Europe is facing a growing cancer burden, as more people are living with cancer amid rising incidence and falling mortality. From 2000 to 2022, age‑standardised cancer incidence in the EU increased by 10% among women and 2% among men. Between 2000 and 2023, cancer mortality declined across EU countries, owing to early detection initiatives and advances in diagnosis and treatment. As a result of these trends, the share of the EU population who have ever been diagnosed with cancer increased from 3.9% to 4.8% between 2010 and 2020. Recent epidemiological evidence also points to a rise in early-onset cancer among adults aged 15‑49. Following collection and harmonisation of cancer registry data from 24 EU countries, Iceland and Norway, the chapter presents cross-country comparable evidence on cancer incidence trends in both the general and younger populations.
Delivering High Value Cancer Care
Abstract
Cancer incidence has increased by 10% among women and 2% among men on average across EU countries in age‑standardised terms between 2000 and 2022
From 2000 to 2022, age‑standardised cancer incidence among women increased by +10% (from 431 to 474 per 100 000 women) on average across 24 EU countries and by +2% among men (from 661 to 674 per 100 000 men). In crude terms, cancer incidence surged by about 30% for both sexes. Breast and lung cancers are the key drivers of the overall increase in cancer incidence among women. Among men, the increase in prostate and skin melanoma cancers is mostly offset by a substantial decrease in lung and stomach cancers.
In 2024, the estimated number of new cancer cases was 1.2 million in women and 1.4 million in men across the 27 EU countries, which means that every minute more than five people are newly diagnosed with cancer in the EU. Estimated age‑standardised cancer incidence was 38% higher among men than women. Half of the estimated incidence was accounted for by the three cancer sites: breast (30%), colorectal (12%) and lung (9%) cancers for women and prostate (22%), lung (14%) and colorectal (13%) cancers for men.
Pancreatic cancer was estimated to be the sixth most common cancer among women in 2024. Its age‑standardised observed incidence increased by 17% in women and 11% in men on average across EU countries from 2000 to 2022. This is a cause of concern, given the low survival rates and limited survival improvements in pancreatic cancer to date.
Cancer mortality dropped across almost all sites, by 18% in women (from 199 to 163 per 100 000 women) and 26% in men (from 372 to 275 per 100 000 men) in age‑standardised terms from 2000 to 2023 in EU countries.
In 2023, cancer mortality remains higher among men than women across all EU countries, Norway and Iceland (referred to as “EU+2 countries” in the report), but gender gaps have narrowed due to larger declines in male mortality.
Age‑standardised cancer mortality rates fell by 24% for male lung cancer and 17% for female colorectal cancer. However, mortality from pancreatic cancer increased for both sexes, which is likely driven by increased incidence and limited progress in survival.
Amid rising incidence and falling mortality, the EU population living with cancer is estimated to have grown by 24% between 2010 and 2020, reaching 5% prevalence in both women and men.
A large social gradient exists in cancer mortality among both men and women, even though overall cancer mortality is consistently declining. Across EU countries, men with a low level of education face an 83% higher cancer mortality rate than highly educated men, while women with a low level of education are 31% more likely to die from cancer than highly educated women.
Early-onset cancer has risen widely among women in 22 EU+2 countries between 2000 and 2022, while increases among men were noted in 12 EU+2 countries
Age‑standardised cancer incidence among younger women aged 15‑49 increased by 16% on average across EU countries from 2000 to 2022 (from 144 to 167 per 100 000 women), based on the harmonised incidence data of 24 EU countries, Iceland and Norway.
Among women, the most significant drivers of the increase in early-onset cancers are breast (+16%), thyroid (+120%), skin melanoma (+48%) and colorectal (+10%) cancers.
Among men, early-onset cancer incidence has remained stable between 2000 and 2022, at 97.0 per 100 000 men. The incidence of early-onset testicular (+38%), skin melanoma (+50%) and colorectal cancers (+12%) increased during this period, while the incidence of early-onset lung cancer substantially decreased (‑57%).
In other OECD countries, trends in cancer incidence among younger populations are similar to those in EU+2 countries. However, the age‑standardised incidence of colorectal cancer among the younger population has increased faster for both sexes in Australia, Canada, Chile, Korea, New Zealand, Türkiye, the United Kingdom and the United States.
Three main drivers are likely behind the observed increase in early-onset cancer incidence. First, an increase in the risk of developing cancer due to changing risk factors and exposures in the younger population compared to older generations (for example shifts in reproductive patterns, metabolic factors and lifestyles). Second, expanded cancer diagnostic scrutiny (expansion to younger age groups, increased uptake and access to cancer screening programmes) results in earlier age of detection and a higher number of diagnoses. Third, increased use of diagnostic imaging and testing in healthcare increases the detection of asymptomatic cancers which would otherwise have been diagnosed later or remained undiagnosed, known as incidental diagnoses.
The growing number of people living with a cancer diagnosis, together with the rise in early-onset cases, is shifting cancer care needs and will affect well-being for many years to come
Strengthening cancer registries in EU countries is key. While many countries have well-established cancer registries, it is essential to strengthen the collection of observed prevalence data as well as observed survival data, ensure the quality of clinical data (such as staging and treatment data), and establish linkages with administrative data to enhance cancer burden monitoring and to anticipate needs for survivorship care and rehabilitation services.
While the overall cancer burden remains higher among men, women are disproportionately affected by early-onset cancers. Given their disadvantaged positions in labour markets and longer life expectancy, the need for strengthened cancer survivorship, employment and financial support increases (Chapter 5).
It is imperative to enhance access to timely cancer diagnosis and treatment to reduce delays that adversely impact health outcomes (Chapter 3) – particularly among disadvantaged populations at higher risk of cancer. Given the growing cancer incidence among younger populations, it is also vital to provide evidence‑based and efficient cancer care (Chapter 4), and to promote social and economic well-being of cancer patients and survivors, notably through a people‑centred approach (Chapter 5).
Driven by higher incidence rates and longer survival, the prevalence of cancer continues to rise across the EU. Based on the European Standard Population 2013, the observed age‑standardised cancer incidence has increased by 10% among women (from 431 to 474 per 100 000) between 2000 and 2022 (or the nearest available year) and by 2% among men (from 661 to 674 per 100 000) (Figure 2.1, Panel A). Furthermore due to the ageing population, in crude terms, cancer incidence has surged by about 30% for both sexes (Annex Figure 2.A.1), meaning that more men and women are being diagnosed with cancer. This places additional pressure on healthcare resources and services.
By contrast, there is a downward trend in cancer mortality. From 2000 to 2023, age‑standardised cancer mortality rates dropped by 18% for women and 26% for men (Figure 2.1, Panel B). Lower mortality rates are partly explained by a reduced incidence of cancers with poor survival prospects – most notably, lower lung cancer rates among men due to decreased smoking. They also reflect higher survival rates, driven in part by better access to early detection and treatment (see Chapter 3), as well as advances in cancer treatments, including more effective surgical procedures and innovative technologies (see Chapter 4).
As a result of increased incidence and decreased mortality, the prevalence of cancer has risen substantially. According to the EUROCARE‑6 study (De Angelis et al., 2024[1]), the share of the EU population ever diagnosed with cancer rose from 3.9% in 2010 to 4.8% in 2020, and the estimated crude prevalence rates increased by 38% overall (35% among women and 42% among men). Even after adjusting for population ageing, prevalence rates grew by more than 24% in both sexes over the same period (Figure 2.1, Panel C). These findings not only indicate that the number of people living with and beyond a cancer diagnosis is increasing across EU countries – adding to the overall cancer burden – but also signal that cancer care systems must adapt to growing demand for follow-up care, rehabilitation, and long-term support for patients, survivors and informal carers (see Chapter 5).
Furthermore, a growing body of epidemiological literature has over the last decade documented an increase in cancer incidence among younger populations, which is commonly referred to as early-onset cancer (EOC) (Scott et al., 2020[2]; Hamilton et al., 2022[3]; Ugai et al., 2022[4]; Koh, Tan and Ng, 2023[5]; Zhao et al., 2023[6]; Ogino and Ugai, 2024[7]; Shiels et al., 2025[8]). These studies consistently demonstrate rising cancer incidence among younger adults, often defined as those aged below 50 or 40 years. In this chapter, early onset cancer is defined as cancer occurring among young adults aged 15‑49.
Age‑standardised rate per 100 000, EU average
Note: The EU averages are unweighted except for Panel C. All cancer sites except for non-melanoma skin cancer are included. Age‑standardisation is based on the 2013 European Standard Population. For Panel A, Greece, Luxembourg and Romania are not included – see also Annex 2.B. For Panel B, Cyprus and Malta are not included – see also the note of Figure 2.7. For Panel C, the cancer prevalence rate is defined as the share of people who have ever been diagnosed with cancer regardless of when the diagnosis occurred.
Source: OECD calculations based on the following data: European Cancer Information System (ECIS) https://ecis.jrc.ec.europa.eu/, accessed on 25 November 2025; International Agency for Research on Cancer (IARC), https://gco.iarc.fr/overtime/en; Lapôtre‑Ledoux et al. (2023[9]) “Incidence des principaux cancers en France métropolitaine en 2023 et tendances depuis 1990”, http://beh.santepubliquefrance.fr/beh/2023/12-13/2023_12-13_1.html; National Institute of Oncology, National Cancer Registry of Hungary (NRR), https://stat.nrr.hu/; Causes of mortality, OECD Health Statistics; De Angelis, et al. (2024[1]) “Complete cancer prevalence in Europe in 2020 by disease duration and country (EUROCARE-6): a population-based study”, https://doi.org/10.1016/S1470-2045(23)00646-0.
EU countries are no exception to this epidemiological trend. The age‑standardised cancer incidence of people aged 15 to 49 accounts for 18% of the overall change in incidence on average between 2000 and 2022 (Figure 2.2). Overall, the age‑standardised incidence in the EU increased by 28.2 per 100 000 population from 2000 to 2022, with 18.4 per 100 000 attributable to those aged 65 and over, followed by 5.0 per 100 000 attributable to those aged 15‑49. Among women, the increase in early-onset cancer contributed to nearly a quarter of the overall change, while it remained almost unchanged among men. Although the cancer burden remains concentrated among adults aged 50 and over, cancer care systems must adapt to meet the needs of a growing number of younger people living with a cancer diagnosis who require treatment, monitoring, and follow-up care.
Contribution to the overall change in age‑standardised cancer incidence rates by age group, from 2000 to 2022 (or nearest year), EU24 average
Note: The EU24 averages are unweighted and do not include Greece, Luxembourg or Romania. All cancer sites except for non-melanoma skin cancer are included. Age‑standardisation is based on the 2013 European Standard Population. See methodological information in Annex 2.B.
Source: OECD calculations based on the following data: European Cancer Information System (ECIS) https://ecis.jrc.ec.europa.eu/, accessed on 25 November 2025; International Agency for Research on Cancer (IARC), https://gco.iarc.fr/overtime/en; Lapôtre‑Ledoux et al. (2023[9]) “Incidence des principaux cancers en France métropolitaine en 2023 et tendances depuis 1990”, http://beh.santepubliquefrance.fr/beh/2023/12-13/2023_12-13_1.html; National Institute of Oncology, National Cancer Registry of Hungary (NRR), https://stat.nrr.hu/.
This chapter presents recent epidemiological developments in the cancer burden across EU27 countries, Iceland and Norway (hereinafter referred to as “EU+2 countries” in this chapter), focussing on cancer incidence and mortality (see Box 2.1). Section 2.2 presents estimated cancer incidence for 2024 and analyses incidence trends from 2000 to 2022 (or the nearest available year). Section 2.3 then discusses changes in cancer mortality from 2000 to 2023, including a focus on disparities by education levels. Section 2.4 provides a special focus on early-onset cancer in EU+2 countries including details on the most common cancer sites among those aged 15‑49. Finally, Section 2.5 discusses policy implications, including the need to address socio-economic inequalities in the cancer burden and to strengthen survivorship programmes and support services, particularly for those diagnosed at a younger age.
