Alcohol prompts rise in mouth and gullet cancers

1st December 2009 : The deaths from lung, stomach and bowel cancers have fallen steadily in Europe since the 90s, according to new figures. But alcohol related cancers, particularly among UK women, are on the rise while there are wide variations in death rates among the 27 individual member states.

Figures on deaths from cancer in the European Union published today on Annals of Oncology online at https://annonc.oxfordjournals.org show deaths from the disease fell 9% in men and 8% in women between 1990-94 and 2000-04.

The annual average death toll among men in the 27 member states fell from 185.2 deaths per 100,000 of the population in 1990-94 to 168 deaths per 100,000 in 2000-04. For women, the number of deaths fell from 104.8 to 96.9 per 100,000.

Dr Cristina Bosetti, who heads up the Unit of Cancer Epidemiology at the Mario Negri Institute, at the University of Milan, said the continuing downward trend was due mainly to the falls in lung and other tobacco related cancers in men, a persistent decline in gastric cancer, and appreciable falls in bowel cancer.

“Screening and early diagnosis have contributed to the decline in cervical [19% overall] and breast cancer [13% overall], although the fall in breast cancer mortality is mainly due to improved treatment,” she said.

“Therapeutic advancements have also played a role in the reduced mortality from testicular cancer, Hodgkin lymphoma and leukaemias, although the declines have been delayed and are smaller in eastern Europe,” she continued.

But where alcohol or tobacco consumption, or a combination of the two, has increased, particularly in women, deaths from lung, mouth, pharyngeal and oesophageal cancers have risen. Tobacco and alcohol account for more than 80% of cases.

“Countries like France and Italy, which had the highest alcohol consumption up to the early 1980s, but where alcohol drinking has substantially declined over the last few decades, showed favourable trends in oral cancer mortality since the mid/late 1980s, whereas male trends were less favourable in most countries from northern Europe, where alcohol drinking has increased,” write the authors.

A recent, sharp spike in mouth cancer has also emerged in central/eastern European countries, mainly Hungary and Slovakia.

Deaths from oesophageal cancer remained stable in women overall, but rose in middle-aged women. These deaths fell substantially in France, Italy and Spain but increased in most of northern, central, and eastern Europe, with particularly high rises in Denmark, Scotland and the Baltic countries.

In 2000-04, the highest death rates in men were in Scotland (10.9/100,000), England and Wales (8.5/100,000) and Hungary (8.2/100,000). In women the highest rates were in Scotland (4/100,000), England and Wales (3/100,000) and Ireland (2.8/100,000).

The lowest rates among men were in Greece, Bulgaria, Italy and Finland (less than 3/100,000); the lowest rates among women were in Belarus, Greece, and Ukraine (less than 0.4/100,000).

The figures also point to a twofold difference in both cancer incidence and deaths from the disease across Europe.

For men, the highest death rates in 2000-04 were in Hungary (255.2/100,000), the Czech Republic (215.9/100,000) and Poland (209.8/100,000).

The lowest rates were in Sweden (125.8/100,000), Finland (130.9/100,000) and Switzerland (136.9/100,000).

For women, the highest death rates were in Denmark (141/100,000), Hungary (131.5/100,000) and Scotland (123.1/100,000), and the lowest in Spain (78.9/100,000), Greece (79.7/100,000) and Portugal (80.9/100,000).

This reflects the different patterns of cigarette smoking among men and women across Europe in the past.

A greater focus on curbing drinking, overweight and obesity will help to drive down cancer deaths, say the authors.