routine screening is only recommended for certain types of cancer, including cervical, breast and colorectal cancer. With mortality figures still unacceptably high, a number of challenges need to be overcome to ensure progress.
1. Cancer is a major public health challenge in Europe
Cancer represents a genuine public health issue. Europe alone accounts for a quarter of cancer cases worldwide, despite representing only 9% of the global population. The incidence and mortality of 25 major cancers were estimated for the European Union (EU) in 2018. Knowing these figures is important to help us better tailor cancer prevention measures. The estimates were made from databases containing the incidence and mortality rates for each individual EU country. In 2018, there were around 3.91 million new cancer cases and 1.93 million cancer-related deaths in Europe.
The most common cancers identified were breast cancer in women (523,000 cases), colorectal cancers (500,000 cases), and lung and prostate cancers (470,000 and 450,000 cases, respectively). These four cancers alone represent half of the overall cancer burden in Europe. The most common causes of death from cancer in 2018 were, in increasing order, lung cancer (388,000 deaths), followed by colorectal cancer (243,000 deaths), then breast and pancreatic cancers (138,000 and 128,000 deaths, respectively). Within the EU, the estimated number of new cases of cancer was approximately 1.6 million in males and 1.4 million in females, with 790,000 men and 620,000 women dying from the disease in 2018.1
2. Detecting cancer early is of crucial importance
The cancer figures in Europe are alarming and should encourage us to step up prevention efforts.
Cancer prevention consists of screening, along with educational measures to help people recognize the symptoms and therefore encourage diagnosis at as early a stage as possible.
Although screening is acknowledged to be an important component of cancer prevention policy, it is only recommended for three forms of cancer: cervical, breast and colorectal cancer.
Despite a rapid increase in the incidence and mortality rates of cancers, there are significant differences in the preventive impact of cancer screening policies.
There are numerous challenges to be overcome in the field of cancer prevention. In particular, the presence or otherwise of sufficient evidence to be able to recommend screening, the existence or otherwise of obstacles to the implementation of established screening policies, as well as the reinforcement of research to discover new biomarkers for screening. Even when the evidence is there, screening policies are not always implemented. For example, the World Health Organization recommends screening for cervical, breast and colorectal cancers, yet differences are still seen in the way this screening is implemented in Europe according to the European Commission. There are multiple barriers impeding screening, including a lack of community support, a lack of financial resources and difficulty reaching target populations to offer them screening.
Research to find new biomarkers is a key strategy in cancer prevention. Cervical cancer is a prime example. The HPV test, which detects the nucleic acids of high-risk HPV genotypes, could protect women against cervical cancer for 6 years, whereas cytology only protects for 3 years.2
Additional studies are necessary to, firstly, improve cancer screening practices, and, secondly, develop research into new biomarkers.
- Ferlay J, Colombet M, Soerjomataram I, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer. 2018;103:356-387. doi:10.1016/j.ejca.2018.07.005
- Dillner J. Early detection and prevention. Mol Oncol. 2019;13(3):591‐598. doi:10.1002/1878-0261.12459