Cancer incidence is set to increase by over one fifth by 2040 while cancer mortality will increase by almost one third across the European region, although there will be wide variations between cancers, suggests a new analysis.

The research, presented at the European Society of Medical Oncology annual meeting, suggests that cancer incidence will rise by 21% between 2020 and 2040, ranging from a 35% increase in mesothelioma cases to a 5% reduction in testicular cancer.

Cancer mortality is expected to increase by 32% over the same period, ranging from a 56.5% increase in deaths from prostate cancer to a 4.3% increase for testicular cancer.

However, all of the predictions are subject to assumptions over how the general population will change by 2040, with increases in overall mortality and alterations in migration patterns having a notable potential impact.

The analysis was carried out by a team from the Health In Society Unit, European Commission – Joint Research Centre, Ispra, Italy. Study presenter Tadeusz Dyba, PhD, said they hope that the results will “be of value for planning cancer health policy in the European Union, as well as in member countries, and in EFTA countries.”

“The results we obtained allow international comparisons, highlighting differences and identifying possible actions to mitigate inequalities between and within countries,” commented co-author Manola Bettio, MD, also from the Health In Society Unit.

“The first and easiest way to reduce the future cancer burden across Europe is prevention, because the good news is that almost 40% of cancers can be prevented by reducing people’s exposure to environmental and lifestyle risks, which are also linked to social and economic development,” she added.

Discussing the findings, Olga Husson, PhD, from the Netherlands Cancer Institute in Amsterdam, who was not involved in the study, pointed out that “unfortunately” the projections are not adjusted for age.

Cancers in adolescents and young adults represent only 7% of the total cancer population, so the current results are “largely driven by the larger group of older cancer patients.”

In the case of testicular incidence and mortality, the small rises seen in the overall analysis mask what will likely be relatively large increases in both younger populations.

Consequently, the researchers “underexpose this problem,” Husson said, which runs the “risk of paying no or only limited attention to the survivorship issues of young people with cancer,” who have “a long life ahead of them.”

Details of the Analysis

In his presentation, Dyba explained that the analysis involved two stages.

For the first stage, figures from the European Cancer Information System were used to calculate crude cancer incidence and mortality rates for 2020 for the 27 EU countries (Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, and Sweden) plus the three EFTA nations (Iceland, Norway, and Switzerland).

The team then obtained projections for changes to the general population by EUROSTAT for the years 2025, 2030, 2035, and 2040, and applied those to calculate expected changes in cancer incidence and mortality up to 2040.

Importantly, the EUROSTAT projections included assumptions for five alternative scenarios in addition to the baseline assumption of no alterations to general population dynamics:

• Lower fertility, at 20% lower than in 2020

• Lower overall mortality, at an increase in life expectancy of 2 years by 2070

• Lower migration, at a net reduction of 33%

• Higher migration, at a net increase of 33%

• No migration, with net migration set to zero

“Because of that, we could take advantage of those data and make alternative predictions of the cancer incidence and mortality burden,” Dyba said. He highlighted that each scenario would have a different impact on population age distributions.

In particular, the lower fertility scenario would lead, by 2040, to a large reduction in the number of people aged 0-15 years, while leaving older age groups untouched.

No migration, on the other hand, would affect all age groups up to around 50 years of age, causing a notable reduction in both male and female populations by 2040, an effect not seen in older groups.

“So it’s not straightforward to predict how the cancer incidence and mortality burden would look under different scenarios,” Dyba said.

Incidence of All Cancers Predicted to Increase  

The calculations revealed that, using the baseline scenario, the incidence of all cancers, not including non-melanoma skin cancer, is set to increase between 2020 and 2040 by 16.2% in women and 25.8% in men, or 21.4% overall, to 3.4 million cases.

The lowest increase in cancer incidence, at 19.7%, would be expected if there is no migration between 2020 and 2040, while the highest would be seen with longer life expectancy, at 23.4%.

In addition, cancer mortality is set to increase by 27.4% in women and 36.1% in men over the same period, or 32.2% overall, to 1.7 million deaths.

The lowest increase in cancer mortality would again be seen with no migration, at 31.5%, rising to 35.4% with longer life expectancy.

Differences Between Countries 

The analysis also showed that the crude increase in incidence and mortality will vary widely by country, with large increases expected in Spain, France, Italy, and Poland, depending on the scenario.

In terms of individual cancers, the highest increase in incidence is expected for mesothelioma, at 35.2%, while the incidence of testicular cancer is expected to decrease between 2020 and 2040 by 5.2%.

The highest increase in cancer mortality over the two decades is predicted to be in patients with prostate cancer, increasing by 56.5%. The lowest increase in mortality is expected to be in testicular cancer, at 4.3%.

The study had no specific funding. The study authors and Dr Husson have disclosed no relevant financial relationships.

European Society of Medical Oncology (ESMO) Congress 2021: Abstract 1501O. Presented September 20.

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