Where are you most likely to survive cancer in Europe and why?

In 2021, cancer was the second leading cause of death in the European Union, accounting for 1.1 million fatalities. This represented 21.6 per cent of all deaths across the bloc that year.

Scientists have been dedicating significant effort and resources to finding effective cures for cancer, focusing on advancing treatments and improving early diagnosis. 

Cancer survival estimates vary significantly depending on the type of cancer and the country.

Survival refers to the proportion of individuals diagnosed with cancer who remain alive after a specified period. It is commonly expressed as 1-year and 5-year survival.

The term "survival rates" is widely used, but Professor Michel Coleman, Co-Principal Investigator at the CONCORD Central Analytic Team and a professor at the London School of Hygiene and Tropical Medicine, clarifies that cancer survival estimates are probabilities, not rates.

"A rate is a time-dependent quantity, such as an incidence rate or a mortality rate," he explained.

Euronews Health examines cancer survival across Europe, exploring the factors contributing to the disparities among countries.

Cancer-related mortality in Europe

The data includes 24 EU countries, except for Greece, Hungary, and Luxembourg, and five other European countries: the UK, Switzerland, Norway, Iceland, and Turkey, so comparisons are based on these 29 countries.

Before presenting cancer survival estimates, it's important to consider cancer-related mortality across the EU and which cancer types these deaths are attributed to.

According to OECD and Eurostat data from 2019, lung cancer accounted for 24 per cent of cancer-related deaths among men and 15 per cent among women. Colorectal cancer contributed 12 per cent for both sexes. 

Prostate cancer represented 10 per cent of deaths among men, while breast cancer accounted for 16 per cent among women. 

Pancreatic cancer made up 6 per cent of cancer-related deaths in men and 8 per cent in women.

As we explain below and show in the chart, survival estimates can vary greatly depending on the type of cancer.

We’ll dive into some of the reasons for this after going through the estimates in 2010-2014, which are based on data from CONCORD-3, published in The Lancet in 2018 by Professor Claudia Allemani, a professor of cancer epidemiology, and her colleagues at the London School of Hygiene and Tropical Medicine.

Lung cancer survival across Europe

Lung cancer survival varies significantly across Europe, with Bulgaria at the lower end (7.7 per cent) and Switzerland and Latvia at the top (20.4 per cent), while the EU-24 average is 15 per cent.

Other countries with notable survival figures include Iceland (20.2 per cent), Austria (19.7 per cent), Sweden (19.5 per cent), and Norway (19 per cent).

At the lower end, following Bulgaria (7.7 per cent), the lowest survival outcomes are observed in Lithuania (9.9 per cent), Croatia (10 per cent), Czechia (10.6 per cent), and Romania (11.1 per cent).

Among Europe’s five largest economies, Germany leads with a survival figure of 18.3 per cent, followed by France (17.3 per cent) and Italy (15.9 per cent). However, both Spain (13.5 per cent) and the UK (13.3 per cent) fall below the EU average.

Although Nordic countries generally rank well, Finland emerges as an exception, with survival at 13 per cent.

Colon cancer survival across Europe

Survival for colon cancer ranged from 51.1 per cent in Croatia to 72.1 per cent in Cyprus, with the EU-24 average at 60 per cent.

Survival reached 65 per cent or higher in six additional countries, including four Nordic nations: Iceland (68.2 per cent), Belgium (67.9 per cent), Switzerland (67.3 per cent), Norway (66.7 per cent), and both Sweden and Finland at 64.9 per cent.

At the lower end of the spectrum, Slovakia (51.8 per cent), Romania (52.2 per cent), Bulgaria (52.4 per cent), and Poland (52.9 per cent) followed Croatia at the bottom of the rankings.

Among the five largest European economies, Germany had the highest survival at 64.8 per cent, while the United Kingdom had the lowest, at 60 per cent.

Prostate cancer survival is high

Survival for prostate cancer is higher compared to many other types of cancer.

The EU-24 average stands at 87 per cent, with twelve countries achieving survival levels above 90 per cent. Cyprus reported the highest survival at 99.2 per cent, followed by Lithuania (94.3 per cent) and Belgium (93.8 per cent).

The lowest survival was observed in Bulgaria at 68.3 per cent, while Poland, Romania, and Slovakia recorded estimates below 80 per cent.

Survival from breast cancer is also high

Survival for breast cancer is also relatively high, with the EU-24 average at 82 per cent. Cyprus tops the rankings with a survival of 92.8 per cent, followed closely by four Nordic countries, excluding Denmark.

