Closing the gap: cancer in Central and Eastern Europe (CEE).
The health transformation that took place after the Second World War in Europe was significantly delayed in the Central and Eastern European (CEE) countries compared to countries of Northern Europe and Great Britain. However, as death rates from cardiovascular disease have begun to fall, cancer has emerged, since the 1990s, as the most common cause of death among young and middle-aged adult women (20-64 years old) in these countries. In the coming decade it seems likely to be the leading cause of death among young and middle-aged adult men.


METHODS
Data on deaths (1959-2002) in each country have been extracted from the World Health Organisation database. Population data are from the Population Division of the Department of Economic and Social Affairs of the United Nations. Direct standardisation has been undertaken using the World Standard Population.


RESULTS
The difference in life expectancy attributable to cancer for the 20-64 years of age group is 0.68 of a year (16% of the total gap) among men and 0.35 of a year (24% of the total) among women. Trends in cancer over time differ significantly by gender, age group and time period in Eastern and Western Europe. The predicted mortality rate in CEE in 2015 equates to 201/100,000 (95% CI 199-204) for men and 106/100,000 (95% CI 104-107) for women.


CONCLUSIONS
In CEE countries, deficiency of primary prevention is a main reason of poor health consciousness (consequences of smoking, fatty diet, low physical activity) and late introduction of secondary prevention responses results in worse survival of the cancer patient; however, tertiary prevention is implemented in a similar way as in western Europe. Our analysis indicates that the greatest possibilities, but also the greatest unmet needs, lie in primary and secondary prevention.
Zatoński
Witold
W
Division of Epidemiology and Cancer Prevention Centre, Marie Sklodowska-Curie Memorial Cancer Centre, 5, Roentgen Str., 02-781 Warsaw, Poland. canepid@coi.waw.pl
Didkowska
Joanna
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008017:Life Expectancy / Q000208:ethnology / Q000639:trends; D008297:Male; D008403:Mass Screening / Q000639:trends; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009369:Neoplasms / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D011322:Primary Prevention / Q000592:standards; D012907:Smoking / Q000401:mortality; D014944:World Health Organization