Gastrointestinal and liver tumours and public health in Europe

State of the Art: Europe com- prises only one eighth of the total world popula- tion but has around one quarter of the global to- tal of cancer cases - some 3.2 million new pa- tients per year. While the disproportionate cancer burden is readily apparent, the disease patterns in Europe cannot simply be generalized - overall cancer incidence and mortality rates vary at least two-fold between European countries and the dif- ferences are often far greater for specific can- cers. With 1.7 million deaths each year, cancer currently represents the second most important cause of death in Europe. The range of survival rates is similarly wide. For individual cancers, the variation across Europe is even greater. This re- flects a wide range of social and epidemiological factors in different countries: cancer prevention programmes; screening programmes; cancer control plans; individual lifestyles and occupa- tional exposures; the existence and accessibility of health-care facilities and technological infra- structure; and the availability of human, financial and material resources for health and economic development. Europe has some of the richest countries in the world, but also some of the poor- est. In 2002, 168 million people were living below the poverty line, about 46% of the European pop- ulation. The time trends in cancer risk also vary be- tween European countries and some cancers show different trends between men and women, or young and old, or poor and rich. The public health profile of cancer in Europe is complex. Trends in the incidence and mortality rates are al- so influenced by successes in health promotion (e.g. tobacco control), efficient screening (e.g. breast, bowel, cervix) and better treatment. These have been reflected in lower incidence, reduced mortality, higher survival, improved life expectan- cy and a better quality of life for cancer survivors. Conclusions: Cancer of the gastrointestinal (GI) tract is the most common cancer in Europe. More than half of GI cancer cases arise from the colon. They can remain asymptomatic until late in the natural history of the disease, and as this is the stage at which they can be cured, screen- ing has been advocated for well members of the population and surveillance for those with con- ditions predisposing to cancer.