beating bladder cancer
Epidemiology of bladder cancer in Europe The European Commission’s Joint Research Centre is spearheading the development of a harmonised cancer information system for Europe in collaboration with the European Network of Cancer Registries. Dr Emanuele Crocetti, MD, Joint Research Centre, Public Health Policy Support Unit, Institute for Health and Consumer Protection, European Commission, explains the role of the ongoing collaboration and presents data relating to epidemiology of bladder cancer
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131,000 (103,000 men and 28,000 women), and new cases are expected to increase to 141,000 in 2020.
he European Commission Joint Research Centre (JRC) in Ispra, Italy, has recently extended its capacity in connecting research and policy with a recently established activity, the setting-up of an integrated and comprehensive cancer information system for Europe. The goal is to improve access to, and availability of updated and reliable information on the cancer burden in Europe. The information system includes data on both primary and recurrent cases, on geographical patterns, and on temporal trends in incidence, mortality, prevalence and survival. Such information is required to support health policy interventions and, at a later stage, enable evaluation of their effectiveness.
Within the European Union, there is huge variability in incidence rates; among men – from the age-adjusted rate (on the World standard population, ASR) of 31.0, for Belgium, to the lower rate of 9.2 for the UK; and for women, rates range from 7.4, for Hungary, to 2.5 for Cyprus.
To achieve these aims, a strong collaboration has been established between the JRC and the population-based cancer registries (CR), all over Europe, because of their invaluable role as raw data collectors. Since 2013, the JRC has hosted the Secretariat of the European Network of Cancer Registries (ENCR), a scientific network of over 150 European registries.
With regards to cancer mortality, in the European Union, bladder cancer represents the ninth most frequent cause of cancer death, with around 40,000 deaths (3% of total cancer deaths,) estimated in 2012, and nearly 43,000 estimated for 2015. Mortality from bladder cancer has decreased over time throughout Europe, among men, while it is relatively stable and/or sometimes decreasing among women.
In the European Union (EU-28), according to estimates from the International Agency for Research on Cancer (IARC), bladder cancer ranks fifth among the most frequently diagnosed cancers, with about 124,000 new cases predicted in 2012 for both sexes, representing around 5% of all the incident cases. Among men, with 97,000 new diagnoses estimated for 2012 bladder cancer represents around 7% of all new cancer cases, ranking fourth after prostate, lung, and colorectal cancers. Among women, it is the thirteenth most frequently diagnosed tumor, with 27,000 new cases per year, representing around 2% of all new cancer cases. In 2015, estimated new cases were about
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The epidemiology of bladder cancer is related to the main risk factor: smoking. Therefore, the temporal trend of age-standardised incidence rates has followed the changes in the prevalence of smokers in the population. Indeed, in many countries, there was a long standing increasing trend (especially among men) in previous years, followed by a more recent decrease and/or a flattening of trends.
Approximately 324,000 EU citizens are estimated to have had a bladder cancer diagnosis in the last five years (five-year prevalence). In other words, around 9% (around 3,700,000) of all European citizens who have had a previous (5-year) cancer diagnosis, and are not deceased, had a bladder cancer diagnosis. These patients require clinical follow-up and the assistance of urologists. As regards survival indicators, the EUROCARE project has compared cancer survival data among European countries for decades, and currently the 6th edition will benefit from fruitful collaboration and coordination with the ENCR-JRC project.
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The most recent data from the EUROCARE-5 project has shown that the 5-year relative survival for bladder cancers, diagnosed between 2000 and 2007, is, on average, around 69% varying from 75% in Northern European countries to 65% in Eastern Europe. Some of these differences are presumably related to the stage at diagnosis. In fact, after one year from diagnosis the probability of surviving an additional 5 years not only improves substantially – it is on average 81%, but the geographical differences decrease from 85% in Southern Europe to 80% in Central Europe. Finally, unlike many other tumors, bladder cancer survival is higher in men (European agestandardised 5-year relative survival 69%) than in women (66%). Bladder cancer registration represents a challenge for CR staff due to its complex biology. This includes both non-invasive and invasive tumors and the use of different grade and stage definitions. Moreover, this cancer is typically characterised by multifocal onsets and recurrences. Therefore, comparable and reliable information, collected at EU-28 level, will only be achieved if common classifications and rules are correctly applied in order to ensure that data refer to equivalent lesions. Indeed, the decision to include or exclude non-invasive papillary or flat tumors may affect incidence and survival estimates, making comparisons unreliable. Current ENCR recommendations to European cancer registries recommend full registration (all histological type and stages) of bladder tumors. To achieve the goal of harmonised European bladder cancer information, ongoing collaboration between the Joint Research Centre and the European Network of Cancer Registries is vital, as well as a strong collaboration with urologists and oncologists, to keep in contact the data collection with all the relevant scientific innovations