Histograms of all age-standardized (world population) death certification rates for 23 cancers or groups of cancers for the period 1990-92 were produced for 35 countries of the European region (including a dozen new national entities) providing data to the World ealth Organization database. Substantial variations were observed in mortality from most common sites. For lung cancer the rate in males was 81/100,000 in Hungary, followed by Belgium, the Czech Republic, the Russian Federation and Poland, while in Sweden, Iceland and Norway, where comprehensive antismoking campaigns have been adopted over the last two decades, the rates were between 24 and 30 per 100,000 males. The lung cancer epidemic in European females is still in its early phases in most countries, with the sole exception of Scotland (29/100,000, ie the highest rates in the world), the rest of the UK, Denmark, Iceland, Ireland and Hungary. With reference to colorectal cancer, the highest rates were in the Czech Republic (38/100,000 males, 21/100,000 females) and other central European countries, and the lowest in Greece, Romania and a few Republics of the former Soviet Union, as well as Finland and Sweden. The highest gastric cancer mortality rates were in the Russian Federation (41/100,000 males, 18/100,000 females), followed by a few Republics of the former Soviet Union and Portugal in Western Europe. The highest breast cancer rates (25-29 per 100,000 females) were in the UK, Belgium, Ireland, The Netherlands, Denmark and other Scandinavian countries. For overall cancer mortality, the range of variation was between 260/100,000 in Hungary and 132/100,000 in Sweden for males, and between 142/100,000 in Denmark and 76/100,000 in Kyrgizstan for females, ie approximately a twofold variation in both sexes.
Death certification data for 19 cancers or groups of cancers, plus total cancer mortality, in 16 major European countries were analysed using a log-linear Poisson model with arbitrary constraints on the parameters to disentangle the effects of age, birth cohort and period of death. Three major patterns emerged including: first, the prominent role of cohort of birth in defining trends in mortality from most cancer sites (except testis or Hodgkin's disease, where newer treatments had a major period of death effect); and second, the major role of lung and other tobacco-related neoplasm epidemics in determining the diverging pattern of cancer mortality, for each sex and in various European countries and geographic areas. In most countries, the peak male cohort values were reached for generations born between 1900 and 1930. This was observed in women only for Denmark and the U.K., i.e. the two countries where lung and other tobacco-related neoplasm epidemics had already reached appreciable levels. This confirms the importance of cigarette smoking in subsequent generations as a major cause of cancer deaths in Europe. Further, there is a persistent rise in several cancer rates, again chiefly on a cohort basis, in Eastern Europe, which calls for urgent intervention to control the cancer burden in these countries.
On the basis of overall national death certification data, it is not possible to analyse mortality from cervical cancer in Europe, since 20-65% of deaths from uterine cancer in largest countries are still certified as uterus, unspecified. We analysed, therefore, age-standardised death certification rates from uterine cancer between 1960 and 1998 in women aged 20-44 years, since most deaths from uterine cancer below the age of 45 years arise from the cervix. In all Western European countries, except Ireland, substantial declines in cervical cancer mortality in younger women were observed, although the falls were larger and earlier for some Nordic countries. The trends were irregular in the UK, with earlier declines between 1960 and 1970, followed by a rise between 1970 and 1985, and a subsequent fall. In Ireland, mortality from uterine cancer at age 20 to 44 years has been rising since the early 1980s, to reach 3.4/100000 in 1995-1996. In Eastern Europe, some fall in mortality was observed in Hungary and Poland, while trends were upwards in Romania since 1980, and in Bulgaria. In all these countries, moreover, absolute rates remained appreciably higher than in most of Western Europe, and in the late 1990s there was over a 10-fold variation between the highest rates in Romania (10.6/100000 women aged 20-44 years) and the lowest ones in Finland (0.5/100000) or Sweden (0.9/100000). Within the European Union, the variation was over 6-fold, the highest rates being registered in Ireland (3. 4/100000) and Portugal (3.2/100000). The declines registered in cervical cancer mortality in young women were largely due to screening, and the persisting variations in mortality across Europe underline the importance of the adoption of organised screening programmes, with specific urgency in Eastern Europe.