While this chapter primarily focusses on cancer incidence and mortality, the prevalence of people who have ever been diagnosed with cancer is not fully incorporated due to data gaps in cancer registries. Notably, prevalence figures based directly on cancer registries are publicly available in only 15 EU+2 countries: the five Nordic countries (via NORDCAN), Austria, Belgium, Czechia, Ireland, Italy, Latvia, the Netherlands, Poland, Slovenia and Spain.1
Estimates of cancer prevalence are also produced by EUROCARE, the International Agency for Research on Cancer (IARC), and the Institute for Health Metrics and Evaluation (IHME). However, the lack of registry-based prevalence constrains policymakers’ ability to anticipate needs for survivorship care, long-term follow-up and rehabilitation services (OECD, 2024[10]). Given that 27 EU+2 countries have well-established cancer registries that all record incidence, mortality and survival (Table 2.1) – theoretically enabling the calculation of prevalence – there is scope to further strengthen the availability of prevalence data derived from registries. CancerWatch, a new EU initiative to improve the quality and timeliness of cancer registry data, represents a meaningful step toward producing timely and more reliable cancer burden indicators.
The completeness of clinical data and mechanisms to ascertain its quality are also critical for the reliability of cancer registries (see Chapter 4). Cancer patients are often required to undergo multiple examinations and treatments from various healthcare providers. Clinical data, screening participation data, cancer staging and treatment information are recorded or linked from relevant sources in the majority of EU+2 countries (Table 2.1). Staging information is particularly important for analysing the cancer burden, as increases in cancer incidence may be a simple product of expansion in screening programmes, resulting in earlier detection and the potential overdiagnosis of some cancers (e.g. thyroid and prostate cancers). Without staging information, it is difficult to distinguish inflated incidence from genuine progress in detection, diagnosis, and treatment, as overdiagnosis may artificially reduce mortality and inflate survival estimates (Cho et al., 2014[11]; Ellis et al., 2014[12]). Linkages between screening programmes and staging information are particularly essential for assessing the effectiveness of early detection programmes.
Lastly, it is important to establish necessary linkages between cancer registries and other population or administrative databases. Without such linkages, the capacity to explore the cancer burden remains constrained, limiting, for example, the monitoring of socio-economic inequalities in cancer (see Box 2.2). Equally important patient-reported indicators on quality of life, treatment side effects and psychosocial outcomes remain largely absent from registry data. Although some patient-reported indicators are available in Belgium, Denmark, the Netherlands and Norway, they are not collected systematically for all cancers (Table 2.1). While routine collection of patient-reported information may require additional resources and tools, the lack of these indicators undermines the development of patient-centred cancer care, as highlighted in Chapter 5, and limits countries’ ability to assess whether improved survival is matched by improvements in survivors’ lived experiences.
Recorded in the cancer registry or linked to other databases (denoted as ✔)
1. Greece’s national cancer registry was established in February 2024 and is currently under development.
2. Romania’s national cancer registry is under development in accordance with the National Plan for Preventing and Combating Cancer in Romania 2023‑2030 and it is anticipated that all indicators mentioned above will be collected.
3. For socio-economic status information, data collection is occasional in Belgium and a work in progress in Norway.
Source: 2023 OECD Policy Survey on Cancer Care Performance; 2025 OECD Policy Survey on High-Value Cancer Care.
1. National cancer prevalence is estimated in Italy and Spain, because their regional cancer registries do not cover the entire population.
2.2.1. It is estimated that more than five people were diagnosed with cancer every minute in the EU in 2024
The European Cancer Information System (ECIS) estimates that in 2024, the number of new cancer cases in the EU27 countries stands at 1.2 million among women and 1.4 million among men. In other words, this corresponds to 2.4 women and 2.8 men being diagnosed with cancer every minute, totalling 5.1 new cancer diagnoses per minute. In age‑standardised terms, cancer incidence is estimated at 547 per 100 000 population on average across EU countries for both sexes as of 2024, comprising 471 per 100 000 among women and 650 per 100 000 among men (Figure 2.3).
Based on the 2013 European Standard Population, age‑standardised incidence rates are 38% higher among men than women on average in EU countries (Figure 2.3, Panel A). Among men, the rates are above 700 per 100 000 in Estonia (793 per 100 000), Lithuania (771), Croatia (736), Denmark (733) and Hungary (732), and below 600 per 100 000 in Cyprus (459), Bulgaria (501), Luxembourg (544), Malta (561), and Austria (588). Among women, estimated age‑standardised cancer incidence rates are the highest in Denmark (618) and the Netherlands (555) and the lowest in Bulgaria (344), Cyprus (351), Lithuania (400) and Spain (403).
Gender gaps in age‑standardised incidence rates are the largest in the Baltic countries, namely Lithuania (with 371 more men than women diagnosed per 100 000), Estonia (+338) and Latvia (+291). By contrast, the lowest gender gaps are estimated for Malta (+80), Cyprus (+109), the Netherlands (+110), Denmark (+) and Sweden (+119). Regarding socio-economic gaps in cancer incidence, see Box 2.2.
The six most common cancer sites account for approximately two‑thirds of age‑standardised cancer incidence rates on average across the 27 EU countries for both women and men (Figure 2.3, Panel B). For women, these cancer sites were estimated to be breast, colorectal, lung, corpus uteri, skin melanoma and pancreas. It is estimated that 51% of female cancer incidence can be explained by breast (30%), colorectal (12%) and lung (9%) cancers in 2024, whereas half of the male cancer incidence is accounted for by prostate (22%), lung (14%) and colorectal (13%) cancers. As for female cancer incidence, it is concerning that pancreatic cancer is estimated as the sixth most common cancer (17 per 100 000 women), especially because survival is very low and has not significantly improved over the last two decades.
Overall, ECIS estimated that by 2040, there will be 3.2 million cancer cases in the EU – an increase of half a million cases (18%) as compared to ECIS’ previous 2022 estimates.
Estimated age‑standardised cancer incidence rate per 100 000, 2024
Note: Age‑standardisation is based on the 2013 European Standard Population. The estimates are based on incidence trends from previous years and may differ from observed rates in more recent years. In Panels A and B, all cancer sites except for non-melanoma skin cancer are included. In Panel B, “lung” indicates trachea, bronchus and lung. According to data from the Cancer Registry of Norway, ECIS estimations overestimate the country’s cancer incidence rate.
Source: European Cancer Information System (ECIS) https://ecis.jrc.ec.europa.eu/, accessed on 12 December 2025.
Growing evidence indicates that the pattern of cancer incidence significantly differs by socio‑economic status (SES). Inequalities arising from income, education or occupation are widely documented in epidemiological studies (Conway et al., 2019[13]). Accordingly, adults with lower SES are at higher risk of being diagnosed with lung, stomach, cervical and pancreatic cancers, while adults with higher SES have higher risk of breast, thyroid, skin melanoma and prostate cancers (Mihor et al., 2020[14]; Li et al., 2024[15]; Pizzato et al., 2025[16]).
The majority of European cancer registries lack SES information on registrants or do not have linkage to external databases containing these data (Box 2.1). Furthermore, researchers often resort to location-based deprivation indicators or quintiles to proxy the social circumstances of cancer patients and track inequalities in the cancer burden. The National Cancer Registry of Ireland and the Swedish National Board of Health and Welfare for example can link SES data or apply location-based deprivation quintiles where relevant, enabling the dissemination of age‑standardised cancer incidence, mortality and survival rates by SES. In Ireland, while people in the most deprived areas are less likely to be newly diagnosed with breast and prostate cancer, they are most likely to be diagnosed at later stages of these cancers, signalling differences in diagnostic patterns among those with lower SES (Bambury et al., 2023[17]).
In Sweden, the age‑standardised cancer incidence for men and women in the lowest SES category (Level 1) was 4% and 6% lower, respectively, than those with the highest SES (Level 5) (Figure 2.4, Panel A). However, the mortality rate for men and women in the lowest SES category (Level 1) was 43% and 23% higher, respectively, than for those in the highest category (Level 5) (Figure 2.4, Panel B). These findings suggest lower detection rates among disadvantaged population.
Cancer incidence and mortality by area-based socio-economic status level, Sweden, 2023
Note: SES Levels 1 to 5 are ordered from the lowest to the highest level of SES.
Source: National Board of Health and Welfare’s Analysis Tool (Socialstyrelsens analysverktyg, Sweden), https://dataanalys.socialstyrelsen.se/superset/dashboard/cis_start/.
Similar evidence is reported for breast cancer patients in a French population-based study (Borghi et al., 2024[18]). The age‑standardised incidence rates of breast cancer are on average 15% lower in the least affluent areas than in the most affluent areas during the period of 2008 to 2015, but women in the least affluent areas are 18% more likely to be diagnosed at later stages (stages III-IV) than those in the most affluent areas.
2.2.2. From 2000 to 2022, age‑standardised cancer incidence rates increased by 10% among women and by 2% among men across EU countries
With Europe’s ageing population and rising life expectancy, the share of the population newly diagnosed with cancer has been on the rise. Drawing on OECD analyses of cancer registry data, this section presents observed incidence trends from 2000 to 2022 or the nearest available year. It should be noted that cross-country comparisons of incidence trends are subject to limitations from variations in the scope and quality of cancer registries. Methodological details and source data are elaborated in Annex 2.B and Annex Table 2.B.1, respectively.
Between 2000 and 2022, cancer incidence has risen among women and men. In crude terms, cancer incidence increased substantially between 2000 and 2022 – by 29% in women and 31% in men (Annex Figure 2.A.1), indicating that more people are being diagnosed with cancer. This rise is largely driven by population ageing and longer living populations: as the share of older individuals grows, the number of cancer diagnoses naturally increases. When the effect of ageing population is removed using the 2013 European Standard Population, the trend is more modest. Age‑standardised incidence rates rose by 10% in women (from 431 to 474 per 100 000 women), while increasing slightly by 2% in men (from 661 to 674 per 100 000 men) (Figure 2.5). As such, gender gaps in incidence rates have narrowed across EU countries, with the EU average gender gap falling by 13% from 230 to 200 per 100 000.
Female cancer incidence rates increased widely in 20 out of the 24 EU countries during this period. Significant increases are observed in Cyprus (+46%), Croatia (+28%), Latvia (+26%) and Norway (+23%), although part of this rise may result from improved screening and diagnostic pathways as noted in Annex 2.B. On the contrary, age‑standardised female cancer incidence has declined in Austria (‑14%), Hungary (‑9%), Czechia (‑3%) and Germany (‑1%) from 2000 to 2022.
Among men, age‑standardised cancer incidence has risen in around half of the 24 EU countries, with the largest increases registered in the Baltic countries – Estonia (+24%), Latvia (+27%) and Lithuania (+22%) – and Cyprus (+40%), whereas substantial reductions were recorded in Austria (‑21%), Italy (‑16%), Germany (‑13%), Hungary (‑13%) and Belgium (‑13%).
When it comes to other OECD countries, Australia shows the highest cancer incidence for both women and men as of 2017. Substantial increases are observed among women in Korea (+47%) and Japan (+31%), and among men in Colombia (+16%) and Japan (+14%). By contrast, age‑standardised cancer incidence rates declined for both sexes in Chile, Israel, New Zealand and the United States.
Age‑standardised cancer incidence rate per 100 000, all ages, 2000 and 2022 (or nearest year)
Note: The EU24 averages are unweighted and do not include Greece, Luxembourg or Romania. All cancer sites except for non-melanoma skin cancer are included. Age‑standardisation is based on the 2013 European Standard Population. The latest available years are 2010 for Portugal and the Slovak Republic, 2015 for Bulgaria and Japan, and 2017 for other OECD countries. Given that population coverage within the referenced registry data differs between countries, the results should be interpreted with caution. See also the methodological information in Annex 2.B.
Source: OECD calculations based on the following data: European Cancer Information System (ECIS) https://ecis.jrc.ec.europa.eu/, accessed on 25 November 2025; International Agency for Research on Cancer (IARC), https://gco.iarc.fr/overtime/en; Lapôtre‑Ledoux et al. (2023[9]) “Incidence des principaux cancers en France métropolitaine en 2023 et tendances depuis 1990”, http://beh.santepubliquefrance.fr/beh/2023/12-13/2023_12-13_1.html; National Institute of Oncology, National Cancer Registry of Hungary (NRR), https://stat.nrr.hu/.
