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East/West: Study Shows Europe's Richer Countries Have More Reported Cancer Cases, But Why?

A new health study shows that prosperous countries such as Sweden have the highest number of reported cancer cases in Europe. The lowest levels of such cases are in poorer countries like Poland. In this report, RFE/RL correspondent Don Hill explains the unexpected findings, and what effect the results of this new study may have on future health care in these countries.

Prague, 10 June 2002 (RFE/RL) -- The medical journal "Annals of Oncology" recently published the results of a study of 3 million cancer patients from 38 cancer registries in 17 European countries. What the study found was that the number of cancer patients in rich countries with the best health care, such as Sweden, Switzerland. or Germany, greatly outnumbered the number of cancer patients in poorer countries with less advanced health care, such as Poland, Estonia, or Slovakia.

But the unexpected results can be explained.

The high quality of health care in wealthier countries results in earlier detection of illnesses, so more cancer sufferers become registered patients sooner. Good health care also results in cancer patients living longer, so there are more of them to treat. Low prevalence is due not only to low detection of the disease but also to high mortality rates.

Also, the incidence of cancer increases with age. Where health care is best, people live longer, resulting in more older people and, therefore, more cancer patients.

Still, oncologists believe the study's findings are significant and potentially useful. Dr. Diane Stockton is a physician on the staff of the Scottish Cancer Intelligence Unit. Her unit contributed data to the study. She discussed the results in a telephone interview with RFE/RL. "The information on prevalence is used for planning cancer services, because it gives an idea not just of instance or survival from a cancer but kind of a composite of this information," Stockton said.

"Instance" refers to the number of new cancer cases reported. "Survival" rates refer to the length of time people remain alive following a cancer diagnosis.

Stockton said she thinks the study: "is adding to general knowledge. It will have an immediate application to health planners, who will be able to use it.... It will give them a lot of information for different cancers on the impact on possible health services."

Stockton said the data can be analyzed in different combinations to inform health planners and public-health officials. "You can look at prevalence as the total prevalence, which is, let us say, prevalence at the end of 1992, which is what this study looked at. That is how many people were alive at the end of 1992 who had cancer at any point in the past. You can also look at prevalence in, say, two years. And that [comparison] will tell you how many people were diagnosed with cancer in the last two years," Stockton said.

Professor Michel Coleman of the London School of Hygiene told the Reuters news service that the study is the first to document the rate of cancer prevalence across many countries. He said it shows that about one out of every 50 people in the countries studied is a cancer survivor.

Stockton said she particularly noted the impact of diet on instances of cancer and its prevalence. "You know, the other issues that are involved include the base instance of cancer, which is very different based on different diets in the countries we're talking about," Stockton said. An example, she said, is breast cancer. Breast cancer is being so successfully treated that breast-cancer patients make up a large proportion of overall cancer survivors. "With these prevalence estimates, something that comes out very clearly is that there are lots of women out there.... Almost half the women that are alive with cancer are women with breast cancer. And breast cancer has been related very much to diet, with higher instances of breast cancer in countries with richer diets," Stockton said.

Among men, the most prevalent cancer is colon, or rectal, cancer.