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Colorectal cancer (CRC) mortality rates in the European Union (EU) and the U.K. have declined since 2018, a new study showed, but trends among younger adults are raising concern.

Using data from the WHO and Eurostat databases, CRC mortality rates have fallen by 4.8% for men and 9.5% for women since 2018, with the largest declines predicted for 2024 among those ages 70 and older (declines in age-standardized rates of -11.6% for men and -15.9% for women), reported Carlo La Vecchia, MD, of the University of Milan, and colleagues.

However, there were unfavorable trends in CRC mortality rates among those younger than 50 in Italy and the U.K., as well as in Poland and Spain for men, and in Germany for women, they noted in .

"I would estimate that about two-thirds of the decline in CRC death rates is due to earlier and better diagnosis and removal of preneoplastic and neoplastic lesions at colonoscopy, and about one-third to better treatment of the disease, including surgery, radiotherapy, and chemo/immunotherapy," La Vecchia told MedPage Today in an email.

The increase in predicted CRC mortality for people ages 25 to 49 may be due to the increasing prevalence of overweight and obesity across more of Europe, he added.

"Alcohol consumption has also been linked to early-onset CRC," the researchers wrote in their paper. "Early-onset CRC tends to be more aggressive and more frequently right-sided compared to late-onset ones. This increase in incidence among young adults prompted the United States Preventive Service Task Force to recommend lowering the age to start CRC screening to 45 years."

The incidence of and mortality from CRC have been rising in young adults in the U.S. since the 1990s, and this trend has also been noted in other high-income countries, the researchers pointed out.

La Vecchia said this increase suggests that the minimum age for CRC screening should be lowered to 45 to 49 in Europe. "Organized programs for CRC screening are present in selected European areas/countries only. Most of these cover ages 50 to 69," he added.

According to the study, a decrease in total cancer mortality rates is predicted in the EU for 2024, with decreases of 6.5% for men and 4.3% for women. In the U.K., total cancer mortality rates are also predicted to fall, with decreases of 13.8% for men and 9.9% for women.

"However, the number of deaths is still rising, with a total of 1,270,800 predicted deaths in 2024 in the EU and 172,900 in the U.K., due to population growth and aging," the authors wrote.

In addition to CRC, there was an overall decrease in predicted stomach cancer mortality rates in the EU among both men and women. In contrast, there was an unfavorable trend for both men and women in regards to pancreatic cancer, with a mortality increase of 1.6% for men and 4% for women. There was also a predicted increase in lung cancer mortality for women of 0.3%.

These predictions were based on cancer death certifications and population data from the WHO and Eurostat databases going back to 1970. La Vecchia and team looked at data for all cancers and for the 10 most common sites of cancer: stomach, colorectum, pancreas, lung, breast, uterus (cervix and uterine corpus), ovary, prostate, and bladder, as well as leukemias. Data were derived for the EU as a whole and for the five most populous countries (France, Germany, Italy, Poland, and Spain) and for the U.K.

The research team has been creating these predictions since 2011, according to La Vecchia. The researchers noted that previous predictions of cancer mortality have been found to be reliable. In the previous set of predictions for 2020, "the errors were about or less than 3% for all neoplasms considered," they wrote.

However, the predictions should be used with caution because they assume there will be no changes in the determinants for recent trends in cancer mortality, they added.

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