Analysing the evolution of incidence by cancer site reveals that breast and lung cancers are the key drivers of the overall increase in cancer incidence among women from 2000 to 2022 (Figure 2.6). The age‑standardised incidence rate of breast cancer has risen by +14 per 100 000 women (from 119 to 133 per 100 000), increasing in 19 out of 24 EU countries. Comprehensive reviews by Mao et al. (2023[19]) and Obeagu and Obeagu (2024[20]) highlight a strong association of late menopause and delayed childbirth with breast cancer incidence. In addition to these reproductive factors, hormone replacement treatment, family history of breast cancer, behavioural risk factors (including alcohol consumption, overweight and obesity) are also noted as risk factors.
The age‑standardised incidence of lung cancer increased by +14 per 100 000 women (from 27 to 41 per 100 000). Increasing lung cancer incidence among women is related to smoking rates in the EU area, which reached a peak and started falling over the last decade (OECD/European Commission, 2025[21]). Incidence has also surged by 62% (from 13 to 21 per 100 000) for skin melanoma and by 98% (from 9 to 17 per 100 000) for thyroid cancer. As for thyroid cancer, this trend may reflect issues of cancer overdiagnoses as highlighted in earlier literature (Li, Maso and Vaccarella, 2020[22]). By contrast, ovarian and cervical cancer incidence has declined, the latter likely related to initiatives aimed at vaccinating against human papillomavirus (HPV) (Nygård et al., 2024[23]; Zhang et al., 2025[24]).
The limited increase in cancer incidence rates among men is due to a large reduction in the incidence of lung cancer (by ‑23 per 100 000 men, from 114 to 91 per 100 000), with the gradual decline in men’s smoking rates likely contributed to this trend (OECD/European Commission, 2025[21]), and stomach cancer (by 12 per 100 000 men, from 35 to 23 per 100 000). This decrease more than offset an increase of 19 and 12 per 100 000 men for prostate and skin melanoma cancers, respectively (Figure 2.6). However, between 2000 and 2022, the incidence of prostate cancer has at least doubled in Estonia, Poland and Latvia. Available evidence suggests that the rise in incidence observed in these countries is associated with the broader use of prostate‑specific antigen (PSA) testing, while the impact on prostate cancer mortality has remained minimal, indicating potential overdiagnosis (Heijnsdijk et al., 2009[25]; Bray et al., 2010[26]; Patasius, Krilaviciute and Smailyte, 2020[27]; Vaccarella et al., 2024[28]; Hugosson et al., 2022[29]; Patasius et al., 2019[30]).
Age‑standardised cancer incidence rate per 100 000 by cancer site, EU average
Note: The EU averages are unweighted and do not include Greece, Luxembourg or Romania. Age‑standardisation is based on the 2013 European Standard Population. See also the methodological information in Annex 2.B.
Source: OECD calculations based on the following data: European Cancer Information System (ECIS) https://ecis.jrc.ec.europa.eu/, accessed on 25 November 2025; International Agency for Research on Cancer (IARC), https://gco.iarc.fr/overtime/en; Lapôtre‑Ledoux et al. (2023[9]) “Incidence des principaux cancers en France métropolitaine en 2023 et tendances depuis 1990”, http://beh.santepubliquefrance.fr/beh/2023/12-13/2023_12-13_1.html; National Institute of Oncology, National Cancer Registry of Hungary (NRR), https://stat.nrr.hu/.
Lastly, the age‑standardised incidence of colorectal cancer slightly decreased in both sexes between 2000 and 2022, from 56 to 54 per 100 000 women and from 90 to 87 per 100 000 men. On the other hand, the age‑standardised incidence rate of pancreatic cancer rose by 17% in women (from 13 to 15 per 100 000 women) and by 11% in men (from 19 to 21 per 100 000 men) compared to 2000. A growing body of recent literature indicates that cadmium, a non-nutritive heavy metal widely distributed in the environment, is associated with pancreatic carcinogenesis. The most recent systematic review indicated that individuals exposed to cadmium had more than twice the risk of developing pancreatic cancer compared to those with lower or no exposure (Soleimani et al., 2025[31]).
2.3.1. From 2000 to 2023, average age‑standardised cancer mortality rates dropped by 18% among women and 26% among men in EU countries
During the period of 2000 to 2023, the EU average of age‑standardised cancer mortality rates dropped by 18% in women (from 199 to 163 per 100 000 women) and by 26% in men (from 372 to 275 per 100 000 men) (Figure 2.7).1 Mortality rates remained consistently higher among men than women in both 2000 and 2023 in all EU+2 countries. However, gender gaps in mortality rates narrowed from 174 per 100 000 in 2000 to 111 per 100 000 in 2023. Combined with stable incidence in men and rising incidence in women, gender gaps in cancer burden are gradually closing.
In 2023, female cancer mortality rates were highest in Hungary (219 per 100 000 women), Croatia (199), Denmark (191) and Slovenia (188), whereas they were relatively lower in Southern European countries: Spain (130), Portugal (138) and Greece (138). A significant decrease in female cancer mortality rates was recorded in Denmark, Czechia, Ireland and Hungary, whereas improvements were more moderate in Bulgaria, Latvia and Romania. Malta also saw a large decline in female cancer mortality between 2012 and 2022 (Annex Figure 2.A.2).
Male cancer mortality rates were the highest in Croatia (371 per 100 000 men), Hungary (366) and Latvia (364), whereas they were substantially lower in Luxembourg (188) and the Nordic countries – Sweden (196), Iceland (215), Finland (216) and Norway (223). Moreover, cancer mortality declined almost 40% or more in Luxembourg, Czechia, Hungary and Belgium.
Age‑standardised cancer mortality rates are generally lower for both sexes in other OECD countries. In 2023, age‑standardised mortality rates in women were most elevated in the United Kingdom (186 per 100 000 women), Canada (165), Chile and the United States (157), with the largest declines recorded in Israel, the United States and Costa Rica during the period of 2000 to 2023. Among men, cancer mortality rates were the highest in the United Kingdom (257 per 100 000 men), Japan (239) and Australia (234) in 2023, but substantially lower in Mexico (137) and Costa Rica (180). Similarly to EU+2 countries, reductions in age‑standardised cancer mortality rates have been larger among men.
Age‑standardised cancer mortality rate per 100 000
Note: The EU24 averages are unweighted and do not include Cyprus and Malta. Age‑standardisation is based on the 2015 OECD population. See also note 1. 2022 data are used for Belgium, Bulgaria, Canada, Chile, Costa Rica, Denmark, Estonia, France, Greece, Ireland, Israel, Italy, Korea, Mexico, Portugal, Romania and the United States. 2021 data are used for Colombia, Croatia, Japan and the United Kingdom.
Source: OECD Health Statistics 2025.
On average across the 27 EU countries, cancer mortality has declined across almost all sites (Figure 2.8). For women, reductions in cancer mortality chiefly stem from colorectal (‑4.3 per 100 000 women), breast (‑2.7) and stomach (‑2.6) cancers, collectively reaching a reduction of ‑9.5 per 100 000 women, although lung cancer mortality rates increased by +2.3 per 100 000. For men, reductions in cancer mortality rates are substantially higher in general, driven mostly by gains from lung (‑21.6 per 100 000 men), colorectal (‑8.1), stomach (‑5.7) and prostate (‑4.8) cancers.
Recent evidence shows that the introduction of early detection programmes is linked to lower cancer mortality rates. A population-based study on colorectal cancer screening found that early adopters of opportunistic screening with guaiac-based faecal occult blood tests (gFOBT) – particularly Austria (1980), Czechia (2000) and Germany (1977) – experienced a sharper decline in colorectal cancer mortality, averaging about 3% per year (Cardoso et al., 2021[32]). A scoping review of breast cancer screening programmes in Europe shows that the decrease in cancer mortality between breast cancer screening participants and non-participants is estimated between 33% and 43% in the Nordic and Baltic countries, between 43 and 45% in Southern Europe (Cyprus, Gibraltar, Greece, Italy, Malta, Portugal and Spain), and between 12% and 58% in Western Europe (Austria, Belgium, France, Germany, Ireland, Luxembourg, the Netherlands, Switzerland, the United Kingdom) (Zielonke et al., 2020[33]).
For both sexes, pancreatic cancer mortality increased, by +0.9 per 100 000 women (from 14.3 to 15.2 per 100 000) and by +0.6 per 100 000 men (from 19.6 to 20.2 per 100 000) in the decade to 2022. This increase is most likely driven by the incidence of this cancer increasing by 17% in women and by 11% in men on average across EU countries since 2000 (Section 2.2.22.2). Given the limited progress in survival, efforts to increase care concentration for pancreatic surgeries to improve outcomes (see Chapter 4) as well as to increase the availability of palliative care are crucial within European cancer care systems to address this burden (see Section 2.5.3and Chapter 5).
Age‑standardised cancer mortality rate per 100 000, by cancer site, EU average
Note: The EU averages are weighted. Age‑standardisation is based on the European Standard Population 2013. Upper aerodigestive tract combines lip, oral cavity, pharynx, larynx and oesophagus. See also note 1.
Source: Causes of death (Eurostat), https://doi.org/10.2908/HLTH_CD_ASDR2.
2.3.2. Educational disparities in cancer mortality remain substantial, with estimated mortality gaps reaching 31% for women and 83% for men in the EU
Socio-economic inequalities are a major driver of cancer mortality levels and trends in Europe, particularly for cancer types related to tobacco consumption and infections (OECD/European Commission, 2025[21]; Vaccarella et al., 2023[34]). The EU Cancer Inequalities Registry country factsheets 2015‑2019 demonstrate differences in cancer mortality between those with primary education and those with tertiary education (EC/IARC/Erasmus MC, 2025[35]). Estimated age‑standardised cancer mortality rates are consistently higher among people with a lower level of education for both women and men (Figure 2.9), with very few exceptions (i.e. only in Slovenia, Spain and France – where estimated educational disparities are insignificant for women).
On average across the 27 EU countries, gaps in cancer mortality are 79 per 100 000 among women aged 40‑70 (333 per 100 000 among those with low education vs. 254 per 100 000 among those with high education) and 265 among men (583 vs. 318 respectively) for the period of 2015 to 2019. For women, mortality gaps are the largest in Denmark (179 per 100 000), Norway (179) and Lithuania (168).
Among men, Hungary records the highest cancer mortality rates for people at both education levels (1 127 per 100 000 for the low educated versus 507 for the high educated) with the largest mortality gap (620 per 100 000 men) among all EU+2 countries. Moreover, the Baltic and Central European countries tend to have above‑average mortality differences between men with a low level of education and men with a high level of education: e.g. Czechia (548 per 100 000),2 Latvia (538), Lithuania (538), Croatia (500), Estonia (461), Romania (461).
These gaps in cancer morality may be partially explained by differences in the adherence to cancer screening programmes between people with lower SES and people with higher SES (see also Chapter 4). As noted in Chapter 3, the uptake of mammography over the past two years is on average 25 percentage points (p.p.) higher among people with a high level of education than those with a low level of education, based on the analysis of the Survey on Healthy Ageing and Retirement in Europe (SHARE). In European countries, moreover, analysis of the European Health Interview Survey (EHIS) shows that screening participation rates are lower among people with lower household income – by 45% for breast, 40% for cervical and 18% for colorectal (Bozhar et al., 2022[36]). The same study also documents that those born outside the EU, those who have a lower level of education and unemployed individuals are less likely to participate in early detection programmes.
Disparities in estimated cancer mortality rates are generally lower among women than men, which is well aligned with the recent epidemiological literature: For example, an analysis of German health insurance data between 2003 and 2019 by Tetzlaff et al. (2023[37]) reveals that cancer mortality rates were 50% higher in women living in the most deprived area than women in the least deprived region (with a gap of 84 per 100 000), while the gap was estimated at 80% among men. The authors have also noted that these socio-economic disparities have widened over time in Germany.
