Investigators discovered that overweight and obesity may be contributing to rising rates of colon cancer mortality in younger patients, according to a recent study published by Santucci et al in the Annals of Oncology. The findings represent the first time colon cancer mortality rates among younger patients were predicted to increase in some countries in the European Union and confirm a trend first noticed in the United Kingdom in 2021.
Background
The mortality rate of colon cancer has recently decreased overall across Europe. However, recent studies have identified higher mortality rates among patients between the ages of 25 and 49 with early-onset disease.
Study Methods and Mortality Predictions by Cancer Type
In the recent study, the investigators used the 1970 to 2018 World Health Organization and Eurostat databases to analyze cancer mortality rates—including gastric, intestinal, pancreatic, lung, breast, endometrial, cervical, ovarian, prostate, and bladder cancers and leukemia—in male and female patients across 27 European Union member states as a whole as well as separately in the United Kingdom. They then observed cancer mortality rates among the five most populous countries in the European Union: France, Germany, Italy, Poland, and Spain.
In all 27 of the European Union member states, the investigators estimated that for male patients, there would be a 6.5% decrease (from 132 per 100,000 individuals in 2018 to 123 per 100,000 individuals in 2024) in the age-standardized mortality rates for all cancer types, whereas for female patients, there would be a 4% decrease (from 82.5 per 100,000 individuals in 2018 to 79 per 100,000 individuals in 2024). They anticipated that approximately 1.3 million patients would die of cancer in the European Union. In the United Kingdom, the age-standardized mortality rate for all cancer types was expected to fall by nearly 14% from 120 to 104 per 100,000 individuals among male patients and by 10% from 92.5 to 83 per 100,000 individuals among female patients in 2024.
However, the investigators stressed that because of the increasing number of elderly individuals in the population, the actual number of deaths from cancer may rise from 675,265 in 2018 to more than 705,100 in 2024 among male patients and from 535,291 in 2018 to more than 565,700 in 2024 among female patients in the European Union. In the United Kingdom, the number of deaths could rise from 91,059 to 92,000 among male patients and from 79,631 to 80,900 among female patients—representing a total of approximately 172,900 deaths.
The investigators calculated the number of deaths from cancer that may have been avoided over a 36-year period between 1989 and 2024, assuming the rates remained constant at the 1988 rates. They estimated that a total of 6.2 million deaths from all cancer types may have been avoided in the European Union (4.2 and 1.9 million among male and female patients, respectively), and a total of 1.3 million deaths may have been avoided in the United Kingdom (899,000 and 426,000, respectively).
The investigators revealed that the mortality rates continued to improve in the European Union and the United Kingdom for breast cancer. In 2024, they predicted a decrease of 6% from 14 female patients per 100,000 individuals in the European Union in 2018 to 13 per 100,000 individuals in 2024, and a decrease of 11% from 15 to 13 per 100,000 individuals in the United Kingdom.
“Advances in the diagnosis of breast cancer contribute to these substantial declines in [mortality] rates, but improvements in the treatment and management of the disease are the main reasons for more [patients] surviving,” highlighted co–senior study author Eva Negri, ScD, of the University of Bologna.
Pancreatic cancer—which can often be challenging to detect or to treat successfully—was the only major cancer type where no improvements in the mortality rates were predicted for both male and female patients in the European Union but not in the United Kingdom. Pancreatic cancer accounted for more than 3% of new cancer diagnoses in Europe but for approximately 7% of cancer mortality—making it the fourth leading cause of cancer mortality in Europe.
The mortality rates were expected to rise by 1.6% and 4% among male and female patients respectively, in the European Union. Trends may be more favorable in the United Kingdom, where pancreatic cancer mortality rates were expected to fall by 7% among male patients and 2% among female patients.
“Smoking is the main risk factor for pancreatic cancer, but it only partly explains the increased [mortality] rates over time. Overweight, obesity, diabetes, and heavy alcohol consumption may also play a role,” suggested Dr. Negri.