Among the five largest European economies, the difference in survival is minimal, ranging from 85.2 per cent in Spain to 86.7 per cent in France 

Lithuania and Romania recorded the lowest survival, both falling below 75 per cent.

Survival remains critically low for pancreatic and liver cancers

Survival for pancreatic and liver cancers in the EU remains very low compared to many other cancers.

For pancreatic cancer, survival ranged from 5.5 per cent in Malta to 13.7 per cent in Latvia, with the EU-24 average at approximately 9 per cent. The UK had the sixth lowest survival at 6.8 per cent.

Liver cancer survival varied from 4.2 per cent in Estonia to 20.7 per cent in Belgium, with an approximate EU-24 average of 12 per cent.

Once again, the UK reported the lowest survival in this cancer type at 13 per cent, while Italy ranked second highest at 20.3 per cent.

Survival for stomach cancer is just over one in four

Survival for stomach cancer is better than for pancreatic and liver cancers but remains relatively low, at just over one in four (27 per cent) across the EU-24.

Survival ranged from 16 per cent in Bulgaria to 37.5 per cent in Belgium. Cyprus, Austria, and Germany also reported survival estimates exceeding one in three.

Conversely, survival was 20 per cent or below in Denmark and Croatia. The UK ranked fifth lowest, with a survival estimate of 20.7 per cent.

Four in 10 survival rate for ovarian cancer

The survival estimate for ovarian cancer in the EU-24 averaged 39.2 per cent.

Sweden recorded the highest survival at 46.5 per cent, followed closely by Cyprus, Latvia, and Norway, where estimates exceeded 45 per cent.

On the other end, Malta and Ireland reported the lowest survival rates, with figures below one-third. Among the top five economies, the UK had the lowest estimate at 36.2 per cent.

Melanoma cancer survival exceeds 80 per cent

Survival for melanoma cancer varied significantly, ranging from 60.7 per cent in Turkey to 93.6 per cent in Switzerland, with the EU-24 average standing at 83 per cent.

In addition to Germany, Austria, and the Netherlands, all Nordic countries reported higher survival rates, exceeding 87 per cent.

At the lower end, Bulgaria and Poland followed Turkey, with survival estimates below 70 per cent.

Lymphoma survival reaches 60 per cent

Survival for lymphoma, a type of blood cancer, averaged 61 per cent across the EU-24. Romania and Bulgaria reported the lowest survival estimates, below 45 per cent, while Switzerland, Latvia, and Iceland recorded the highest, exceeding 71 per cent.

Why does survival vary across cancer types?

"They're very different diseases," Coleman, a professor of epidemiology, said in an interview with Euronews Health.

"Depending on where the cancer occurs and the type of organ that is nearby, they are more or less lethal depending on the type of the cell, the genetic makeup, and organs that are nearby," he added. 

For example, he noted, a tumour that arises in the brain is more likely to kill someone than one that arises in the foot.

However, the survival gap isn't solely due to differences between diseases. Other factors include variations in the availability and advancement of treatments, as well as the stage at which the cancer is diagnosed, Coleman explained.

"If a cancer is very early and localised, it stands to reason that survival will be better with a given treatment than if the survival is very advanced and widespread when it is diagnosed," he said.

Why does cancer survival vary significantly across countries?

On the differences in survival estimates between countries, Coleman offered two key explanations.

Firstly, they relate to the differences in this age of diagnosis, which are huge influences on the probability of surviving. The stage varies widely between countries for any given cancer.

Secondly, the availability of and access to different treatments that are more or less effective also varies between countries.

"For example, radiotherapy which is used or significant as a potentially curative treatment for almost half of all cancers is much more widely available in the richer countries of Western and Northern Europe than is the case in the less advanced countries in Eastern and in some cases Southern Europe," he said.

Regarding why survival rates are poorer in the UK compared to Germany and France, Dr Volker Arndt from the German Cancer Research Center (DKFZ) told Euronews Health, "this difference presumably relates to differences in healthcare capacity and how the healthcare system is organized, including waiting times".

Allemani, also a Co-Principal Investigator at CONCORD, emphasised the critical role of treatment availability, noting that while early diagnosis is essential, it is insufficient without access to effective treatment.

She also stressed the importance of cancer registration in Europe, warning that many registries, particularly in Eastern Europe, are currently threatened.