As presented in Figure 2.7, the leading causes of cancer death among women are breast, lung, and colorectal cancers, whereas those among men are lung, colorectal and prostate cancers. Among these cancer sites, lung cancer is a key driver of socio-economic gaps in cancer mortality (EC/IARC/Erasmus MC, 2025[35]). An umbrella review predominantly focussed on European countries and the United States reveals that an individual with lower SES is more likely to be diagnosed with and die from lung cancer (Redondo-Sánchez et al., 2022[38]). For 18 European countries, Vaccarella et al. (2023[34]) estimate that lung cancer accounts for the largest share of cancer mortality inequalities in both women and men: 10‑56% of female cancer mortality and 29‑61% of male cancer mortality.
These findings underscore the persistent socio-economic inequalities in cancer burden across European countries, even as overall cancer mortality continues to decline. This suggests a clear need for targeted policy interventions aimed at disadvantaged populations (see Section 2.5.1 and Chapter 3).
Estimated age‑standardised mortality rate per 100 000, those aged 40‑70, by education, 2015‑2019
Note: The EU averages are unweighted. Age‑standardisation is based on the 2013 European Standard Population. “Low education” refers to ISCED Levels 0‑2 and “High education” to ISCED Levels 5‑8. Countries are ranked by gaps in mortality rates between those with low education and those with high education.
Source: IARC, European Commission, Erasmus MC (2025). Country Factsheet Series. Socio‑economic inequalities in cancer mortality across the EU27, Norway and Iceland.
Discussions on early-onset cancer among young adults have rapidly gained attention in the epidemiological literature over the past decade, with evidence pointing to both site‑specific and overall increases (Section 2.4.1). For example, Zhao et al. (2023[6]) estimate that more than 3.26 million new cases were diagnosed among those aged less than 50 (i.e. a 79% increase since 1990), based on the Global Burden of Disease 2019 study of 29 cancers in 204 countries. Particularly sharp rises are observed for breast, colorectal, stomach and prostate cancers. Their projections from 2020 to 2030 suggest that cancer incidence among younger population will continue to climb globally, especially in those aged 40‑49. Building on this growing body of evidence, Section 2.4.2 analyses cancer incidence trends in the EU from 2000 to 2022 among adults aged 15‑49. Section 2.4.3 provides cross-country comparable evidence on incidence trends among younger adults by cancer site. Lastly, Section 2.4.4 reviews emerging evidence on the mechanisms driving early-onset cancer, including shifts in risk profiles, diagnostic expansion and potential overdiagnosis.
2.4.1. Early-onset breast and colorectal cancer has gained prominence in epidemiological literature over the last two decades
Rising colorectal cancer incidence among younger adults (aged under 40 or 50) has been on the research agenda in the United States as early as the 2000s (Ugai et al., 2022[4]). One of the earliest registry-based studies by O’Connell et al. (2003[39]) demonstrated that colorectal cancer incidence had increased among those aged 20‑40 based on the Surveillance, Epidemiology, and End Results (SEER) data from 1973 to 1999. At the same time, in Australia, the average annual percent change (AAPC) in age‑standardised cancer incidence was reported at 3.0% for colorectal cancer among those aged 15‑39 (Troeung et al., 2017[40]). Across 20 European countries, the average annual per cent change in age‑standardised colorectal cancer incidence was estimated at 7.9% among those aged 20‑29, 4.9% among 30‑39 and 1.6% among 40‑49 (Vuik et al., 2019[41]).
The epidemiological literature on early onset cancer has also expanded beyond colorectal cancer. In the United States, Barr et al. (2016[42]) analysed SEER data on the 40 most common cancer sites among individuals aged 15‑39, reporting significant increases in kidney, thyroid, prostate, and corpus uteri cancers, alongside more moderate increases in colorectal and testicular cancers. Similarly, focussing on newly diagnosed cases in adolescents and young adults (AYAs) aged 15‑39 in the United States between 1973 and 2015, Scott et al. (2020[2]) document an increase of 30% in age‑standardised cancer incidence and an average annual per cent change of 0.6% for both female and male AYAs, noting the rise of kidney, thyroid and colorectal cancers.
In Europe, the average annual per cent change in breast cancer incidence among women under 40 was estimated at 1.2% from 1990 to 2008 across Belgium, Bulgaria, France, Italy, Portugal, Spain and Switzerland (Leclère et al., 2013[43]). Trama et al. (2023[44]) also documented an overall upward trend in cancer incidence among AYAs across 22 European countries between 1998 and 2012. More recently, in the French cancer registry zone (18% of French population), cancer incidence among AYAs increased at an annual per cent change of +1.6% in crude terms (+1.8% for women and +1.6% for men) from 2000‑2014 and then declined at ‑0.8% from 2015‑2020 (Desandes et al., 2025[45]). However, the incidence of breast, colorectal, kidney, glioblastomas, liposarcomas and Hodgkin lymphomas shows a regular increase over the whole period, whereas a decline is observed for head and neck cancers and skin melanomas.
2.4.2. Since 2000, early-onset cancer incidence has risen widely among women
The incidence trend of early-onset cancer – defined as cancer occurring among young adults aged between 15 and 49 – is examined in this section, using harmonised cancer registry data of 24 EU countries, Iceland and Norway and 11 other OECD countries. The analysis covers the period from 2000 to 2022 or the nearest available year for each country (see Annex 2.B for a detailed description of the source data).
Figure 2.10 illustrates the decomposition of changes in age‑standardised cancer incidence rates among the population aged 15‑49 across EU countries between 2000 and 2022 (see Annex Figure 2.A.3 for country-specific early-onset cancer incidence rates). Across EU countries, the average age‑standardised cancer incidence among younger adults aged 15‑49 surged by +22.8 per 100 000 women, from 143.8 to 166.6 per 100 000 for women (+16%), while remaining stable at 97.0 per 100 000 for men. Across EU countries, average annual per cent changes in age‑standardised cancer incidence rates among younger adults were estimated at +1.0% among women with the 95% confidence interval of 0.6 to 1.4 and at +0.3% among men with the 95% confidence interval of ‑0.1 to 0.7 (Annex Figure 2.A.4), indicating that on average in the EU, rising early-onset cancer incidence is statistically significant among women but not among men.3
The most significant drivers of the increase in cancer incidence among young women since 2000 are thyroid cancer (+9.9 per 100 000 women), breast cancer (+8.7), skin melanoma (+4.2) and colorectal cancer (+0.8). Simultaneously, reductions in the incidence of cervical cancer (‑2.2 per 100 000) and ovarian cancer (‑1.6) are also observed, but they are not large enough to offset the increases coming from other cancer types.
As for men, the incidence of early-onset testicular and skin melanoma cancers has risen by +3.7 per 100 000 and +2.8 per 100 000, respectively from 2000 to 2022. Western and Northern European countries tend to show a higher incidence of testicular cancer and the increasing incidence trend among European youth has been noted compared to other regions (Huang et al., 2022[46]). On the other hand, there has been improvement in smoking-related cancers such as lung (a decrease of ‑6.9 per 100 000), lip, oral cavity and pharynx (‑3.5), and larynx cancers (‑2.2), which are collectively large enough to offset the other increases in male early-onset cancer incidence. This is consistent with the fact that smoking rates among men have declined in European countries (OECD/European Commission, 2025[21]).
The corollary of these epidemiological developments is that while the overall cancer burden remains higher among men (Sections 2.2 and 2.3), women are disproportionately affected when it comes to early onset cancer. In fact, gender gaps in the age‑standardised cancer incidence rate among young adults widened from 47 per 100 000 in 2000 to 70 per 100 000 in 2022, reflecting an increasingly unfavourable trend for women. Given longer life expectancy among women and rising cancer incidence of younger women, the need for strengthened cancer survivorship services increases (see Section 2.5.3).
Change in average age‑standardised cancer incidence rates per 100 000 among those aged 15 to 49, EU24 average
Note: The EU24 averages are unweighted and do not include Greece, Luxembourg or Romania. All cancer sites except for non-melanoma skin cancer are included. Age‑standardisation is based on the 2013 European Standard Population. France is not included in the EU averages for testicular cancer, and Cyprus is not included in the EU averages for skin melanoma cancer among men due to limited observations. See the methodological information in Annex 2.B.
Source: OECD calculations based on the following data: European Cancer Information System (ECIS) https://ecis.jrc.ec.europa.eu/, accessed on 25 November 2025; International Agency for Research on Cancer (IARC), https://gco.iarc.fr/overtime/en; Lapôtre‑Ledoux et al. (2023[9]) “Incidence des principaux cancers en France métropolitaine en 2023 et tendances depuis 1990”, http://beh.santepubliquefrance.fr/beh/2023/12-13/2023_12-13_1.html; National Institute of Oncology, National Cancer Registry of Hungary (NRR), https://stat.nrr.hu/.
2.4.3. In most EU countries, the incidence of thyroid and breast cancer among younger women is increasing
Table 2.2 presents age‑standardised cancer incidence rates among those aged 15‑49 in 2022 or the nearest available year for each country and changes in age‑standardised incidence rates from 2000 (average annual per cent changes are presented for each cancer site and country, alongside 95% confidence intervals, in Annex Table 2.A.1).
Compared to 2000, the age‑standardised breast cancer incidence among younger women has risen by +8.7 per 100 000 women, from 53.3 to 62.0 per 100 000, on average across EU countries in 2022 (+16% in relative terms). The estimated average annual per cent change in incidence is 1.1% and is statistically significantly different from zero (Annex Table 2.A.1). The largest increases are observed in Cyprus, Czechia, Estonia, Ireland, Norway, Portugal, Slovenia and Sweden, whereas incidence declined in the following three EU countries: Hungary, Finland and Belgium in the latest available year, compared to 2000. Modifiable risk factors (overweight, smoking and physical inactivity) are associated with increased breast cancer incidence among women aged 40-49 years in Finland (METCA Study Group, 2025[47]), while advanced maternal age is also found to increase the risk of early-onset breast cancer (Londero et al., 2024[48]; Scott et al., 2020[2]). In light of the broad and consistent increase in breast cancer incidence at younger ages across EU countries, the age range of breast cancer screening programmes is being reconsidered, although current evidence does not consistently support the cost-effectiveness of lowering screening age (see Section 2.5.2).
Between 2000 and 2022, the incidence of thyroid cancer in younger women has more than doubled from 8.2 to 18.1 per 100 000 across EU countries (+120%). The highest incidence was recorded in Cyprus, Croatia and Italy. A significant increase is observed in Latvia and the Slovak Republic (with an average annual per cent change of +10.6% and +8.5% respectively), whereas incidence has not significantly increased in Estonia and even decreased in Iceland (Annex Table 2.A.1). Although some of these rapid increases may be due to better surveillance systems (see Annex 2.B), there is also the concern of overdiagnosis of thyroid cancer which has been well documented in the literature (Li et al., 2024[15]; Sung et al., 2021[49]; IARC et al., 2025[50]) – see Chapter 4. This result is consistent with a recent study using the 2021 Global Burden of Disease, showing an increase of +156% in the number of new cases of thyroid cancer among women aged 15‑49 years between 1990 and 2021 (Jiang et al., 2025[51]).
Testicular cancer is predominant among young adult men, and it has been the largest contributor to the rise in age‑standardised incidence among men aged 15‑49 since 2000. Its incidence went up by +3.7 per 100 000 men, from 9.9 to 13.6 per 100 000 on average (+38% in relative terms), with the highest incidence rates recorded, at above 20.0 per 100 000 men, in Croatia and Slovenia. The largest change in incidence rates can be seen in Croatia, the Netherlands and Poland. Portugal saw the fastest increase in terms of average annual per cent change (+8.8%). Meanwhile, there was either no change or a decrease in incidence in Denmark, Germany, Hungary, Iceland, Ireland and Norway. Systemic reviews identify family history, adult height, low fertility, environmental exposure and prenatal or early-life exposures as risk factors (Tateo et al., 2025[52]; Mhamane et al., 2024[53]; McGlynn and Trabert, 2012[54]). Perfluorooctanoic acid (PFOA) – widely used in non-stick cookware and liquid-resistant coatings – has been recently classified by IARC as carcinogenic to humans, with sufficient evidence associated with testicular cancer (Zahm et al., 2024[55]). The growing incidence and improving survival of early-onset testicular cancer across many countries calls for wider support for accompanying fertility-related issues (see Chapter 5) (van der Meer et al., 2024[56]).
