Persisting cancer mortality gap between western and eastern Europe

Background: Over the last three decades, cancer mortality has shown favourable patterns in Europe. Patterns and trends however have been less favourable for most eastern countries. Methods: We computed cancer mortality rates in western (WE) and eastern European (EE) countries using the official mortality database of the World Health Organisation, using joinpoint regression models to identify significant changes in trends over time. Results: Cancer mortality declined by 1–1.4% annually in WE since 1990, to reach an age-standardised rate (world standard) of 125.4/100,000 men and 81.3/100,000 women in 2016. In contrast, EE rates only started to decline around the 2000s in men and remained stable in women, to reach 171.9/100,000 men and 98.2/100,000 women. Lung cancer rates were 30.8/100,000 men and 14/100,000 women in WE versus 47.1/100,000 men and 15.2/100,000 women in EE. In relative terms, the mortality excess in EE increased from 32 to 37% in men and from 15 to 21% in women, compared with WE. The largest percent excesses were for cancers of the upper respiratory tract, stomach, intestines and lung in men and uterus in women. Prostate cancer rates increased in EE to reach 12.7/100,000 in 2016, whereas they decreased to 10.2/100,000 in WE. Compared with rates in 1990, over the period 1991–2016, about 3.9 million cancer deaths were avoided in WE, but no notable improvements was seen in EE. If cancer mortality rates in EE had been those observed in WE, over 55,000 deaths would have been avoided in 2016. Conclusion: Differences in lifestyle patterns, mainly smoking and alcohol, besides different roll-out of improvements in cancer diagnosis and management are the key determinants of the persisting difference in cancer mortality between western and eastern Europe. There is no evidence for the gap to close.