Trends in mortality from major cancers in the European Union, including acceding countries, in 2004

BACKGROUND: In May 2004, 10 additional countries joined the European Union (EU), including a total of 75 million inhabitants. Most of these were from central and eastern European countries with comparably high cancer mortality rates and with relatively unfavorable trends. Therefore, it is important to provide updated mortality data regarding major cancers in various countries and to analyze trends for the current population of the EU. METHODS: The authors considered mortality rates (directly standardized to the world standard population) for all cancers and for 8 major cancer sites in the year 2000 in the 25 countries of the EU and analyzed corresponding trends since 1980 using data derived from the World Health Organization data base. RESULTS: For men, overall cancer mortality in the year 2000 varied by a factor > 2 between the highest rate of 258.5 per 100,000 men in Hungary and the lowest rate of 122.0 per 100,000 men in Sweden. Central and Eastern European accession countries had the highest rates not only for lung and other tobacco-related cancers but also for gastrointestinal cancers and leukemias. The geographic pattern was different and the range of variation was smaller for women, i.e., between 136.7 per 100,000 women in Denmark and 76.4 per 100,000 women in Spain in the year 2000. In the EU as a whole, lung cancer mortality in men peaked at 55.4 per 100,000 men in 1988 and declined thereafter to 46.7 per 100,000 men in 2000. Gastric cancer steadily declined from 19.7 per 100,000 men in 1980 to 10.1 per 100,000 men in 2000. Other major sites showed moderately favorable trends over the last few years. In women, breast cancer peaked at 21.7 per 100,000 in 1989 and declined to 18.9 per 100,000 in 2000. Mortality from gastric, (cervix) uterus, and intestinal cancers demonstrated steady decreases, but lung cancer increased from 7.7 per 100,000 women in 1980 to 11.1 per 100,000 women in 2000. The increase in lung cancer mortality in women age < 55 years was 38% between 1990 and 2000 (from 2.16 per 100,000 women to 2.99 per 100,000 women), reflecting the spread of tobacco smoking among women in the EU over the last few decades. CONCLUSIONS: The priority for further reduction of cancer mortality in the EU remains tobacco control together with more widespread availability of modern diagnostic and treatment procedures for neoplasms that are amenable to treatment.     

Recent trends in colorectal cancer mortality in Europe

Colorectal cancer mortality has been declining over the last two decades in Europe, particularly in women, the trends being, however, different across countries and age groups. We updated to 2007 colorectal cancer mortality trends in Europe using data from the World Health Organization (WHO). Rates were analyzed for the overall population and separately in young, middle‐age and elderly populations. In the European Union (EU), between 1997 and 2007 mortality from colorectal cancer declined by around 2% per year, from 19.7 to 17.4/100,000 men (world standardized rates) and from 12.5 to 10.5/100,000 women. Persisting favorable trends were observed in countries of western and northern Europe, while there were more recent declines in several countries of eastern Europe, including the Czech Republic, Hungary and Slovakia particularly in women (but not Romania and the Russian Federation). In 2007, a substantial excess in colorectal cancer mortality was still observed in Slovakia, Hungary, Croatia, the Czech Republic and Slovenia in men (rates over 25/100,000), and in Hungary, Norway, Denmark and Slovakia in women (rates over 14/100,000). Colorectal mortality trends were more favorable in the young (30–49 years) from most European countries, with a decline of ～2% per year since the early 1990s in both men and women from the EU. The recent decreases in colorectal mortality rates in several European countries are likely due to improvements in (early) diagnosis and treatment, with a consequent higher survival from the disease. Interventions to further reduce colorectal cancer burden are, however, still warranted, particularly in eastern European countries.     

Trends in laryngeal cancer mortality in Europe

After a steady increase since the 1950s, laryngeal cancer mortality had tended to level off since the early 1980s in men from most European countries. To update trends in laryngeal cancer mortality in Europe, age-standardized (world standard) mortality rates per 100,000 were derived from the WHO mortality database for 33 European countries over the period 1980-2001. Jointpoint analysis was used to identify significant changes in mortality rates. In the European Union (EU) as a whole, male mortality declined by 0.8% per year between 1980 and 1989, by 2.8% between 1989 and 1995, by 5.3% between 1995 and 1998, and by 1.5% thereafter (rates were 5.1/100,000 in 1980-1981 and 3.3/100,000 in 2000-2001). This mainly reflects a decrease in rates in men from western and southern European countries, which had exceedingly high rates in the past. Male laryngeal mortality rose up to the early 1990s, and leveled off thereafter in several countries from central and eastern Europe. In 2000-2001 there was still a 10-15-fold variation in male laryngeal mortality between the highest rates in Croatia (7.9/100,000) and Hungary (7.7/100,000) and the lowest ones in Sweden (0.5/100,000) and Finland (0.8/100,000). Laryngeal cancer mortality was comparatively low in women from most European countries, with stable rates around 0.3/100,000 in the EU as a whole over the last 2 decades. Laryngeal cancer trends should be interpreted in terms of patterns and changes in exposure to alcohol and tobacco. Despite recent declines, the persistence of a wide variability in male laryngeal cancer mortality indicates that there is still ample scope for prevention of laryngeal cancer in Europe.     

Cancer mortality in Italy, 1997: quantifying the fall in rates in women and men.