Significant reductions in early-onset lung cancer incidence more than offset increases in the incidence of other cancer types among younger men. Compared to 2000, the average incidence dropped by 6.9 per 100 000 men, from 12.2 to 5.3 per 100 000 in 2022 (‑57% in relative terms). Reductions in early-onset lung cancer incidence rates were substantial in Central European countries: Hungary, Croatia, Slovenia, Poland and Malta. Gálffy et al. (2024[57]) also reported that Hungary’s lung cancer incidence dropped among those aged 40‑49 from 2011 to 2021. However, there was little improvement in Cyprus and Portugal, both of which reported virtually no change in incidence rates among those aged 15‑49 during this period (Annex Table 2.A.1).
The incidence of early-onset skin melanoma has increased for both women and men since 2000, on average by +4.2 per 100 000 (+48% in relative terms) and by +2.8 per 100 000 (+50% in relative terms), respectively. During the observation period, substantial increases in the incidence were recorded among women in Slovenia, Italy, Denmark and Sweden and among men in Italy, Denmark and Malta. A statistically significant drop in early-onset skin melanoma cancer incidence was only seen in Iceland for women. This finding is consistent with a recent study showing that the incidence of skin melanoma in Iceland reached a peak in 2002‑2006, but has since been declining, thanks to government regulation on the use of sunbeds, public awareness and education campaigns on the risks of UV exposure and tanning beds, and improved access to dermatology services (Thomas et al., 2024[58]).
Lastly, early-onset colorectal cancer incidence has slightly risen across EU countries since 2000, with changes standing at +0.8 per 100 000 women (+10% in relative terms) and +1.0 per 100 000 men (+12%). However, on average in the EU, the average annual per cent change in colorectal cancer incidence among young population is not statistically significantly different from zero for both women and men (Annex Table 2.A.1). Nonetheless, Croatia, France (aligned with Desandes et al. (2025[45])), Poland, the Netherlands and the Nordic countries all saw a significant increase in early-onset colorectal cancer incidence in both sexes, whereas Czechia, Italy and Spain recorded a statistically significant decrease.
These results are in contrast to the early-onset colorectal cancer trend seen in other OECD countries (see also Box 2.3). For Australia, Canada, the United Kingdom (England) and the United States, Downham et al. (2025[59]) have documented the fastest increase in colorectal cancer incidence among those aged under 40. While the reasons behind the rising incidence in these countries are yet to be identified, early-life exposure to bacteria is mentioned as an emerging risk of colorectal cancer among younger populations in recent studies (Díaz-Gay et al., 2025[60]). The consumption of ultra-processed food is also associated with increased risk of early-onset colorectal cancer among women (Wang et al., 2025[61]).
Age‑standardised cancer incidence per 100 000, 2022 or nearest year (and change from 2000), age 15‑49
Note: The EU24 averages are unweighted and do not include Greece, Luxembourg or Romania. Age‑standardisation is based on the 2013 European Standard Population. The latest available years are 2010 for Portugal and the Slovak Republic, 2015 for Bulgaria and Japan, and 2017 for other OECD countries. Given that population coverage within the referenced registry data differs between countries, the results should be interpreted with caution. See also the methodological information in Annex 2.B.
1. For testicular cancer, data for France are unavailable in the 2023 study.
2. For lung cancer, data for Chile are excluded due to limited observations.
3. For skin melanoma, data for Cyprus and Chile are likewise excluded. Average annual per cent changes (AAPCs) are presented in Annex Table 2.A.1.
Source: OECD calculations based on the following data: European Cancer Information System (ECIS) https://ecis.jrc.ec.europa.eu/, accessed on 25 November 2025; International Agency for Research on Cancer (IARC), https://gco.iarc.fr/overtime/en; Lapôtre‑Ledoux et al. (2023[9]) “Incidence des principaux cancers en France métropolitaine en 2023 et tendances depuis 1990”, http://beh.santepubliquefrance.fr/beh/2023/12-13/2023_12-13_1.html, pp. 188‑204; National Institute of Oncology, National Cancer Registry of Hungary (NRR), https://stat.nrr.hu/.
Early-onset breast and thyroid cancers are also the major contributors to the rise of cancer incidence among young women in other OECD countries between 2000 and 2017.
The largest increases in age‑standardised early-onset breast cancer incidence are recorded in Korea (+42.2 per 100 000 women), Japan (+27.9) and Türkiye (+22.1): or +4.7%, +3.5% and +2.3%, respectively, on the basis of average annual per cent change (Annex Table 2.A.1).
The incidence of early-onset thyroid cancer has statistically significantly increased in all other OECD countries, with an estimated average annual per cent change of over 8% in Korea, Türkiye and Chile.
Similarly to EU+2 countries, the incidence of early-onset testicular cancer has increased in a number of other OECD countries, while that of early-onset lung cancer has broadly decreased.
Absolute changes in the incidence of early-onset testicular cancer are largest in Chile (+13.5 per 100 000 men) and Colombia (+4.0). The largest estimated changes are seen in Korea (+6.6%), Japan (+5.5%), Colombia (4.3%) and Türkiye (+3.2%).
For early-onset lung cancer, age‑standardised incidence rates have declined in almost all other OECD countries, with substantial reductions registered in Türkiye (‑10.9 per 100 000 men), the United States (‑4.1), Israel (‑3.7) and Canada (‑3.3).
The pattern of early-onset cancer differs markedly between the EU+2 and other OECD countries for both skin melanoma and colorectal cancer in men and women. The early-onset skin melanoma cancer incidence has generally increased in EU+2 countries, but has not increased substantially in other OECD countries (Annex Table 2.A.1). Declines in skin melanoma cancer incidence among the young population are significant for both women and men in Australia and New Zealand, where changing demographics and public awareness campaigns are cited as potential reasons for these declines (Whiteman et al., 2024[62]; Wen et al., 2024[63]).
For early-onset colorectal cancer, age‑standardised incidence has increased broadly, except for women in Colombia and Israel (Annex Table 2.A.1). Large increases are observed in Australia, Chile, Canada, the United Kingdom and the United States, as reported by Downham et al. (2025[59]). In the United States, Shah et al. (2021[64]), analysing the colorectal cancer incidence trend among young adults over a similar observation period (2001‑2017), also confirmed that the increase represents a genuine epidemiological phenomenon rather than a detection artefact, as incidence rose across all stages at diagnosis.
Note: See methodological information in Annex 2.B. For Chile, Colombia, Japan, Türkiye and the United States, the registry data cover less than 10% of the population. Results should therefore be interpreted with caution.
2.4.4. The rise in early-onset cancer reflects changing risk profiles, broader diagnostic activity and, for some cancers, potential overdiagnosis
While fundamental reasons behind the rise of early-onset cancer incidence are yet to be determined and remain to be further investigated, there are potentially three main drivers. The first one is a genuine increase in the number of early-onset cases due to heightened risk exposures among younger generations. Shifts in metabolic factors and early-life environments – including changes in obesity, diet, physical inactivity, reproductive patterns, microbiome alterations and other exposures – explain the observed increase in cancer incidence among younger population (Díaz-Gay et al., 2025[60]; Wang et al., 2025[61]). For breast cancer, the recent change in reproductive patterns such as delayed and fewer childbirths is repeatedly cited as a prominent risk factor (Mao et al., 2023[19]; Obeagu and Obeagu, 2024[20]). The consumption of ultra-processed food has also been associated with increased risk of early-onset colorectal cancer among women (Wang et al., 2025[61]). Ugai et al. (2022[4]) also argue that the persistent rise in some cancers, including colorectal and pancreatic cancers, points to early-life exposures.
The second factor relates to advancement and expansion of healthcare access and cancer detection over time (including increased use of imaging, endoscopy, or earlier healthcare contact), which likely expanded detection opportunities among younger population. For colorectal cancer, increased diagnostic evaluation – including colonoscopy, CT colonography and faecal immunochemical test (FIT) – has been associated with increased detection of early-onset cases (Ladabaum et al., 2020[65]; Issa and Noureddine, 2017[66]). For skin melanoma, while exposure to ultraviolet radiation still explain 80% of cutaneous melanoma cases in 2022 worldwide, some recent evidence suggests diagnostic scrutiny playing a role. The cross-sectional analysis of cancer incidence and UV radiation exposure in the United States for example suggests that increased incidence correlates more strongly with measures of diagnostic scrutiny and more frequent biopsies (Adamson, Welch and Welch, 2022[67]).
Lastly, the increased use of diagnostic imaging and testing may have contributed to overdiagnosis for some cancers, via detection of slow-growing cancers among young adults who would otherwise die from other causes before the cancer became clinically relevant. For thyroid cancer, Jiang et al. (2025[51]) note a strong correlation between the economic development of a country and the rise in cancer incidence rates, most likely due to increased detection capacity leading to overdiagnosis and overtreatment. Based on available evidence, the number of overdiagnoses cases for thyroid, prostate and kidney cancers can be substantial (Richman and Gross, 2025[68]).
2.5.1. Continued policy efforts are needed to monitor socio-economic disparities in the cancer burden
The cancer burden disproportionately affects people with lower socio-economic status – see Box 2.2 and Section 2.3.2. The social gradient in cancer outcomes partly reflects the higher prevalence of modifiable behavioural risk factors, lower participation in early detection programmes, and reduced health literacy and awareness of cancer risks and symptoms among disadvantaged populations (Pacheco et al., 2024[69]; Li et al., 2024[70]; OECD/European Commission, 2023[71]; Tran et al., 2023[72]). To reduce inequalities in cancer outcomes, targeted policy measures are necessary. Reinforcing primary care to raise awareness of symptoms, scaling up screening programmes in deprived areas, improving health literacy and ensuring access to timely and high-quality cancer care are key options for consideration (see Chapters 3 and 4).
While there is some room for more targeted primary care and public health interventions to better serve people with lower SES, inequalities in cancer burden are not uniformly addressed and integrated into cancer care policies across EU+2 countries. For instance, only six EU+2 countries (France, Germany, Ireland, the Netherlands, Poland and Sweden) have a dedicated section on inequalities in their national cancer plans as of 2025, even though more than 90% of EU+2 countries have implemented a national cancer plan (OECD/European Commission, 2025[21]).
Likewise, disparities in the cancer burden are not regularly monitored or reported with national or regional cancer registry data in Europe (see Box 2.1 and Box 2.2). Less than half of EU+2 countries enable linkages to SES data to monitor socio-economic inequalities, according to the 2025 OECD Policy Survey on High-Value Cancer Care. SES information is either recorded or linked from other data sources in some EU+2 countries: Belgium, Denmark, Ireland, Italy, Lithuania, Norway, the Netherlands, Poland, Slovenia and Sweden, but not in others.
2.5.2. Breast cancer screening programmes may need adjusting to detect early-onset cases, under the condition that the benefits outweigh the costs
From 2000 to 2022, age‑standardised early-onset breast cancer incidence among women has increased by 16%, reaching 62 cases per 100 000 women aged 15‑49 on average across EU countries in 2022. This epidemiological trend highlights the need to re‑examine current screening age ranges, using up-to-date, evidence‑based guidance that carefully weighs potential benefits against the risks of overdiagnosis and overtreatment, without extending screening to younger populations unless robust data on effectiveness and cost-effectiveness clearly support doing so. According to the 2022 EU Council Recommendation on Cancer Screening, breast cancer screening for women aged 50‑69 with mammography is recommended. Lowering the age limit for screening to 45 and raising the upper age limit to 74 is also suggested for consideration.
