The changing epidemiology of lung cancer in Europe

doi:10.1016/S0169-5002(03)00230-7

Lung Cancer

Volume 41, Issue 3, September 2003, Pages 245-258

https://doi.org/10.1016/S0169-5002(03)00230-7 Get rights and content

Abstract

Background: Since the incidence and mortality of the histological subtypes of lung cancer in Europe has changed dramatically during the 20th century, we described the variation and changes in incidence, treatment modalities and survival of lung cancer. Methods: For geographical variation and changes in incidence, data of the European cancer incidence and mortality (EUROCIM) database were used, and data on survival were derived from the EUROCARE database. For trends in treatment modalities and survival, according to histology and stage, data of the Eindhoven Cancer registry were used. Results: Although the incidence of lung cancer among men in Denmark, Finland, Germany (Saarland), Italy (Varese), the Netherlands, Switzerland and the United Kingdom has been decreasing since the 1980s, the age-adjusted rate for men in other European countries increased at least until the 1990s. Among women the peak in incidence had not been reached in the 1990s. The proportion of adenocarcinoma has been increasing over time; the most likely explanation is the shift to low-tar filter cigarettes. In the 1990s more patients with localised non-small cell lung cancer received surgery than in the 1970s. Among patients with non-localised non-small cell lung cancer and among those with small cell lung cancer there was a trend towards more chemotherapy. There was fairly large variation in survival within Europe. Despite improvement in both the diagnosis and treatment, the overall prognosis for patients with non-small-cell lung cancer hardly improved over time. In contrast, the introduction and improvement of chemotherapy since the 1970s gave rise to an improvement in survival for patients with small-cell lung cancer. Conclusion: The epidemic of lung cancer is not over yet, especially in southern and eastern Europe. Prevention remains the best policy, but improvement in the management of lung cancer also remains very important.

Introduction

In the 20th century the incidence and mortality of lung cancer has increased so dramatically in most European countries that it can be considered one of the major epidemics of the former century. Nowadays lung cancer is still death cause number one among cancer [1], [2]. This paper focuses on the incidence of lung cancer, treatment strategies and survival. With respect to incidence, the geographical variation and the time trends, according to histology are described. Changes in treatment are described, according to histology, age and stage of disease. With respect to survival, the geographical variation and time trends are described, also according to histology, age and stage of disease. For explanation of the trends, determinants as exposure to risk factors, changes in diagnostic techniques and new treatment modalities are taken into account.

Section snippets

Patient data

For calculating trends in age-standardised incidence rates in European cancer registries between 1978 and 1997 we used data of the European cancer incidence and mortality (EUROCIM) database. Only registries with data since 1978 were included. Age-adjustment was performed by direct standardisation according to the European Standard Population (ESR: European Standardised Rate) [1].

For calculating variation in survival within Europe data of the EUROCARE database (a concerted action among European

Trends in incidence

The incidence of lung cancer has changed dramatically since the 1970s (Table 2). The age-standardised rate for men in Denmark, Finland, Germany (Saarland), Italy (Varese), the Netherlands, Switzerland and the United Kingdom increased up to the early 1980s and then started to decline. In most southern and eastern European countries the incidence of lung cancer among men increased up to the late 1980s or even up to the late 1990s. In Iceland, Norway and Sweden the incidence among men was

Trends in incidence

The incidence of lung cancer among men has been increasing since the beginning of the 20th century. The incidence of lung cancer among men in Denmark, Finland, Germany (Saarland), Italy (Varese), the Netherlands, Switzerland and the United Kingdom has been increasing dramatically until the early 1980s, whereafter it has been decreasing. The incidence of lung cancer among men in other European countries increased at least until the 1990s. Among women the peak in the incidence of lung cancer had

Future directions

PET scan is a new technology to investigate nodal, as well as distant dissemination, and can be used for staging and follow-up. In this way, mediastinoscopy and unnecessary surgery can be avoided. In a Dutch study about 20% of surgery could be avoided by using the PET scan [83].

Despite the fact that combined chemo-radiotherapy is promising, the exact dose, volume and timing are not yet known. Therefore, studies are needed to address this issue.

Although therapy for lung cancer has made progress

Conclusions

Since the incidence of lung cancer is still very high and is increasing among women and also among men in many countries, and prognosis is still very poor, lung cancer is still death cause number 1 among cancer deaths. Therefore, prevention is important. Although the proportion of smokers has been decreasing in many western countries, the increased proportion of teenage smokers is alarming. The results of an American study suggest that increases in teenage smoking prevalence will lead to

Acknowledgements

We thank the cancer registries of Denmark, UK, Estonia, Finland, France (Bas Rhin, Calvados, Doubs), Germany (Saarland), Iceland, Italy, the Netherlands, Norway, Poland (Cracow, Warsaw), Scotland, Slovenia, Spain, Sweden, Switzerland (Basel and Geneva) and Wales for data collection.

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REVIEWThe changing epidemiology of lung cancer in Europe

Abstract

Introduction

Section snippets

Patient data

Trends in incidence

Trends in incidence

Future directions

Conclusions

Acknowledgements

Lancet Oncol.

Eur. J. Cancer

Eur. J. Cancer

Lung Cancer

Ann. Thorac. Surg.

Radiother. Oncol.

Lancet

Eur. J. Cancer

Mayo Clin. Proc.

Eur. J. Cancer

Int. J. Radiat. Oncol. Biol. Phys.

Eur. J. Cancer

Lung Cancer

J. Thorac. Cardiovasc. Surg.

Int. J. Radiat. Oncol. Biol. Phys.

J. Thorac. Cardiovasc. Surg.

Int. J. Radiat. Oncol. Biol. Phys.

Int. J. Radiat. Oncol. Biol. Phys.

Eur. J. Cancer

Eur. J. Cancer

Ann. Oncol.

Chest

Annual report to the nation on the status of cancer, 1973–1996, with a special section on lung cancer and tobacco smoking

J. Natl. Cancer Inst.

Survival of cancer patients in Europe: the EUROCARE study

Lung cancer and cigarette smoking in Europe: an update of risk estimates and an assessment of inter-country heterogeneity

Int. J. Cancer

Cigarette smoking and lung cancer cell types

Cancer

Trends in smoking in Europe

Eur. J. Cancer Prev.

The changing epidemiology of smoking and lung cancer histology

Environ. Health Perspect.

Risk of squamous cell carcinoma and adenocarcinoma of the lung in relation to lifetime filter cigarette smoking

Cancer

Epidemiology of tobacco use and dependence

Epidemiol. Rev.

The decline of smoking among Swedish men

Int. J. Epidemiol.

Changes in lung-cancer mortality trends in Spain

Int. J. Cancer

Lung cancer in Estonia in 1968–1987: time trends and public health implications

Eur. J. Cancer Prev.

Recent trends and future directions for lung cancer mortality in Europe

Br. J. Cancer

Time trend and the age-period-cohort effect on the incidence of histologic types of lung cancer in Connecticut, 1960–1989

Cancer

United States lung carcinoma incidence trends: declining for most histologic types among males, increasing among females

Cancer

Lung carcinoma trends by histologic type in Vaud and Neuchatel, Switzerland, 1974–1994

Cancer

REVIEW
The changing epidemiology of lung cancer in Europe