1 Unité dÉpidémiologie du Cancer and Registres Vaudois et Neuchâtelois des Tumeurs, Institut Universitaire de Médecine Sociale et Préventive, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; 2 Istituto di Ricerche Farmacologiche Mario Negri, Milano; 3 Division of Epidemiology and Biostatistics, European Institute of Oncology, Milano; 4 Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, Milano, Italy
Received 27 June 2002; revised 20 September 2002; accepted 22 November 2002
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Abstract |
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Key words: cancer, European Union, mortality, time trends
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Introduction |
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We considered trends in mortality from eight major cancer sites in the EU between 1955 and 1994. There was some leveling off or decline for most cancer sites, with the main exception of lung cancer in women [2]. We have now updated these figures to 1998, on the basis of official death certifications provided by the World Health Organization (WHO). The EU was defined as the 15 member states in 199598 (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, The Netherlands, Portugal, Spain, Sweden, UK). Age-standardised rates (in 5-year age groups from 05 to 8084 and 85 years) were based on the world standard population.
Table 1 and Figure 1 give long-term trends in mortality from major cancers in men. The fall in lung cancer has become appreciable, from the peak of 52.4 per 100 000 in 198589 to 46.6 in 199598 (11%). An 11% fall was also observed for colorectal cancer. While prostate cancer has tended to stabilise or moderately decline over the last few years, the fall in gastric cancer persisted, and was over 30% during the last decade alone. Pancreatic cancer rates tended also to decline, with a 3% decline over the last 5 years. Over the last decade, there has been a 12% decline in bladder cancer, and a greater than 5% decline in mouth or pharynx and oesophageal cancer.
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Thus, most common cancers showed favourable trends for both sexes over the last decade in the EU, as in the USA [5]. Some of these, including the fall in mortality from leukaemias and breast cancer, particularly evident in the middle-aged population, are partly or largely due to therapeutic advancements [610].
The decline in breast cancer in some countries of the EU is partly attributable to screening and earlier diagnosis [8, 9]. These are also the major determinants of the continuing fall in mortality from cervix uteri cancer [4]. Improvements in food preservation, diet and nutrition are the main determinants of the favourable trends in stomach cancer in both sexes [11], and probably also in intestinal cancer [12], the fall of which started in the late 1970s, and has been appreciably greater for females than for males.
It is also of interest that, over the last decade, mortality from several neoplasms which had showed long-term rises up to the mid-1980s in the EU, has tended to level off. These include, among others, cancers of the pancreas for both sexes, and prostate and ovary, mainly in middle age, reflecting different cohort patterns for these neoplasms [13]. For ovarian cancer, the favourable trends in young and middle-aged women have been related to oral contraceptive use in the generations born after 1930 [14].
The main difference between cancer mortality for females and males has been observed for lung and other tobacco-related neoplasms. Lung cancer rates, after long-term rises, declined by over 10% in European males during the last decade, and a similar fall was observed for bladder cancer, which may also indicate decreased exposure to occupational carcinogens [15]. The fall was smaller (i.e. 5%) for oral and pharyngeal and oesophageal cancers, which are strongly related to alcohol as well as to tobacco consumption [1618].
Lung cancer rates, in contrast, have risen by 15% in European women over the last decade. Although the rise was smaller than the 28% observed during the previous decade, this reflects the persisting spread of the tobacco-related (lung) cancer epidemic in European women, and again underlines the importance of urgent intervention to control tobacco smoking in women. The observation that the rises were apparently smaller below the age of 75 years is, however, encouraging in terms of cohort effects in female lung cancer rates. Together with non-Hodgkins lymphomas in both sexes [19], female lung cancer remains one of the few neoplasms showing upward mortality rates in the EU over the last decade.
Lung cancer rates in European women are, however, still about one-third of those in US women, and 50% lower than breast cancer rates in the EU. An integrated and effective intervention to reduce the smoking epidemic in European women should help stop the tobacco-related lung cancer epidemic in the EU reaching the size now registered in the USA [20, 21].
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Acknowledgements |
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Footnotes |
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References |
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