Population-based breast cancer screening is implemented in 26 EU+2 countries, while opportunistic screening is in place in Bulgaria, Lithuania and Romania (see Chapter 3). Figure 2.11 presents the target age ranges covered by breast cancer screening programmes as of 2025. Ten EU+2 countries organised population-based breast cancer screening programmes that are accessible to women aged 45‑49 as of 2025: namely, Austria, Cyprus, Czechia, Greece, Hungary, Iceland, Luxembourg, Poland, the Slovak Republic and Sweden. For women aged 40‑44, Iceland and Sweden include this group in their target population, while opt-in screening is available in Austria, Czechia (with out-of-pocket expense) and the Slovak Republic.
Adjustment of the target ages for breast cancer screening needs to be supported by robust evidence to ensure cost-effectiveness, as is the case for the current target age range of 50‑69 (Sidiropoulou and Fonseca, 2025[73]; Pokharel et al., 2023[74]). Cost-effectiveness analyses on lowering the screening age rely mainly on modelling studies and emerging observational data, with little evidence from randomised-control trials demonstrating a clear benefit for screening in younger age groups. For instance, one Finnish study reports net benefits from screening women aged 45‑49 for breast cancer (Siegfrids et al., 2025[75]), but a systematic review of European screening programmes finds that screening below age 50 is far less cost-effective – approximately EUR 105 000 per life‑year gained, five times higher than for older women.
Overall, screening age adjustments should be informed by well-established evidence since the existing studies remain insufficient to justify the cost-effectiveness of universally expanding breast cancer screening to younger populations in some countries. Alternatively, risk-stratified screening – already implemented in some EU countries to target high-risk individuals (such as those with high breast tissue density, family history or genetic susceptibility) – could offer a more efficient and cost-effective way to expand early detection (see Chapter 4).
Breast cancer screening age coverage, 2025
Note: Both population-based and opportunistic screening programmes are considered. In Austria, Czechia and the Slovak Republic, women younger than the main target group can opt in to the organised breast cancer screening programme. In Austria, women aged 40‑45 may voluntarily register for mammography within the national programme, although they are not systematically invited. In Czechia, women aged 40‑45 can also opt in but examinations in this age group are not reimbursed and must be paid out of pocket. In the Slovak Republic, women aged 40‑50 may self-enrol for screening on a voluntary basis within the organised programme. For Estonia, the target age for breast cancer screening is expected to expand up to 74 years old. In some regions of Spain, women aged 45‑49 are included for breast cancer screening.
Source: OECD (2024[10]), Beating Cancer Inequalities in the EU: Spotlight on Cancer Prevention and Early Detection; OECD/European Commission (2025[76]), EU Country Cancer Profiles 2025; Croatian Institute of Public Health.
2.5.3. People are being diagnosed with cancer at younger ages and are living longer with the disease, having a lasting impact on care needs and well-being
The rising incidence of early-onset breast, colorectal, skin melanoma and testicular cancers, coupled with improved survival, not only increases cancer burden – especially among women – but also suggests that diagnostic cancer care, treatment and supportive services must be adapted to the growing number of people living with cancer for an extended period. This is particularly true for breast and colorectal cancers, which are more common and where 5‑year survival estimates have improved across almost all countries (see Chapter 4). A people‑centred approach for individuals living with cancer is becoming increasingly important – not only to help them understand and manage their prognosis, but also to prevent their exclusion from the labour market by addressing long-term sick leave and promoting return-to-work initiatives before, during, and after treatment (see Chapter 5).
Measures to support people living with cancer are particularly crucial for women. The incidence of early-onset cancer has increased by 16% among women between 2000 and 2022, whereas it has remained stable among men (see Section 2.4.2). Since women in OECD and EU countries generally face fewer labour market opportunities than men – characterised by lower wages, fewer paid hours, and greater unpaid work (OECD, 2025[77]), policies such as extended paid sick leave, return-to-work programmes, and support for working-age informal carers are increasingly vital to help women navigate treatment and safeguard their economic and social well-being. For men, increasing early-onset testicular cancer may not necessarily adversely affect men’s survival rates (which are already high), but their access to sexual health treatment and fertility preservation needs consideration (Hamilton et al., 2022[3]). In Germany, for example, sperm cryopreservation is covered by public health insurance from 2019 (Fernández-González et al., 2022[78]). This is also the case in France, the Netherlands, Scandinavian countries, Slovenia and Poland. The Slovak Republic also implemented a survivorship programme for testicular cancer (see Chapter 5).
Lastly, this chapter has highlighted limited progress in the burden of pancreatic cancer, with both increasing age‑standardised cancer incidence and mortality rates since 2000. Ensuring greater concentration of pancreatic cancer surgeries to improve outcomes (see Chapter 4) as well as the availability and early integration of palliative care into the cancer care pathway – particularly through the development of home‑based services – is critical to support better quality of life (see Chapter 5).
References
[67] Adamson, A., H. Welch and H. Welch (2022), “Association of UV Radiation Exposure, Diagnostic Scrutiny, and Melanoma Incidence in US Counties”, JAMA Internal Medicine, Vol. 182/11, p. 1181, https://doi.org/10.1001/jamainternmed.2022.4342.
[17] Bambury, N. et al. (2023), Cancer inequalities in Ireland by deprivation, 2004-2018, National Cancer Registry Ireland, Cork.
[42] Barr, R. et al. (2016), “Incidence and incidence trends of the most frequent cancers in adolescent and young adult Americans, including “nonmalignant/noninvasive” tumors”, Cancer, Vol. 122/7, pp. 1000-1008, https://doi.org/10.1002/cncr.29867.
[18] Borghi, G. et al. (2024), “Socioeconomic Deprivation and Invasive Breast Cancer Incidence by Stage at Diagnosis: A Possible Explanation to the Breast Cancer Social Paradox”, Cancers, Vol. 16/9, p. 1701, https://doi.org/10.3390/cancers16091701.
[36] Bozhar, H. et al. (2022), “Socio-economic inequality of utilization of cancer testing in Europe: A cross-sectional study”, Preventive Medicine Reports, Vol. 26, p. 101733, https://doi.org/10.1016/j.pmedr.2022.101733.
[26] Bray, F. et al. (2010), “Prostate cancer incidence and mortality trends in 37 European countries: An overview”, European Journal of Cancer, Vol. 46/17, pp. 3040-3052, https://doi.org/10.1016/j.ejca.2010.09.013.
[32] Cardoso, R. et al. (2021), “Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study”, The Lancet Oncology, Vol. 22/7, pp. 1002-1013, https://doi.org/10.1016/s1470-2045(21)00199-6.
[11] Cho, H. et al. (2014), “When Do Changes in Cancer Survival Mean Progress? The Insight From Population Incidence and Mortality”, JNCI Monographs, Vol. 2014/49, pp. 187-197, https://doi.org/10.1093/jncimonographs/lgu014.
[1] De Angelis, R. et al. (2024), “Complete cancer prevalence in Europe in 2020 by disease duration and country (EUROCARE-6): a population-based study”, Lancet Oncology, Vol. 25/3, pp. 293-307, https://doi.org/10.1016/S1470-2045(23)00646-0.
[45] Desandes, E. et al. (2025), Incidence et son évolution entre 2000 et 2020 des cancers chez les adolescents et jeunes adultes (15-39 ans) dans les départements français couverts par un registre général du cancer, Étude collaborative partenariale entre le réseau français des registres des cancers (Francim), le service de Biostatistique- Bioinformatique des Hospices civils de Lyon (HCL), Santé publique France et l’Institut national du cancer (INCa).
[60] Díaz-Gay, M. et al. (2025), “Geographic and age variations in mutational processes in colorectal cancer”, Nature, Vol. 643/8070, pp. 230-240, https://doi.org/10.1038/s41586-025-09025-8.
[59] Downham, L. et al. (2025), “Increase of early-onset colorectal cancer: a cohort effect”, JNCI: Journal of the National Cancer Institute, https://doi.org/10.1093/jnci/djaf238.
[35] EC/IARC/Erasmus MC (2025), EU-CanIneq Country Factsheets on Socioeconomic Inequalities in Cancer Mortality, European Cancer Inequalities Registry, https://cancer-inequalities.jrc.ec.europa.eu.
[12] Ellis, L. et al. (2014), “Cancer incidence, survival and mortality: Explaining the concepts”, International Journal of Cancer, Vol. 135/8, pp. 1774-1782, https://doi.org/10.1002/ijc.28990.
[79] European Commission/IARC/Erasmus MC (2024), EU-CanIneq Methodology to estimate education inequalities in cancer mortality in 2015-2019 for 27 EU Member States, Iceland and Norway.
[78] Fernández-González, M. et al. (2022), “Sperm and testicular tissue cryopreservation and assisted reproductive technology outcomes in male cancer patients: a 15-year experience”, Journal of Cancer Research and Clinical Oncology, Vol. 149/8, pp. 5321-5330, https://doi.org/10.1007/s00432-022-04488-y.
[57] Gálffy, G. et al. (2024), “Decreasing incidence and mortality of lung cancer in Hungary between 2011 and 2021 revealed by robust estimates reconciling multiple data sources”, Pathology and Oncology Research, Vol. 30, https://doi.org/10.3389/pore.2024.1611754.
[3] Hamilton, A. et al. (2022), “Early-Onset Cancers in Adults: A Review of Epidemiology, Supportive Care Needs and Future Research Priorities”, Cancers, Vol. 14/16, https://doi.org/10.3390/cancers14164021.
[25] Heijnsdijk, E. et al. (2009), “Overdetection, overtreatment and costs in prostate-specific antigen screening for prostate cancer”, British Journal of Cancer, Vol. 101, pp. 1833–1838, https://doi.org/10.1038/sj.bjc.6605422.
[46] Huang, J. et al. (2022), “Worldwide Distribution, Risk Factors, and Temporal Trends of Testicular Cancer Incidence and Mortality: A Global Analysis”, European Urology Oncology, Vol. 5/5, pp. 566-576, https://doi.org/10.1016/j.euo.2022.06.009.
[29] Hugosson, J. et al. (2022), “Prostate Cancer Screening with PSA and MRI Followed by Targeted Biopsy Only”, New England Journal of Medicine, Vol. 387/23, https://doi.org/10.1056/NEJMoa2209454.
[50] IARC et al. (2025), Gestione del carcinoma della tiroide in Italia: Rapporto di monitoraggio nazionale, International Agency for Research on Cancer, Lyon, https://www.iarc.who.int/news-events/iarc-scientists-present-to-the-italian-senate-a-new-report-on-thyroid-cancer-care-in-italy.
[66] Issa, I. and M. Noureddine (2017), “Colorectal cancer screening: An updated review of the available options”, World Journal of Gastroenterology, Vol. 23/28, p. 5086, https://doi.org/10.3748/wjg.v23.i28.5086.
[51] Jiang, T. et al. (2025), “Global, regional, and national burden of thyroid cancer in women of child-bearing age, 1990 to 2021 and predictions to 2035: An analysis of the global burden of disease study 2021”, Front Endocrinol, Vol. 16/1555841, https://doi.org/10.3389/fendo.2025.1555841.
[5] Koh, B., D. Tan and C. Ng (2023), “Patterns in Cancer Incidence Among People Younger Than 50 Years in the US, 2010 to 2019”, JAMA Network Open, Vol. 6/8, https://doi.org/10.1001/jamanetworkopen.2023.28171.
[65] Ladabaum, U. et al. (2020), “Strategies for Colorectal Cancer Screening”, Gastroenterology, Vol. 158/2, pp. 418-432, https://doi.org/10.1053/j.gastro.2019.06.043.
[9] Lapôtre-Ledoux, B. et al. (2023), “Incidence des principaux cancers en France métropolitaine en 2023 et tendances depuis 1990”, Bulletin épidémiologique hebdomadaire, Vol. 12-13, pp. 188-204, http://beh.santepubliquefrance.fr/beh/2023/12-13/2023_12-13_1.html.
[43] Leclère, B. et al. (2013), “Trends in incidence of breast cancer among women under 40 in seven European countries: A GRELL cooperative study”, Cancer Epidemiology, Vol. 37/5, pp. 544-549, https://doi.org/10.1016/j.canep.2013.05.001.