The two main determinants of oral and oesophageal cancer in Europe are alcohol and tobacco, and the two cancer sites show several similarities in their descriptive epidemiology. This study compares mortality from cancers of the oral cavity and oesophagus in European countries to evaluate similarities and differences. From official death certification numbers and population estimates, we obtained age-standardized rates for all ages and truncated (35-64 years). In most countries, rates for men tended to increase between 1955-59 and 1990-92 for both sites, although the increases were more marked for oral cancer. In the UK and Ireland, however, oral cancer decreased and oesophageal cancer increased, while in Finland and Iceland mortality for both sites decreased. The most striking increases were in Hungary, where the truncated rate in most recent calendar periods reached the highest levels in Europe. In France, rates for both cancers were extremely high: oral cancer increased from 1955-59 to the early 1980s, but started to decline afterwards. Mortality rates were much lower for women than men, and the correlation between the two sites was less marked. An age, period and cohort model, applied to the rates for men in selected European countries, suggested strong cohort effects for both cancers, generally more marked for oral cancer, with substantial increases in the cohorts born after 1920. The mortality rates of cancers of the oral cavity and oesophagus show several analogies, as expected from their relation to tobacco and alcohol; but some discrepancies suggest that other, less well-identified, factors may also influence their rates and trends in Europe.
Mortality rates from kidney cancer increased throughout Europe up until the late 1980s or early 1990s. Trends in western European countries, the European Union (EU) and selected central and eastern European countries have been updated using official death certification data for kidney cancer abstracted from the World Health Organisation (WHO) database over the period 1980-1999. In EU men, death rates increased from 3.92 per 100,000 (age standardised, world standard) in 1980-81 to 4.63 in 1994-95, and levelled off at 4.15 thereafter. In women, corresponding values were 1.86 in 1980-81, 2.04 in 1994-95 and 1.80 in 1998-99. Thus, the fall in kidney cancer mortality over the last 5 years was over 10% for both sexes in the EU. The largest falls were in countries with highest mortality in the early 1990s, such as Germany, Denmark and the Netherlands. Kidney cancer rates levelled off, but remained very high, in the Czech Republic, Baltic countries, Hungary, Poland and other central European countries. Thus, in the late 1990s, a greater than three-fold difference in kidney cancer mortality was observed between the highest rates in the Czech Republic, the Baltic Republics and Hungary, and the lowest ones in Romania, Portugal and Greece. Tobacco smoking is the best recognised risk factor for kidney cancer, and the recent trends in men, mainly in western Europe, can be related to a reduced prevalence of smoking among men. Tobacco, however, cannot account for the recent trends registered in women.
Trends in mortality from cancer of the gall-bladder and bile ducts over the period 1965-1989 were analysed for 25 European countries on the basis of official death certifications from the World Health Organization databank. A high-mortality area--i.e. with overall death certification rates, world standard, around or over 2/100,000 men and 4/100,000 women in 1985-1989--was identified in Germany and the surrounding central European countries (Austria, Czechoslovakia, Hungary and Poland). The highest rates were in Hungary (3.9/100,000 men and 7.4/100,000 women). During the two decades considered, rates increased in Czechoslovakia and Hungary, remained stable in Poland and declined in Austria and Germany. Intermediate-mortality areas included Scandinavian countries (except Norway) and Switzerland: their rates in the late 1980s were between 1.5 and 2.5/100,000 men and between 2.2 and 4.2/100,000 women. Mortality increased in Finland and Sweden, declined in the Netherlands and Switzerland, and did not change consistently in Denmark. Low-mortality countries (i.e. with rates in 1985-1989 below 2.0/100,000 men and 2.5/100,000 women) included Belgium, France, Britain, Ireland, Norway, Bulgaria and Mediterranean countries. Over the last two decades, certification rates declined in Bulgaria and Great Britain, but increased in all other countries. The ratio between the countries with the highest and lowest gall-bladder cancer mortality rates declined from 21 to 12 in women, although they remained stable around 10 for men. The pattern was similar when analysis was restricted to truncated rates from patients aged between 35 and 64 years. These trends, and particularly the exceedingly high rates in central Europe, the low rates in Mediterranean countries and the low and declining rates in Britain and Ireland are discussed in terms of known (cholelithiasis) or potential (dietary) factors in gall-bladder cancer aetiology, and of trends in cholecystectomy rates.
