Survival of women with cancers of breast and genital organs in Europe 1999–2007: Results of the EUROCARE-5 study

Abstract

Background

Survival differences across Europe for patients with cancers of breast, uterus, cervix, ovary, vagina and vulva have been documented by previous EUROCARE studies. In the present EUROCARE-5 study we update survival estimates and investigate changes in country-specific and over time survival, discussing their relationship with incidence and mortality dynamics for cancers for which organised screening programs are ongoing.

Methods

We analysed cases archived in over 80 population-based cancer registries in 29 countries grouped into five European regions. We used the cohort approach to estimate 5-year relative survival (RS) for adult (⩾15 years) women diagnosed 2000–2007, by age, country and region; and the period approach to estimate time trends (1999–2007) in RS for breast and cervical cancers.

Results

In 2000–2007, 5-year RS was 57% overall, 82% for women diagnosed with breast, 76% with corpus uteri, 62% with cervical, 38% with ovarian, 40% with vaginal and 62% with vulvar cancer. Survival was low for patients resident in Eastern Europe (34% ovary–74% breast) and Ireland and the United Kingdom [Ireland/UK] (31–79%) and high for those resident in Northern Europe (41–85%) except Denmark. Survival decreased with advancing age: markedly for women with ovarian (71% 15–44 years; 20% ⩾75 years) and breast (86%; 72%) cancers. Survival for patients with breast and cervical cancers increased from 1999–2001 to 2005–2007, remarkably for those resident in countries with initially low survival.

Conclusions

Despite increases over time, survival for women’s cancers remained poor in Eastern Europe, likely due to advanced stage at diagnosis and/or suboptimum access to adequate care. Low survival for women living in Ireland/UK and Denmark could indicate late detection, possibly related also to referral delay. Poor survival for ovarian cancer across the continent and over time suggests the need for a major research effort to improve prognosis for this common cancer.

Introduction

Cancers of breast, uterine corpus, uterine cervix, ovary, vagina and vulva are among the commonest cancers affecting European women.

Breast cancer is the commonest cancer affecting European women, with European age-standardised incidence 71/100,000 in 2012 [1], and relatively good survival [2]. High calorie diet, obesity and lack of physical activity [3] are not only risk factors but also negatively influence prognosis. Breast cancer is commoner in women of high socioeconomic status – who have fewer children and their first child later – than low socioeconomic status women [4]. National or regional breast cancer screening programmes were implemented in many European countries starting in the 1990s [5], and resulted in earlier diagnosis, improved access to effective treatments and better organisation of care [6].

Cancer of the corpus uteri is less common (European age-standardised incidence 14/100,000 in 2012 [1]), has a relatively good prognosis, shares some aetiological factors with breast cancer (e.g. obesity [7]) and has a similar incidence distribution with age to breast cancer, reaching a maximum at around 60 years, with stable or declining incidence thereafter.

Cervical cancer occurs at a younger age than cancer of the corpus and is uncommon in Europe (age-standardised incidence 11/100,000) but common in developing countries [1]. It has a poorer prognosis than corpus uteri cancer, with European age-standardised 5-year relative survival of about 63% [2]. Cervical screening has been successful for the secondary prevention of cervical cancer [8]. Vaccines against human papillomavirus (HPV) have been introduced in many developed countries for the primary prevention of this cancer [9], [10].

Ovarian cancer is mainly a disease of older women, with 50% of cases occurring in women over 65 years. European age-standardised incidence was 10/100,000 in 2012 [1], the disease has a poor prognosis [2], [11].

Vaginal and vulvar cancers are rare, with European age-standardised incidence 1/100,000) [1], and relatively good prognoses [2]. Evidence is growing that HPV infection is a major cause of these cancers [9].

Survival differences across Europe and between continents have been documented by previous studies [2], [12]. The aim of the present EUROCARE-5 study was to update survival estimates for these cancers and investigate changes in country-specific and over time survival.