Although the mortality rates of lung cancer appeared to be falling in male patients, this type of cancer remained the leading cause of mortality among male and female patients in both the European Union and United Kingdom. The investigators predicted lung cancer mortality rates in 2024 of 28 male patients and 13.6 female patients per 100,000 individuals in the European Union—representing a 15% reduction among male patients since 2018 but no reduction among female patients. In the United Kingdom, the lung cancer mortality rates were expected to be 19 male patients and 16 female patients per 100,000 individuals, representing a 22% and 17% reduction among male and female patients, respectively.
Predictions Regarding Colon Cancer
In both the European Union and the United Kingdom, colon cancer was found to be the second leading cause of mortality after lung cancer among male patients and the third leading cause of mortality after breast and lung cancer in female patients; however, mortality rates may be falling, except among female patients in the United Kingdom. Among nonsmokers, colon cancer may be the leading cause of cancer mortality among both male and female patients combined in the European Union and United Kingdom.
Compared with the overall colon cancer mortality rates in 2018, the rates in 2024 in the European Union were predicted to decrease by 5% to 15 male patients per 100,000 individuals and by 9% to 8 female patients per 100,000 individuals. In the United Kingdom, the rates were predicted to decrease by 3% to 14 male patients per 100,000 individuals but may remain stable in female patients, at about 10 per 100,000 individuals.
“These overall favorable trends can be explained by improved diagnosis and treatment of colon cancer. [Mortality] rates tended to decrease in countries with better access to screening and early diagnosis. However, the increased mortality among young [patients] is a concern,” emphasized co–senior study author Carlo La Vecchia, MD, Professor of Medical Statistics and Epidemiology at the University of Milan.
The investigators predicted that the greatest increase in colon cancer mortality rates among younger patients would be observed in the United Kingdom, where they could rise by 26% among male patients and nearly 39% among female patients in 2024 compared with the mortality rates in 2018. The mortality rates of colon cancer may also increase by 1.5% and 2.6% among respective male and female patients in Italy, by 5.5% among male patients in Spain, by 5.9% among male patients in Poland, and by 7.2% among female patients in Germany.
“Key factors that contribute to the rise in colon cancer rates among young [patients] include overweight, obesity, and related health conditions such as high blood sugar levels and diabetes. Additional reasons are increases in heavier alcohol drinking over time in central and northern Europe and the [United Kingdom] and reductions in physical activity,” Dr. La Vecchia proposed. “These predictions underline the importance of controlling and, ultimately, eliminating tobacco use. Tobacco remains responsible for 25% of all cancer [mortality] among [male patients] and 15% among [female patients] in the [European Union]. Not only is it the main risk factor for [mortality] from lung cancer, but also several other cancers, including pancreatic cancer. Controlling the rise in heavy alcohol drinking in central and northern Europe is an additional issue. Alcohol consumption has been linked to early-onset colon cancer, and countries where there has been a reduction in alcohol consumption—such as France and Italy—have not experienced such marked rises in [mortality] rates from this cancer [type]. Early-onset colon cancer tends to be more aggressive, with lower survival rates, compared [with] colon cancer that is diagnosed in older [patients],” he detailed.
Conclusions
“Our predictions … highlight the importance of closing the gaps between countries across Europe in relation to cancer diagnosis and treatment. [Mortality] rates continue to be higher in Poland and other central and eastern European countries, and this is due partly to inadequate screening programs to detect cancers such as breast, cervical, and colorectal cancers as well as [a] lack of access to the most modern therapies,” Dr. La Vecchia underscored. “National governments should consider strengthening policies to encourage increased physical activity, a reduction in the number of [patients] who are overweight or obese, and a reduction in alcohol consumption. In terms of prevention, governments should consider the extension of screening for colon cancer to younger ages, starting at age 45. Screening programs vary across Europe, but an increase in the incidence of colon cancer among young [patients] in the [United States] has prompted the U.S. Preventive Services Task Force to recommend lowering the age at which screening starts to 45 years,” he concluded.
Disclosure: For full disclosures of the study authors, visit annalsofoncology.org.