[15] Li, M. et al. (2024), “Evolving epidemiological patterns of thyroid cancer and estimates of overdiagnosis in 2013–17 in 63 countries worldwide: a population-based study”, The Lancet Diabetes & Endocrinology, Vol. 12/11, pp. 824-836, https://doi.org/10.1016/S2213-8587(24)00223-7.
[22] Li, M., L. Maso and S. Vaccarella (2020), “Global trends in thyroid cancer incidence and the impact of overdiagnosis”, The Lancet Diabetes & Endocrinology, Vol. 8/6, pp. 468-470, https://doi.org/10.1016/s2213-8587(20)30115-7.
[70] Li, S. et al. (2024), “An umbrella review of socioeconomic status and cancer”, Nature Communications, Vol. 15/9993, https://doi.org/10.1038/s41467-024-54444-2.
[48] Londero, A. et al. (2024), “Breast cancer and the steadily increasing maternal age: are they colliding?”, BMC Women’s Health, Vol. 24/1, https://doi.org/10.1186/s12905-024-03138-4.
[19] Mao, X. et al. (2023), “Association of reproductive risk factors and breast cancer molecular subtypes: a systematic review and meta-analysis”, BMC Cancer, Vol. 23/1, https://doi.org/10.1186/s12885-023-11049-0.
[13] Martine, K. et al. (eds.) (2019), Measuring socioeconomic status and inequalities, International Agency for Research on Cancer, Lyon.
[54] McGlynn, K. and B. Trabert (2012), “Adolescent and adult risk factors for testicular cancer”, Nature Reviews Urology, Vol. 9/6, pp. 339-349, https://doi.org/10.1038/nrurol.2012.61.
[47] METCA Study Group (2025), “Incidence trends of early-onset breast cancer by lifestyle risk factors”, BMC Cancer, Vol. 25/1, https://doi.org/10.1186/s12885-025-13730-y.
[53] Mhamane, S. et al. (2024), “Global Burden of Testicular Cancer and Its Risk Factors”, Indian Journal of Medical and Paediatric Oncology, Vol. 46/02, pp. 142-149, https://doi.org/10.1055/s-0044-1796675.
[14] Mihor, A. et al. (2020), “Socioeconomic inequalities in cancer incidence in Europe: a comprehensive review of population-based epidemiological studies”, Radiology and Oncology, Vol. 54/1, pp. 1-13, https://doi.org/10.2478/raon-2020-0008.
[23] Nygård, S. et al. (2024), “Impact of Multicohort Human Papillomavirus Vaccination on Cervical Cancer in Women Below 30 Years of Age: Lessons Learned From the Scandinavian Countries”, The Journal of Infectious Diseases, Vol. 231/3, pp. e497-e500, https://doi.org/10.1093/infdis/jiae584.
[20] Obeagu, E. and G. Obeagu (2024), “Breast cancer: A review of risk factors and diagnosis”, Medicine, Vol. 103/3, p. e36905, https://doi.org/10.1097/md.0000000000036905.
[39] O’Connell, J. et al. (2003), “Rates of Colon and Rectal Cancers are Increasing in Young Adults”, The American Surgeon, Vol. 69/10, pp. 866-872, https://doi.org/10.1177/000313480306901010.
[77] OECD (2025), OECD Employment Outlook 2025: Can We Get Through the Demographic Crunch?, OECD Publishing, https://doi.org/10.1787/194a947b-en.
[10] OECD (2024), Beating Cancer Inequalities in the EU: Spotlight on Cancer Prevention and Early Detection, OECD Publishing, Paris, https://doi.org/10.1787/14fdc89a-en.
[21] OECD/European Commission (2025), Country Cancer Profiles 2025: Synthesis Report, OECD Publishing, Paris, https://doi.org/10.1787/20ef03e1-en.
[76] OECD/European Commission (2025), EU Country Cancer Profiles 2025, OECD Publishing, Paris, https://www.oecd.org/en/about/projects/eu-country-cancer-profiles-2025.html.
[71] OECD/European Commission (2023), EU Country Cancer Profiles 2023, OECD Publishing, Paris, https://doi.org/10.1787/55f07000-en.
[7] Ogino, S. and T. Ugai (2024), “The global epidemic of early-onset cancer: nature, nurture, or both?”, Annals of Oncology, Vol. 35/12, pp. 1071-1073, https://doi.org/10.1016/j.annonc.2024.08.2336.
[69] Pacheco, S. et al. (2024), “Socio-Economic Inequalities in Beliefs About Cancer and its Causes: Evidence From two Population Surveys”, Psycho-Oncology, Vol. 33/12, https://doi.org/10.1002/pon.70035.
[30] Patasius, A. et al. (2019), “Prostate cancer incidence and mortality in the Baltic states, Belarus, the Russian Federation and Ukraine”, BMJ Open, Vol. 9, https://doi.org/10.1136/bmjopen-2019-031856.
[27] Patasius, A., A. Krilaviciute and G. Smailyte (2020), “Prostate Cancer Screening with PSA: Ten Years’ Experience of Population Based Early Prostate Cancer Detection Programme in Lithuania”, Journal of Clinical Medicine, Vol. 9/12, https://doi.org/10.3390/jcm9123826.
[16] Pizzato, M. et al. (2025), “Education level and risk of breast cancer by tumor subtype in the (EPIC) cohort”, International Journal of Cancer, Vol. 157/4, pp. 672-686, https://doi.org/10.1002/ijc.35413.
[74] Pokharel, R. et al. (2023), “A Systematic Review of Cost-Effectiveness Analyses of Colorectal Cancer Screening in Europe: Have Studies Included Optimal Screening Intensities?”, Applied Health Economics and Health Policy, Vol. 21/5, pp. 701-717, https://doi.org/10.1007/s40258-023-00819-3.
[38] Redondo-Sánchez, D. et al. (2022), “Socio-Economic Inequalities in Lung Cancer Outcomes: An Overview of Systematic Reviews”, Cancers, Vol. 14/2, p. 398, https://doi.org/10.3390/cancers14020398.
[68] Richman, I. and C. Gross (2025), “Overdiagnosis of Cancer—Not Only Associated With Aging”, JAMA Internal Medicine, Vol. 185/11, p. 1375, https://doi.org/10.1001/jamainternmed.2025.4925.
[31] Rotimi, D. (ed.) (2025), “Cadmium exposure and risk of pancreatic cancer: Systematic review and meta-analysis”, PLOS One, Vol. 20/4, p. e0319283, https://doi.org/10.1371/journal.pone.0319283.
[2] Scott, A. et al. (2020), “Trends in Cancer Incidence in US Adolescents and Young Adults, 1973-2015”, JAMA Network Open, Vol. 3/12, https://doi.org/10.1001/jamanetworkopen.2020.27738.
[64] Shah, R. et al. (2021), “Trends in the incidence of early‐onset colorectal cancer in all 50 United States from 2001 through 2017”, Cancer, Vol. 128/2, pp. 299-310, https://doi.org/10.1002/cncr.33916.
[8] Shiels, M. et al. (2025), “Trends in Cancer Incidence and Mortality Rates in Early-Onset and Older-Onset Age Groups in the United States, 2010–2019”, Cancer Discovery, Vol. 15/7, pp. 1363-1376, https://doi.org/10.1158/2159-8290.CD-24-1678.
[73] Sidiropoulou, Z. and V. Fonseca (2025), “A Systematic Review of the Cost-Effectiveness of Screening Modalities for Breast Cancer in European Countries”, Cancers, Vol. 17/21, p. 3585, https://doi.org/10.3390/cancers17213585.
[75] Siegfrids, F. et al. (2025), “Cost-effectiveness of expanding the target population of biennial screening for breast cancer from ages 50–69 to 45 and/or 74: A cohort modelling study in the Finnish setting”, Health Economics Review, Vol. 15/1, https://doi.org/10.1186/s13561-025-00628-5.
[49] Sung, H. et al. (2021), “Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries”, CA: A Cancer Journal for Clinicians, Vol. 71/3, pp. 209-249, https://doi.org/10.3322/caac.21660.
[52] Tateo, V. et al. (2025), “Epidemiology and Risk Factors for Testicular Cancer: A Systematic Review”, European Urology, Vol. 87/4, pp. 427-441, https://doi.org/10.1016/j.eururo.2024.10.023.
[37] Tetzlaff, F. et al. (2023), “Widening area-based socioeconomic inequalities in cancer mortality in Germany between 2003 and 2019”, Scientific Reports, Vol. 13/1, https://doi.org/10.1038/s41598-023-45254-5.
[58] Thomas, S. et al. (2024), “Declining invasive and rising in situ melanoma incidence trends in Iceland: A nationwide cohort study”, Journal of the European Academy of Dermatology and Venereology, Vol. 39/7, pp. 1278-1284, https://doi.org/10.1111/jdv.20386.
[44] Trama, A. et al. (2023), “Cancer burden in adolescents and young adults in Europe”, ESMO Open, Vol. 8/1, p. 100744, https://doi.org/10.1016/j.esmoop.2022.100744.
[72] Tran, C. et al. (2023), “Individual and joint effect of socioeconomic status and lifestyle factors on cancer in Korea”, Cancer Medicine, Vol. 12/16, pp. 17389-17402, https://doi.org/10.1002/cam4.6359.
[40] Troeung, L. et al. (2017), “Increasing Incidence of Colorectal Cancer in Adolescents and Young Adults Aged 15–39 Years in Western Australia 1982–2007: Examination of Colonoscopy History”, Frontiers in Public Health, Vol. 5, https://doi.org/10.3389/fpubh.2017.00179.
[4] Ugai, T. et al. (2022), “Is early-onset cancer an emerging global epidemic? Current evidence and future implications”, Nature Reviews Clinical Oncology, Vol. 19/10, pp. 656–673, https://doi.org/10.1038/s41571-022-00672-8.
[34] Vaccarella, S. et al. (2023), “Socioeconomic inequalities in cancer mortality between and within countries in Europe: a population-based study”, The Lancet Regional Health - Europe, Vol. 25, p. 100551, https://doi.org/10.1016/j.lanepe.2022.100551.
[28] Vaccarella, S. et al. (2024), “Prostate cancer incidence and mortality in Europe and implications for screening activities: population based study”, British Journal of Medicine, Vol. 386, https://doi.org/10.1136/bmj.q1995.
[56] van der Meer, D. et al. (2024), “The increasing burden of testicular seminomas and non-seminomas in adolescents and young adults (AYAs): incidence, treatment, disease-specific survival and mortality trends in the Netherlands between 1989 and 2019”, ESMO Open, Vol. 9/2, p. 102231, https://doi.org/10.1016/j.esmoop.2023.102231.
[41] Vuik, F. et al. (2019), “Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years”, Gut, Vol. 68/10, pp. 1820-1826, https://doi.org/10.1136/gutjnl-2018-317592.
[61] Wang, C. et al. (2025), “Ultraprocessed Food Consumption and Risk of Early-Onset Colorectal Cancer Precursors Among Women”, JAMA Oncology, https://doi.org/10.1001/jamaoncol.2025.4777.
[63] Wen, D. et al. (2024), “Exploring melanoma shifts: a two-decade analysis in New Zealand”, New Zealand Medical Journal, Vol. 137/1596, pp. 35-42, https://doi.org/10.26635/6965.6430.
[62] Whiteman, D. et al. (2024), “Changes in the incidence of melanoma in Australia, 2006–2021, by age group and ancestry: a modelling study”, Medical Journal of Australia, Vol. 221/5, pp. 251-257, https://doi.org/10.5694/mja2.52404.
[55] Zahm, S. et al. (2024), “Carcinogenicity of perfluorooctanoic acid and perfluorooctanesulfonic acid”, The Lancet Oncology, Vol. 25/1, pp. 16-17, https://doi.org/10.1016/s1470-2045(23)00622-8.
[24] Zhang, Y. et al. (2025), “HPV vaccination, screening disparities, and the shifting landscape of cervical cancer burden: a global analysis of trends, inequalities, and policy implications”, BMC Women’s Health, Vol. 25/1, https://doi.org/10.1186/s12905-025-03841-w.
