Annals of Oncology

letters to the editor

Burden of cervical cancer in the 27 member states of the European Union: estimates for 2004
In a recent publication in this journal, estimates for 2004 of the burden of cervical cancer incidence and mortality were provided for 25 member states belonging to European Union (EU) in that year and for three other countries (Iceland, Norway and Switzerland) [1]. On the 1st of January 2007, Bulgaria and Romania joined the EU as well. Therefore, we computed the rates of incidence and mortality from cervix uteri cancer using the same methods as described before. The latest mortality data for 2002 were extracted from the World Health Organization mortality database (http://www.who.int/ whosis/mort). For Bulgaria, national incidence rates were available for 1998, whereas, for Romania, national incidence was computed by modeling from the mortality data using representative agespecic incidence/mortality ratios [2]. Deaths from uterine cancer not otherwise specied were reallocated as explained in the previous report [1]. Number of deaths and incident cases was obtained by multiplying the age-specic rates with the corresponding population size of 2004 derived from World Population Prospects published by the United Nations Population Division (http://esa.un.org/unpp/). Table 1 shows the number of cases and deaths, the crude, standardized and cumulative rates up to the age of 74 years. In Bulgaria, 900 women developed cervical cancer and 500 died from the disease. In Romania, the approximate number of cases and deaths was 2900 and 2100, respectively. Both countries show the highest cervical cancer incidence of the EU: world age-standardized rates of 19.8 (Bulgaria) and 22.3 (Romania) per 100 000 women-years. Romania ranks at the top of member states with highest cervical cancer death rates (13.7/100 000) and Bulgaria (8.6/100 000) comes at the 3rd place after Lithuania (see Figure 1). In total, the estimated burden of neoplasia of the uterine cervix in the 27 EU member states sums up to 34 300 cases and 16 200 deaths. The addition of the two countries makes the westeast gradient even stronger than before the recent expansion of the EU [1]. The thematic map in Figure 2 makes clear that more support of European public health authorities has to be allocated to the East European member states to help

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Annals of Oncology

Table 1. Number of cases and deaths from cervical cancer, crude, age-standardized and cumulative rates in the European Union: EU15 (15 member states of the EU before 2004); EU10 (10 member states that acceded the EU in 2004), Bulgaria and Romania that acceded the EU in 2007 and the whole of 27 member states that currently compose the EU (EU27) Country Incidence Cases Crude rate W-ASR E-ASR ( 100) (per 100 000 women per year) 227.4 78.3 9.1 28.6 343.3 11.8 20.4 23.1 25.2 13.9 9.5 16.7 19.8 22.3 12.4 10.7 18.9 21.7 24.5 13.9 Mortality Deaths Crude rate W-ASR E-ASR ( 100) (per 100 000 women per year) 95.2 41.3 5.0 21.4 162.8 4.9 10.7 12.7 18.8 6.6 2.8 7.1 8.6 13.7 4.8 3.6 9.0 10.5 17.0 6.0

Cumulative rate (%) 0.82 1.49 1.70 1.91 0.99

Cumulative rate (%) 0.27 0.71 0.84 1.35 0.40

EU15 EU10 Bulgaria Romania EU27

EU, European Union; W-ASR/E-ASR, age-standardized rate using the World/European standard population as reference. EU15 (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Portugal, Spain, Sweden, The Netherlands, United Kingdom); EU10 (Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia, Slovenia).

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Figure 1. Age-standardized rates of incidence and mortality from cervical cancer (per 100 000 women-years) in the 27 member states of the European Union, ranked by increasing mortality, estimates for 2004 (direct standardization using the World reference population).

tackling cervical cancer, a life-threatening disease which can be easily avoided by well-organized prevention [3, 4].

Funding
The European Commission (Directorate of SANCO, du Luxembourg), through the Luxembourg, Grand-Duche European Network for Information on Cancer (International Agency for Research on Cancer, Lyon, France) and the European Research Network of Excellence Cancer Control

using Population Registries and Biobanking funded by the 6th Framework program (Brussels, Belgium); DWTC/SSTC (Federal Service for Scientic, Cultural and Technical Affairs, Brussels, Belgium). M. Arbyn1,3*, P. Autier2,3 & J. Ferlay2
1 Unit of Cancer Epidemiology, Scientic Institute of Public Health, Brussels, Belgium, 2International Agency for Research on Cancer (IARC), Lyon, France, 3European Network for Information on Cancer, IARC, Lyon, France (*E-mail: m.arbyn@iph.fgov.be)

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Annals of Oncology

letters to the editor

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Figure 2. Cervical cancer mortality in the 27 member states of the European Union, estimates for 2004 (world age-standardized rates, adjusted for cause of death from uterine cancer not otherwise specied).

references
1. Arbyn M, Raifu AO, Autier P, Ferlay J. Burden of cervical cancer in Europe: estimates for 2004. Ann Oncol 2007; doi: 10.1093/annonc/mdm079v2. 2. Boyle P, Ferlay J. Cancer incidence and mortality in Europe, 2004. Ann Oncol 2005; 16: 481488. 3. IARC. Cervix cancer screening. IARC Handbooks of Cancer Prevention. Volume 10. Lyon, France: IARC Press, 2005. 4. Arbyn M, Anttila A, Jordan J et al. (eds). European Commission. European Guidelines for Quality Assurance in Cervical Cancer Screening. Luxembourg: Ofce for Ofcial Publications of the European Communities, 2007.

doi:10.1093/annonc/mdm377

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