Trends in ovarian cancer mortality over the period 1955-1989 were analyzed for 25 European countries (excluding the Soviet Union and a few small countries) on the basis of the official death certification data from the World Health Organization database. The overall variation in age-standardized ovarian cancer mortality at all ages declined appreciably, from over 17-fold during the period 1955-1959 (i.e., between 10.5/100,000 in Denmark and 0.6/100,000 in Spain, world standard) to 3.4-fold (i.e., between 9.9/100,000 in Denmark and 2.9/100,000 in Spain) in the late 1980s. When a comparison was made between the late 1950s and the 1980s, ovarian cancer mortality increased in most European countries, except Denmark, Sweden, and Switzerland, where certified mortality was already elevated in the late 1950s, although also in these countries the peak rate around or over 10/100,000 was reached during the 1960s. However, when the changes over the last decade were considered, ovarian cancer mortality trends were downward in all Nordic countries, Germany, Switzerland, Austria, and Czechoslovakia. Mortality was rising somewhat, though to a smaller extent, in Ireland, Britain, and Southern Europe. Trends were more favorable in middle-aged women (35 to 64 years), and, to an even greater extent, in young women (aged 20 to 44), among whom substantial declines, particularly over the last decade, were observed in most European countries, approaching 50% in Britain and Scandinavia. These trends are discussed in terms of changes in risk factor exposure (i.e., trends in average parity and oral contraceptive use), diagnostic and therapeutic improvements, ovariectomy, and changes in case ascertainment and certification.
Trends in mortality from Hodgkin's disease between mid 1950s and the late 1980s have been analysed for 16 western European and seven eastern European countries. In all western countries there were substantial falls in mortality from the late 1960s onwards, for an overall mean decline of 50% in both sexes, although these falls were somewhat larger in Nordic countries (approaching 70% in Denmark and Sweden), and more limited (20 to 30%) in Portugal, Spain and Greece. The reductions in Hodgkin's disease mortality were evident both in younger (under 35) and middle age (35 to 64 years), as well as in children under 15 and, in several countries, in the elderly (above 65), too. They were persistent up to the most recent calendar periods, with no evidence of flattening off. The pattern of trends in Hodgkin's disease mortality was largely different in Eastern Europe. Among seven countries examined, some fall was observed only in Bulgaria and Czechoslovakia, but other countries showed no consistent pattern and there was some increase, too. In absolute terms, the reductions in Hodgkin's disease mortality in Western Europe correspond to the avoidance of over 3,000 deaths per year. This stresses the importance and urgency of improving the availability of currently defined knowledge and resources for treatment of Hodgkin's disease in Eastern Europe.
BACKGROUND: Lung cancer mortality in men has been declining since the late 1980s in most European countries. In women, although rates are still appreciably lower than those for men, steady upward trends have been observed in most countries. To quantify the current and future lung cancer epidemic in European women, trends in lung cancer mortality in women over the last four decades were analyzed, with specific focus on the young. PATIENTS AND METHODS: Age-standardized (world standard) lung cancer mortality rates per 100,000 women-at all ages, and truncated 35--64 and 20--44 years-were derived from the WHO for the European Union (EU) as a whole and for 33 separate European countries. Joinpoint regression analysis was used to identify points where a significant change in trends occurred. RESULTS: In the EU overall, female lung cancer mortality rates rose by 23.8% between 1980--1981 and 1990--1991 (from 7.8 to 9.6/100,000), and by 16.1% thereafter, to reach the value of 11.2/100,000 in 2000--2001. Increases were smaller in the last decade in several countries. Only in England and Wales, Latvia, Lithuania, Russia and Ukraine did female lung cancer mortality show a decrease over the last decade. In several European countries, a decline in lung cancer mortality in young women (20--44 years) was observed over the last decade. CONCLUSIONS: Although female lung cancer mortality is still increasing in most European countries, the more favorable trends in young women over recent calendar years suggest that if effective interventions to control tobacco smoking in women are implemented, the lung cancer epidemic in European women will not reach the levels observed in the USA.
Comment In: Ann Oncol. 2005 Oct;16(10):1565-616172464
We have considered trends in age-standardized mortality from gastric cancer in 25 individual European countries, as well as in the European Union (EU) as a whole, in six selected central-eastern European countries and in the Russian Federation over the period 1950-1999. Steady and persisting falls in rates were observed, and the fall between 1980 and 1999 was approximately 50% in the EU, 45% in eastern Europe and 40% in Russia. However, the declines were greater in Russia and eastern Europe, since rates were much higher, in absolute terms. Joinpoint regression analysis indicated that the falls were proportionally greater in the last decade for men (-3.83% per year in the EU) and in the last 25 years for women (-3.67% per year in the EU) than in previous calendar years. Moreover, steady declines in gastric cancer mortality were observed in the middle-aged and the young population as well, suggesting that they are likely to persist in the near future. In terms of number of deaths avoided, however, the impact of the decline in gastric cancer mortality will be smaller, particularly in the EU.