title: Cancer incidence and mortality patterns in South Eastern Europe in the last decade: gaps persist compared with the rest of Europe.
abstract: BACKGROUND
  Cancer registration coverage and cancer control programmes in South Eastern (SE) Europe, embracing about six new EU member states, remain thin, despite a relatively high incidence and mortality burden from avoidable cancers, particularly in males. We assembled the most recent cancer registry data to estimate the burden of the 17 most common cancers in the region, from Slovenia to Cyprus and Malta.
  
  
  METHODS
  Data were made available for analysis from Bulgaria, Croatia, Cyprus, Malta, Romania (Cluj County), Serbia, Slovenia and Turkey (Antalya and Izmir provinces). We analysed incidence and mortality of the 17 most common cancers (counts and age-standardised rates, for the most recent year available and for the period 1999-2008). We used Joinpoint regression to quantify recent trends.
  
  
  RESULTS
  For much of SE Europe, there were no marked declines in overall cancer mortality rates during 1999-2008. In men, lung cancer incidence and mortality rates were high compared to other European countries (age-standardised rates (ASRW) of incidence being 50-60/100,000 in most of the countries), and still increasing in Bulgaria, Serbia and Turkey. Prostate cancer incidence rapidly increased throughout the region by 3-12% annually, largely without any clear declines in mortality. Colorectal cancer incidence increased throughout the region, as did mortality especially in Croatia, Serbia and Bulgaria (average annual percentage change (AAPC) 1.5-2%). In women, breast cancer mortality significantly declined in Slovenia, Croatia and Malta (Average Annual Percentage of Change [AAPC] -2%, -1% and -5%, respectively), but not elsewhere. Cervical cancer incidence rates remained very high in Romania, Serbia and Bulgaria (ASRW>20/100,000).
  
  
  CONCLUSIONS
  Our data confirmed the North West to South East Europe gradient of increasing incidence and mortality rates of tobacco-related cancers, as well as increasing mortality rates of screen-detectable cancers. The lack of decline in overall cancer mortality also indicates suboptimal levels of cancer control in the region.
authors.affiliation: Croatian National Cancer Registry, Croatian National Institute of Public Health, Zagreb, Croatia. ariana.znaor@hzjz.hr
authors.forename: Ariana
authors.initials: A
authors.lastname: Znaor
authors.forename: Corina
authors.initials: C
authors.lastname: van den Hurk
authors.forename: Maja
authors.initials: M
authors.lastname: Primic-Zakelj
authors.forename: Dominic
authors.initials: D
authors.lastname: Agius
authors.forename: Daniela
authors.initials: D
authors.lastname: Coza
authors.forename: Anna
authors.initials: A
authors.lastname: Demetriou
authors.forename: Nadia
authors.initials: N
authors.lastname: Dimitrova
authors.forename: Sultan
authors.initials: S
authors.lastname: Eser
authors.forename: Hulya
authors.initials: H
authors.lastname: Karakilinc
authors.forename: Snezana
authors.initials: S
authors.lastname: Zivkovic
authors.forename: Freddie
authors.initials: F
authors.lastname: Bray
authors.forename: Jan W Willem
authors.initials: JW
authors.lastname: Coebergh
mesh_terms: D001943:Breast Neoplasms / Q000453:epidemiology / Q000401:mortality; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000401:mortality; D005060:Europe / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality; D008297:Male; D009026:Mortality / Q000639:trends*; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000401:mortality; D012042:Registries / Q000706:statistics & numerical data*; D012044:Regression Analysis; D015996:Survival Rate / Q000639:trends