The Present

Since the previous version of the European Code Against Cancer was created[1], the European Union has expanded its number of Member States and next year, in 2004, will see a further and dramatic expansion as 10 new Member States join (Cyprus, Czech, Hungary, Estonia, Malta, Latvia, Lithuania, Poland, Slovenia and Slovakia). Additionally, it is currently anticipated that Bulgaria and Romania will join in 2007 followed at a later date by Turkey. These expansions enlarge the Union to incorporate a greater diversity of peoples with a much larger degree of heterogeneity present in lifestyle habits and disease risk. The contrast between the Mediterranean countries, the Nordic countries and those countries of Central and Eastern Europe is considerable. In view of the accession of New Member States, an important aspect of the revision of this Code was to take into consideration the new Member States.

For the purposes of this text, the European Union shall be defined as the current 15 Member States (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the United Kingdom) plus the 10 Candidate Countries scheduled for entry in 2004 (Cyprus, Czech, Hungary, Estonia, Malta, Latvia, Lithuania, Poland, Slovenia and Slovakia).

Cancer Burden

In the European Union in 2000 it is estimated that there were 1.892.000 incident cases of all forms of cancer (excluding non-melanoma skin cancers diagnosed): this burden was shared almost equally by each gender although there was a slight excess in men (1.014. 000 cases) than in women (878.000 cases). In 2000, it is estimated that there were 1.156.000 deaths where cancer was the underlying cause in the European Union. Of these table 1. 651.000 were of men and 504.000 women.
The commonest form of cancer diagnosed in the European Union in 2000 was colorectal cancer, with an estimated total of 258,038 new cases. Of these, 123.000 were diagnosed in men while 135.000 were diagnosed in women table 2. There was a total of 138.000 deaths caused by colorectal cancer in the European Union, of which 70.000 were in men and 68.000 in women table 2
In 2000, it is estimated that there are 241.191 incident cases of lung cancer, with the majority diagnosed in men (192.000 cases) and fewer in women (48.901 cases) table 3 . In the same year, it is estimated that there are 231.000 deaths in the European Union caused by lung cancer. Of these, 183.000 occurred in men and 49.000 in women.
There was an estimated 95.500 incident cases of stomach cancer diagnosed in 2000, of which 57,000 were diagnosed in men and 38.000 in women table 4. There was an estimated total of 78.000 deaths caused by stomach cancer: 45.500 in men and 32.500 in women table 4.
In women, there was an estimated 244.500 new cases of breast cancer diagnosed in the year 2000 and there were 91.000 deaths caused by breast cancer table 5. In men, there was an estimated total of 157.000 incident cases of prostate cancer diagnosed in the European Union in 2000 and an estimated 66.500 deaths caused by this disease.
The age-adjusted risk of cancer increases quite quickly with age [2]: there is a difference of at least two orders of magnitude between the risk of developing cancer in the fourth decade of life and the eighth decade of life. Even if age-specific cancer rates remain fixed at 1980 levels, it is to be expected that there will be large increases in the numbers of cases of cancer diagnosed for the first two decades of the twenty-first century. This is simply a consequence of the ageing population; more and more men and women living to older and older ages. The post-World War II “baby-boom”, the first generation in western Europe to have had the benefit of modern medicine and not to have endured a major war, will reach ages where cancer is an important problem from the early days of next century. The effect on the absolute numbers of cases will be quite dramatic, particularly for cancers sites such as prostate cancer where the median age at diagnosis current is around 75 years in the European Union [3].