Cancer

Up to a quarter of Europeans will develop cancer

Each year, 4.6 million new cancer cases are diagnosed in the WHO European Region and 2.1 million people die from cancer. Twenty percent of these deaths are from lung cancer, followed by colorectal (12%), breast (7%), pancreatic (6%) and stomach cancer (5.7%).

“We are all touched by cancer, either directly or through the experiences of friends and family. Across the WHO European Region, we can do much more to prevent cancer and provide care,” says Dr Hans Kluge, WHO Regional Director for Europe.

“We know, for example, that cervical cancer kills 28 000 women in the region annually. Today’s Global Cancer Report shows that our region lags behind some others in cervical cancer screening – the most effective cancer screening programme we currently have. With screening and the provision of human papillomavirus (HPV) vaccine, most of these deaths are preventable. I am firmly committed to people-centred cancer prevention and care across the WHO European Region on this World Cancer Day, and every day,” Dr Kluge adds.

Across the Region, an individual’s risk of developing cancer over their lifetime differs: in western European countries this risk is above 25%, in eastern European countries it ranges from 19% to 25%, and in central Asian countries the risk is between 10% and 19%.

Conversely, the risk of dying from cancer is above 12% in eastern European and central Asian countries, and lower – between 9% and 12% – in western European countries. Two factors are behind higher death rates: late diagnosis and suboptimal treatment. Both considerably decrease a person’s chance of cure or long-term survival.

To address this, WHO/Europe is providing support and guidance to countries in collaboration with the WHO International Agency for Research on Cancer (IARC), the International Atomic Energy Agency (IAEA) and other partners.

Prevention

Tobacco and alcohol use are the most important modifiable risk factors for cancer in the WHO European Region. Up to 85% of lung cancer-related deaths and 15% of stomach cancer-related deaths are attributable to tobacco. The risk of lung, colorectal, stomach, breast and pancreatic cancers rise significantly with alcohol consumption.

Other notable risk factors include obesity, unhealthy diet and lack of physical activity. Comparatively, air pollution and chemicals used in agriculture and food production have a more limited impact.

In addition, some cancers can be prevented through vaccination. Without vaccination, 80% of women and men will be infected with HPV at some time in their lives, usually before the age of 25. HPV vaccines are highly safe and effective in preventing transmission of the HPV strains responsible for cervical cancer, as well as for some cancers of the vulva, vagina, penis, anus and oral region.

Hepatitis B, a potentially life-threatening liver infection caused by the hepatitis B virus, is a major global health problem. It can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer. The hepatitis B vaccine offers 98–100% protection against the virus.

Early diagnosis and screening

As WHO’s recently published “Guide to cancer early diagnosis” explains, strengthening health systems to ensure the timely detection and diagnosis of symptomatic cancer can significantly improve health outcomes for most types of cancer.

Screening is another tool for early detection of cancer, and has been shown to be effective for cervical, breast and colorectal cancer if well organized and carefully monitored. The most effective screening programme, in terms of health outcomes and cost, is for cervical cancer. It is one of WHO’s “best buys” for tackling noncommunicable diseases (NCDs).

Yet some other cancer screening programmes in the Region do more harm than good, and consume limited resources without significantly improving outcomes. The harm–benefit ratio varies according to the type of cancer and from country to country.

For example, in some countries women are called to undertake screening for breast cancer, but diagnosis and/or treatment are not easily accessible, or of poor quality. For the majority of women in these countries, such screening can be more harmful than beneficial, and an early diagnosis programme could be a smarter choice.

Early diagnosis programmes reduce the proportion of cancer diagnosed late thanks to improvements on many fronts, including general practitioners’ knowledge of cancer symptoms, referral processes, affordability and efficiency of diagnosis and treatment services, and population awareness.

On 11–12 February 2020, WHO/Europe is bringing together policy-makers, technical experts, representatives of WHO collaborating centres and non-state actors to a conference on screening in Copenhagen, Denmark. Its overall aim is to increase the effectiveness of screening programmes in the Region, maximizing benefits and minimizing harm. A WHO/Europe guide to screening will be published during the conference.

Palliative care

Effective palliative care, which ensures that the end of life for those with cancer is experienced with dignity and as little pain as possible, is a neglected area of cancer care. Tragically, many people in the Region with cancer die without adequate access to symptomatic relief, despite its affordability.

Across the Region, consumption of opioid medicines to relieve pain is between 10 and 100 times lower in eastern European and central Asian countries than in western European countries, often due to overly restrictive regulation of such medicines.

Many factors can contribute to poor palliative care, including insufficient awareness and training among doctors and health professionals, lack of access to opioid medicines and limited political interest in the area.

Improving palliative care is another of WHO’s best buys for tackling NCDs. Countries that invest in palliative care improve patients’ quality of life and decrease the cost of cancer treatment significantly in the last weeks of life.

At every stage of cancer care, more can and should be done: through prevention by lowering people’s exposure to major cancer risk factors and stopping cancer through vaccination; through effective screening programmes when appropriate; through treatment that follows proven protocols and is available to all; and through palliative care that provides patients with a dignified end of life where pain is managed.

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