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Lifestyle factors driving more bowel cancer deaths in European men, trends study shows

Diet, smoking, linked to higher rates of bowel cancer in men

University of Melbourne

A new study into rates of bowel (colorectal) cancer in Europe reveals a significant reduction in deaths from the disease in women, but more deaths in men.

The University of Melbourne study was published in The British Medical Journal.

Over the past two decades, bowel cancer deaths have steadily decreased in many European countries, mainly due to a reduction in risky health behavior like smoking and drinking alcohol as well as increased screening and advances in treatments. Yet disparities in bowel cancer deaths still exist, particularly between northwest Europe and the rest of Europe.

An international team, led by University of Melbourne epidemiologist Dr Driss Ait Ouakrim, has provided up to date, long-term trends of bowel cancer mortality for all European countries.

Dr Ait Ouakrim and co-author Professor Mark Jenkins, both from the Colorectal Cancer Unit of the Centre for Epidemiology and Biostatistics, collaborated with researchers in France, Italy and Belgium to examine changes in colorectal cancer mortality in 34 European countries.

The team looked at differences by age and sex between 1970 and 2011, using the World Health Organization mortality database.

From 1989 to 2011, bowel cancer mortality increased by an average of 6 per cent for men and decreased by an average of 15 per cent for women in the 34 European countries.

Reductions in bowel cancer mortality of more than 25 per cent in men and 30 per cent in women occurred in Austria, Switzerland, Germany, the United Kingdom, Belgium, the Czech Republic, Luxembourg, and Ireland. By contrast, mortality rates fell 17 per cent or less in the Netherlands and Sweden for both sexes.

Over the same period, smaller or no declines occurred in most central European countries. However, substantial mortality increases occurred in Croatia, the former Yugoslav republic of Macedonia, and Romania for both sexes and in most eastern European countries for men.

Dr Ait Ouakrim said that the difference between the sexes may be explained by behavior. "Men are generally less likely to participate in screening, less informed about health issues, and less inclined to seek medical advice," he said.

"Men also have poorer diets and higher rates of smoking and alcohol consumption than women."

The researchers stress that their results should be interpreted with caution because the reliability of death certification can vary between countries.

However, they say, it is unlikely that errors in diagnostic or certification could have significantly affected the findings.

Dr Ait Ouakrim said countries with the largest reductions in bowel cancer deaths have the highest levels of screening.

"These strategies could be used as models to design and implement effective health policies to prevent more deaths from colorectal cancer," Dr Ait Ouakrim said.

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