Lung cancer is one of most common cancers in the EU

Lung cancer is the third most commonly occurring form of cancer in the EU (after colorectal and breast cancer and excluding non-melanoma-skin cancers), accounting for almost 260,000 newly diagnosed cases in 2004 (Boyle & Ferlay, 2005).

EU Member States, regions and populations differ significantly in lung cancer incidence and mortality. These variations reflect differences in the development of the tobacco epidemic, as described in the EUphact Smoking.

Lung cancer incidence has peaked among men, but continues to rise among women

Southern (Italy, Greece) and Eastern and Central European (Hungary, Czech Republic) men currently have the highest incidence rates of lung cancer within the EU. Most of these countries are in stage three of the tobacco epidemic. The majority of Northern (Sweden, Finland) and Western (France, Netherlands, Germany) European countries show stable or declining incidence rates for men. These countries are in stage four of the tobacco epidemic. In general, the incidence of lung cancer is higher among European men than European women.

In recent decades, the incidence of lung cancer has been rising among women in almost all EU countries. Women in Northern and Western Europe (Denmark, UK) have the highest incidence of lung cancer for females in the EU. Hungary also has a high lung cancer incidence among women. Southern European countries (Malta, Cyprus, and Portugal), where women traditionally rarely smoked, show the lowest incidence rates for women. As smoking is currently very prevalent among younger women, an increase of the female lung cancer rates can be expected.

See also Incidence of trachea, bronchus and lung cancer in the EU-27.

Other factors determining trends in lung cancer incidence

Age

Lung cancer is rarely diagnosed before the age of forty and its incidence peaks between the ages of 75 and 85. There is a strong birth-cohort effect. This means that the smoking behaviour of today's adolescents will determine long-term developments in lung cancer occurrence and mortality in all EU countries (Tyczynski et al., 2003).

Socio-economic status

In many EU countries the incidence of smoking and lung cancer is significantly higher in lower socio-economic groups (Huisman et al., 2005a; Mackenbach et al., 2004). Exposure to smoking at an earlier age, as well as lower rates of successful cessation contribute to the higher risk of lung cancer in this segment of the population (Kunst et al., 2004).

Histopathologic type

Most lung cancers are microscopically SQC, SCLC or AD subtypes. The rates for squamous and small cell carcinoma in males are generally declining, while adenocarcinoma rates are on the rise in virtually all countries. In female populations across Europe, the incidence rates for all three types of lung cancer are rising, but most rapidly for AD. The reasons are not clear, but two hypotheses, both linked to the consumption of modern, low-tar, filter cigarettes, deserve some attention. Firstly that the consumption of filtered, milder cigarettes is linked to an increase in the number and depth of puffs taken. This practice exposes the peripheral lung regions, where adenocarcinoma generally occurs, to higher concentration of carcinogens (Devesa et al., 2005 ). Secondly that the risk of adenocarcinoma could have been increased by the different chemical composition of modern cigarettes that contain less PAHs and more nitrosamines, both carcinogens that may cause different types of lung tumours.