CORRESPONDENCE

The End of the Tobacco-Related Lung Cancer Epidemic in Europe

Fabio Levi, Franca Lucchini, Eva Negri, Carlo La Vecchia

Affiliations of authors: F. Levi, F. Lucchini, Cancer Epidemiology Unit and Cancer Registries of Vaud and Neuchâtel, Institut universitaire de médecine sociale et préventive, Lausanne, Switzerland; E. Negri, Laboratory of Epidemiology, Istituto di Ricerche Farmacologiche ‘Mario Negri,’ Milan, Italy; C. La Vecchia, Cancer Epidemiology Unit and Cancer Registries of Vaud and Neuchâtel, Institut universitaire de médecine sociale et préventive, Laboratory of Epidemiology, Istituto di Ricerche Farmacologiche ‘Mario Negri,’ and Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, Milan, Italy.

Correspondence to: F. Levi, M.D., Cancer Epidemiology Unit and Cancer Registries of Vaud and Neuchâtel, Institut universitaire de médecine sociale et préventive, CHUV-Falaises 1, 1011 Lausanne, Switzerland (e-mail: Fabio.Levi{at}inst.hospvd.ch).

Lung cancer mortality has been increasing among men living in most northern European countries up to the late 1970s and early 1980s, among men living in southern Europe up to the late 1980s or early 1990s, and was still increasing among men living in eastern Europe in the early 1990s (1). Most lung cancer mortality trends among women living in these regions were still increasing in the mid-1990s (13).

To update the trend data in lung cancer mortality across Europe, we analyzed death certification data between 1980 and 1999 from the World Health Organization mortality database for 21 individual European countries and the Russian Federation. These data were subsequently categorized by the 15 countries of the European Union (EU) and the six eastern European countries (Bulgaria, Czech Republic, Hungary, Poland, Romania, and Slovakia) that provided uniform data across the calendar period considered.

In the EU, the peak rate of lung cancer mortality among males was recorded in 1988 at 51.9/100 000 (Fig. 1Go). Since then, a 15% decrease was observed, to 44.1/100 000 in 1999. Lung cancer mortality rates among males in eastern European countries were similar to those among males in the EU in the early 1980s but increased to reach a peak of 62.7/100 000 in 1995. A 6% decrease was observed thereafter, to 59.2/100 000 in 1999. In the Russian Federation, lung cancer mortality among males was 59.7/100 000 in 1980 and increased to 73.0/100 000 in 1991. A 14% decline was registered thereafter, to 62.8/100 000 in 1998. For females, lung cancer mortality rates moderately but steadily increased from 7.6/100 000 in 1980 to 10.5/100 000 in 1999 in the EU and from 7.2/100 000 to 11.2/100 000 in eastern Europe. However, the slope of these upward trends tended to level off. Thus, the increases that occurred in the early 1990s were 8.1% in the EU and 16% in eastern Europe, and in the late 1990s, 3.5% and 5.2%, respectively. In the Russian Federation, a decrease in female lung cancer mortality was observed after 1993, and the rate in 1999 (6.2/100 000) was 4.6% lower than it was in 1980 (6.5/100 000).



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Fig. 1. Trends in overall age-standardized (world population) death certification rates (per 100 000) from lung cancer in males and females in the European Union, eastern European countries, and the Russian Federation, 1980–99.

 
This updated analysis of lung cancer mortality in Europe allows us to make several novel observations. First, the 15% decrease in lung cancer mortality registered for men in the EU since 1988 corresponds to the avoidance of more than 20 000 deaths. Second, although a decrease in male lung cancer mortality after 1991 was also observed in the Russian Federation, that rate remains considerably higher than the rate in the EU. The decline of lung cancer mortality among males in the Russian Federation was largely due to a cohort effect that followed a shortage of cigarettes after World War II (4). In eastern European countries, a modest decrease was observed only since 1995, but rates remain higher than for the EU.

Thus, the lung cancer epidemic in Europe appears to have reached its peak and has started to level off in males. Rates in females have been declining in the Russian Federation but are still rising in other geographic areas, albeit at a lower extent than in the past, suggesting that the female lung cancer mortality rates in the whole EU may not reach the high levels that have been observed in North America (57) as well as in a few northern (e.g., Denmark and the U.K.) or eastern (e.g., Hungary) European countries (1,2).

NOTES

Supported by the Swiss League against Cancer and the Italian Association for Cancer Research.

REFERENCES

1 Levi F, Lucchini F, Negri E, Boyle P, La Vecchia C. Cancer mortality in Europe, 1990–94, and an overview of trends from 1955 to 1994. Eur J Cancer 1999;35:1477–516.[CrossRef][Medline]

2 Brennan P, Bray I. Recent trends and future directions for lung cancer mortality in Europe. Br J Cancer 2002;87:43–8.[CrossRef][Medline]

3 Borras JM, Fernandez E, Gonzalez JR, Negri E, Lucchini F, La Vecchia C, et al. Lung cancer mortality in European regions (1995– 1997). Ann Oncol 2003;14:159–61.[Abstract/Free Full Text]

4 Shkolnikov V, McKee M, Leon D, Chenet L. Why is the death rate from lung cancer falling in the Russian Federation? Eur J Epidemiol 1999;15:203–6.[CrossRef][Medline]

5 Women and smoking: a report of the Surgeon General. Executive Summary. MMWR Recomm Rep 2002;51(RR-12):i–iv, 1–13.[Medline]

6 Jemal A, Chu KC, Tarone RE. Recent trends in lung cancer mortality in the United States. J Natl Cancer Inst 2001;93:277–83.[Abstract/Free Full Text]

7 Levi F, Lucchini F, Negri E, La Vecchia C. Worldwide patterns of cancer mortality, 1990–94. Eur J Cancer Prev 1999;8:381–400.[Medline]


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