[6] Zhao, J. et al. (2023), “Global trends in incidence, death, burden and risk factors of early-onset cancer from 1990 to 2019”, BMJ Oncology, Vol. 2, https://doi.org/10.1136/bmjonc-2023-000049.
[33] Zielonke, N. et al. (2020), “Evidence for reducing cancer-specific mortality due to screening for breast cancer in Europe: A systematic review”, European Journal of Cancer, Vol. 127, pp. 191-206, https://doi.org/10.1016/j.ejca.2019.12.010.
Crude cancer incidence rate per 100 000, all ages, 2000 and 2022 (or nearest year)
Note: The EU24 averages are unweighted and do not include Greece, Luxembourg or Romania. All cancer sites except for non-melanoma skin cancer are included. Age‑standardisation is based on the 2013 European Standard Population. The latest available years are 2010 for Portugal and the Slovak Republic, 2015 for Bulgaria and Japan, and 2017 for other OECD countries. Given that population coverage within the referenced registry data differs between countries, the results should be interpreted with caution. See also the methodological information in Annex 2.B.
Source: OECD calculations based on the following data: European Cancer Information System (ECIS) https://ecis.jrc.ec.europa.eu/, accessed on 25 November 2025; International Agency for Research on Cancer (IARC), https://gco.iarc.fr/overtime/en; Lapôtre‑Ledoux et al. (2023[9]) “Incidence des principaux cancers en France métropolitaine en 2023 et tendances depuis 1990”, http://beh.santepubliquefrance.fr/beh/2023/12-13/2023_12-13_1.html; National Institute of Oncology, National Cancer Registry of Hungary (NRR), https://stat.nrr.hu/.
Age‑standardised cancer mortality rate per 100 000
Note: The EU27 averages are weighted. Age‑standardisation is based on the 2013 European Standard Population. See also endnote 1.
Source: Causes of death (Eurostat), https://doi.org/10.2908/HLTH_CD_ASDR2.
Age‑standardised cancer incidence rate per 100 000, age 15‑49, 2000 and 2022 (or nearest year)
Note: The EU24 averages are unweighted and do not include Greece, Luxembourg or Romania. All cancer sites except for non-melanoma skin cancer are included. Age‑standardisation is based on the 2013 European Standard Population. The latest available years are 2010 for Portugal and the Slovak Republic, 2015 for Bulgaria and Japan, and 2017 for other OECD countries. Given that population coverage within the referenced registry data differs between countries, the results should be interpreted with caution. See also the methodological information in Annex 2.B.
Source: OECD calculations based on the following data: European Cancer Information System (ECIS) https://ecis.jrc.ec.europa.eu/, accessed on 25 November 2025; International Agency for Research on Cancer (IARC), https://gco.iarc.fr/overtime/en; Lapôtre‑Ledoux et al. (2023[9]) “Incidence des principaux cancers en France métropolitaine en 2023 et tendances depuis 1990”, http://beh.santepubliquefrance.fr/beh/2023/12-13/2023_12-13_1.html; National Institute of Oncology, National Cancer Registry of Hungary (NRR), https://stat.nrr.hu/.
Average annual per cent change (95% CI) in age‑standardised cancer incidence, age 15‑49, from 2000 to 2022 (or nearest year)
Note: The EU24 averages are unweighted and do not include Greece, Luxembourg or Romania. All cancer sites except for non-melanoma skin cancer are included. Age‑standardisation is based on the 2013 European Standard Population. The latest available years are 2010 for Portugal and the Slovak Republic, 2015 for Bulgaria and Japan, and 2017 for other OECD countries. Given that population coverage within the referenced registry data differs between countries, the results should be interpreted with caution. See also the methodological information in Annex 2.B. Age‑standardised cancer incidence trends are assessed using a log-linear regression model consistent with the Joinpoint framework (with zero joinpoints).
Source: OECD calculations based on the following data: European Cancer Information System (ECIS) https://ecis.jrc.ec.europa.eu/, accessed on 25 November 2025; International Agency for Research on Cancer (IARC), https://gco.iarc.fr/overtime/en; Lapôtre‑Ledoux et al. (2023[9]) “Incidence des principaux cancers en France métropolitaine en 2023 et tendances depuis 1990”, http://beh.santepubliquefrance.fr/beh/2023/12-13/2023_12-13_1.html; National Institute of Oncology, National Cancer Registry of Hungary (NRR), https://stat.nrr.hu/.
Average annual per cent change (95% CI) in age‑standardised cancer incidence among those aged 15‑49, from 2000 to 2022 (or nearest year)
Note: The EU24 averages are unweighted and do not include Greece, Luxembourg or Romania. Age‑standardisation is based on the 2013 European Standard Population. The latest available years are 2010 for Portugal and the Slovak Republic, 2015 for Bulgaria and Japan, and 2017 for other OECD countries. Given that population coverage within the referenced registry data differs between countries, the results should be interpreted with caution. See also the methodological information in Annex 2.B. Age‑standardised cancer incidence trends are assessed using a log-linear regression model consistent with the Joinpoint framework (with zero joinpoints). *Statistically significant at the 95% confidence interval.
1. For testicular cancer, data for France are unavailable.
2. For lung cancer, data for Chile are excluded due to limited observations.
3. For skin melanoma, data for Cyprus and Chile are likewise excluded.
Source: OECD calculations based on the following data: European Cancer Information System (ECIS) https://ecis.jrc.ec.europa.eu/, accessed on 25 November 2025; International Agency for Research on Cancer (IARC), https://gco.iarc.fr/overtime/en; Lapôtre‑Ledoux et al. (2023[9]) “Incidence des principaux cancers en France métropolitaine en 2023 et tendances depuis 1990”, http://beh.santepubliquefrance.fr/beh/2023/12-13/2023_12-13_1.html; National Institute of Oncology, National Cancer Registry of Hungary (NRR), https://stat.nrr.hu/.
To illustrate the epidemiological evolution of cancer across European countries, the cancer incidence data are compiled from the cancer registries of 24 EU countries as well as Iceland and Norway, drawing on sources available from the European Cancer Information System (ECIS) and the International Agency for Research on Cancer (IARC). IARC data are also used for other OECD countries.
For France, national estimates in the metropolitan area are referenced from a recent study undertaken by the French National Institute of Cancer (INCa) (Lapôtre-Ledoux et al., 2023[9]). For Hungary, the National Cancer Registry (Nemzeti Rákregiszter, NRR) data are used in the absence of other data sources. The description of sources is available in Annex Table 2.B.1.
Age‑standardised incidence rates are computed using the European Standard Population 2013. For overall cancer incidence, non-melanoma skin cancers (C44 according to ICD‑10), malignant neoplasms of other and ill-defined sites (C76), malignant neoplasms without specification of site (C80) and malignant neoplasms of independent (multiple) primary sites (C97) are excluded.
For countries with regional cancer registries, the same set of regional registries is kept for the entire observation period to ensure within-country consistency. Priority is given to regions with larger population share to maximise data representativeness, while maintaining the longest possible observation period. Based on the 2022 population data, the population coverage of selected regional cancer registries is approximately 59% in Germany, 37% in Italy, 78% in Portugal and 21% in Spain. For Chile, Colombia, Japan, Türkiye and the United States, the population coverage of referenced registry data is below 10%.
Trend analysis enables smoothing out country-specific heterogeneity arising from screening practices and better focussing on underlying changes in cancer incidence. However, the latest available years are not within the last decade in Bulgaria (2015), Portugal (2010) and the Slovak Republic (2010). Hence, interpreting the incidence trend data from these countries requires caution.
Furthermore, the quality of cancer surveillance systems varies greatly across countries and thus significantly affects the coverage and completeness of confirmed or estimated cancer cases, which impacts the comparability of incidence data across countries. For example, incidence data often present striking increases in Cyprus: the age‑standardised cancer incidence rate has increased by 24% for men and by 50% for women since 2000, whereas the corresponding changes in the EU average are 0% for men and 10% for women (Figure 2.5). This likely reflects the expanded scope and coverage of Cyprus’ national cancer registry since its launch in 1998, rather than a substantially higher cancer risk compared to the EU average (OECD/European Commission, 2025[76]). National cancer registries have been established more recently in some Baltic and Central European countries, and thus changes in their cancer incidence rates may also appear high, such as in Hungary.
For Greece, Luxembourg and Romania, data from representative cancer registries were unavailable at the time of writing.
Note: Age‑standardised cancer incidence rates are computed using the 2013 European Standard Population.
1. For France, INCa has estimated the nationwide number of cancer cases based on the regional registry data observed in 1990-2018.
2. For Germany, the registries of Hamburg, Lower Saxony, Rhineland-Palatinate, Saarland, Bavaria, North Rhine‑Westphalia and Schleswig-Holstein are included.
3. For Italy, the registries of Emilia-Romagna, Veneto, Catania-Messina-Enna, Liguria, Brescia, Friuli-Venezia Giulia, Mantova and Cremona, Umbria, Palermo, Pavia, Trento, Basilicata, South Tyrol, Siracusa, Sassari, Ragusa, Nuoro and Sondrio are included.
4. For Portugal, the registries of North (RORENO), South (ROR-Sul) and Azores (RORA) are included.
5. For Spain, the registries of Basque Country, Canary Islands, Castellón, Girona, Granada, La Rioja, Murcia, Navarra and Tarragona are included.
6. For Canada, the registries of Nova Scotia, Northwest Territories, Nunavut, Quebec and Yukon are excluded.
7. For Chile, the registry of Valdivia is included.
8. For Colombia, the registries of Cali, Bucaramanga, Manizales and Pasto are included.
9. For Japan, the registries of Miyagi and Osaka are included.
10. For Türkiye, the registries of Izmir and Antalya are included.
11. For the United States, SEER 9 (San Francisco-Oakland and Los Angeles Cancer Registries (California), Connecticut Tumor Registry, Atlanta Tumor Registry (Georgia), Hawaii Tumor Registry, State Health Registry of Iowa, Detroit Cancer Registry (Michigan), New Mexico Tumor Registry, Utah Cancer Registry, Seattle‑Puget Sound Tumor Registry (Washington State) are included.
Source: European Cancer Information System (ECIS) https://ecis.jrc.ec.europa.eu/, accessed on 25 November 2025; International Agency for Research on Cancer (IARC), https://gco.iarc.fr/overtime/en; Lapôtre‑Ledoux et al. (2023[9]) “Incidence des principaux cancers en France métropolitaine en 2023 et tendances depuis 1990”, http://beh.santepubliquefrance.fr/beh/2023/12-13/2023_12-13_1.html; National Institute of Oncology (OOI), National Cancer Registry of Hungary (NRR), https://stat.nrr.hu/.
← 1. Note that Figure 2.7 is based on the 2015 OECD population between 2000 and 2023, while Figure 2.8 and Annex Figure 2.A.2 are based on the 2013 European Standard Population between 2012 and 2022, although country ranking is largely consistent across these figures.
← 2. Note that the underlying data of the EU-CanIneq study are based on historical trends (1998-2003 for Czechia) for the 2015‑2019 results. Population-based linked data were used for most EU countries, but unlinked data were used for Czechia by associating cancer mortality rates of five‑year age cohorts with census data on socio-economic characteristics of each age cohort (European Commission/IARC/Erasmus MC, 2024[79]).
← 3. There are substantial changes in Cyprus and Hungary (see Annex Figure 2.A.3). Nonetheless, the overall trend in early-onset cancer incidence remains robust even without these two countries. Excluding Cyprus and Hungary, the EU average cancer incidence rates among younger adults would change by +23.1 per 100 000 women (compared with +22.8 across all 24 EU+2 countries with available data) and +4.3 among men (compared with no change across all 24 EU countries with available data). The average annual percentage changes in age‑standardised cancer incidence rates would be +1.0% for younger women (95% CI: 0.7 to 1.4) and would remain unchanged at +0.3% for younger men (95% CI: ‑0.1 to 0.7). These robustness checks confirm that the observed rise in early onset cancer incidence is driven by women, while trends among men remain largely stable.