Cancer mortality in Europe in 2020, and an overview of trends since 1990.

[INTRODUCTION] Cancer remains a leading cause of death in Europe, with over 1.2 million deaths recorded in the EU-27 in 2020.

[METHODS] Using WHO death certification data for 33 European countries from 1990 to 2020, we analyzed mortality trends for all neoplasms and 24 cancer sites, stratified by sex and age. We computed age-standardized mortality rates (ASMR) and applied joinpoint regression models to evaluate temporal trends.

[RESULTS] In 2020, the leading causes of cancer death in the EU-27 were lung (ASMR: 30.1/100 000), colorectal (14.6/100 000), and prostate (9.8/100 000) cancer in males and breast (13.8/100 000), lung (13.2/100 000), and colorectal (8.6/100 000) cancer in females. Pancreatic cancer was the fourth most common cause of cancer death in both sexes (ASMR: 8.2/100 000 males and 5.8/100 000 females). Most Central and Eastern European countries reported rates over two-fold higher compared to Western Europe. While overall cancer mortality declined since 1990 (average annual percent change: -1.3% in males and -0.8% in females in the EU-27), mortality from pancreatic (+0.2% in males and +0.8% in females) and female lung cancer (+1.9%) increased.

[CONCLUSION] Declines in cancer mortality are attributable to reduced tobacco use, and improvements in organized screening programs and treatment. Pancreatic cancer mortality remains stable, while female lung cancer mortality continues to rise in some countries, largely due to later adoption of smoking and low cessation rates. Lower participation in screening programs and limited access to novel therapies in many Central and Eastern European countries contribute to poorer cancer outcomes, highlighting the need for equitable prevention, early detection, and treatment strategies across Europe.