THE GEOGRAPHY OF CANCER: THE EUROPEAN COMMUNITY

The ‘Europe against Cancer’ programme was launched in 1987 as a major effort to control cancer in the EC Prevention was the target, and tobacco, alcohol, diet, occupation and screening were the factors of greatest interest. As a baseline for this effort workers from the Danish Institute of Cancer Epidemiology and the International Agency for Research on Cancer in Lyon prepared a report, 'Cancer in the European Community and its Member States’. With the permission of these authors we will quote here extensively from their report. Many of their conclusions were based on estimates, because not all EC countries collect precise information on cancer incidence. Hone the less, they concluded that the study 'leaves little doubt that cancer represents a major health problem in the EC and its member states. The burden of cancer on society, measured by the number of new cases arising every year may be some 20 per cent higher than hitherto assumed.’

In the current twelve-member European Community, there were 750.000 deaths from cancer in 1980 and an estimated 1,200,000 new cases of cancer. Statistical methods can be employed to make allowance for the differing ages of the populations in the different countries and, when this is done, a rank order of cancer incidence and cancer deaths in men and women can be prepared;

It emerges that the risk of dying from cancer in the European Community among men it highest in Luxembourg, Belgium, France and the Netherlands and lowest in Portugal, Greece, Spain and Ireland. The difference is quite large and the incidence of cancer is 55 per cent higher among the French than among the Portuguese. The risk of dying from cancer is 40 per cent lower hi women than in men in the European Community and the highest incidence rates in women are seen in Luxembourg, the UK, Denmark and Ireland, while the lowest are seen in Spain, Greece and Portugal. There are striking disparities between countries in the differences in cancer incidence between sexes. French men are twice as likely to get cancer as French women while in Denmark men and women have a very similar incidence.

Comparing different cancers between European countries can be linked to probable causes. Liver cancer is a good example it is common in Greece, France, Italy and Spain, possibly because of a high intake of wine in these countries. This link is probably a real and causal one, and we shall be discussing it later. Nevertheless, this link probably doesn't explain all the differences. There are other cancers associated with alcohol, including mouth cancers, and these are not particularly common in Greece. It may be that chronic liver infection with hepatitis viruses is a factor in some countries. Looking at cancer of the larynx a similar message emerges, with the French, Spanish, Italian and now Portuguese men having an alarmingly high incidence of this cancer, which is otherwise not one of the most frequent in other countries. The risk factors here are probably both tobacco and alcohol, which seem to interact to make the risk of cancer of the larynx especially high for the French.

Melanoma of the skin in Europe presents us with in interesting paradox. The high-risk countries are in northern Europe, particularly Scandinavia, the Netherlands, Germany and the UK. We shall see later that melanoma of the skin develops as a result of excessive exposure to sunlight; yet people Irving in the sunny climates in southern Europe appear to have a low incidence. The explanation lies in differences between the type of complexion found in the north and the south. The people who get melanoma appear to be those with light complexions who have intermittent exposures, leading to sunburn in young individuals and a tendency to freckle and to burn rather than tan. In North America and Australia, where the racial mix is more evenly spread through the country, the incidence of melanoma gets higher as the equator is approached and the sun gets stronger. The opposite is seen in Europe because the northern Europeans have light complexions and for them occasional exposure, perhaps on holiday in southern Europe, appears to be most harmful.

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Cancer