AIMS AND BACKGROUND: To update data and statistics on cancer death certification in Italy to 1997. METHODS: Data and statistics for 1997 subdivided into 31 cancer sites are presented.Trends in age-standardized rates for major cancer sites are plotted from 1955 to 1997. RESULTS: The age-standardized (world standard) death certification rates from all neoplasms steadily declined from the peak of 199.2/100,000 males in 1988 to 174.7 in 1997 and for females from 102.5 to 93.0. The decline was larger in truncated rates, by about 26% for males since 1983 and by 24% for females since the top rate of the early 1960's. A major component of the favorable trend in males was lung cancer, which showed a 16% decline from the peak of 1987-88, to reach 50.6/100,000 in 1997, corresponding to about 5,000 avoided deaths. The decline in lung cancer was about 34% at age 35 to 64. For females, in contrast, both the absolute number of lung cancer deaths and the age-standardized rate of 7.9/100,000 were among the highest values ever registered, reflecting the different pattern of spread of the tobacco-related lung cancer epidemic in the two sexes. Intestinal cancer rates were stable for males but declined by approximately 10% for females, mostly in middle age, as did breast cancer mortality. Among neoplasms showing favorable trends, there were other tobacco-related neoplasms in men, plus the continuing fall in stomach and cervix uteri. Upward trends were observed for non Hodgkin's lymphomas. CONCLUSIONS: The fall in cancer mortality observed over the last decade in Italy is attributable to a decline in lung and other tobacco-related neoplasms in males, together with a persistent fall in stomach and uterine (cervical) cancer. In women, there were also recent falls in intestinal and breast cancer rates, and declines in both sexes in rarer neoplasms influenced by therapeutic advancements.     

Reprint of: Cancer incidence and mortality patterns in South Eastern Europe in the last decade: Gaps persist compared with the rest of Europe

IntroductionCancer registration coverage and cancer control programmes in South Eastern (SE) Europe, embracing about six new EU member states, remain thin, despite a relatively high incidence and mortality burden from avoidable cancers, particularly in males. We assembled the most recent cancer registry data to estimate the burden of the 17 most common cancers in the region, from Slovenia to Cyprus and Malta.MethodsData were made available for analysis from Bulgaria, Croatia, Cyprus, Malta, Romania (Cluj County), Serbia, Slovenia and Turkey (Antalya and Izmir provinces). We analysed incidence and mortality of the 17 most common cancers (counts and age-standardised rates, for the most recent year available and for the period 1999–2008). We used Joinpoint regression to quantify recent trends.FindingsFor much of SE Europe, there were no marked declines in overall cancer mortality rates during 1999–2008. In men, lung cancer incidence and mortality rates were high compared to other European countries (age-standardised rates (ASRW) of incidence being 50–60/100,000 in most of the countries), and are still increasing in Bulgaria, Serbia and Turkey. Prostate cancer incidence rapidly increased throughout the region by 3–12% annually, largely without any clear declines in mortality. Colorectal cancer incidence increased throughout the region, as did mortality especially in Croatia, Serbia and Bulgaria (average annual percentage change (AAPC) 1.5–2%). In women, breast cancer mortality significantly declined in Slovenia, Croatia and Malta (AAPC −2%, −1% and −5%, respectively), but not elsewhere. Cervical cancer incidence rates remained very high in Romania, Serbia and Bulgaria (ASRW >20/100,000).InterpretationOur data confirmed the North West to South East Europe gradient of increasing incidence and mortality rates of tobacco-related cancers, as well as increasing mortality rates of screen-detectable cancers. Lack of decline in overall cancer mortality also indicates suboptimal levels of cancer control in the region.     

Trends in cancer mortality in Switzerland, 1980-2001.

Trends in cancer mortality in Switzerland were analysed over the period 1980-2001, on the basis of the World Health Organization database. Appropriately developed correction factors were utilized for the period before 1995, to allow for spurious trends introduced by the change between the 8th and the 10th revisions of the ICD. Steady declines in cancer mortality were observed, particularly from the mid-1980s onwards. Over the last decade, the fall in overall age-standardized (world standard) cancer mortality was 11.1% in men (from 158.1 in 1990-1991 to 140.6/100,000 in 2000-2001) and 7.6% in women (from 91.6 to 84.7/100,000), and the decline was larger in truncated rates from 35 to 64 years (-18.0 and -9.7%). In men, all major tobacco and alcohol neoplasms have declined until the late 1990s but have levelled off over the last few years, reflecting recent trends in alcohol and tobacco consumption. The fall in male lung cancer mortality was 20% over the last decade (from 42.9 to 34.3/100,000). In contrast, lung cancer mortality in women has steadily increased by 38% between 1981 and 1991 and by 47% between 1991 and 2001, to reach 10.7/100,000 at all ages and 18.3 at age 35 to 64, due to increased prevalence of smoking in subsequent generations of Swiss women. Other sites showing substantial declines include stomach and colorectum in both sexes, (cervix) uteri and breast in women. Likewise, prostate cancer showed modest favourable trends after 1995. Steady declines were observed for leukaemias, Hodgkin's disease and testicular cancer, namely, the neoplasms most influenced by therapeutic improvements, while trends in lymphomas and myeloma showed no clear pattern.     

The oral cancer epidemic in central and eastern Europe

To monitor recent trends in oral and pharyngeal cancer mortality in 38 European countries, we analyzed data provided by the World Health Organization over the period 1975–2004. Joinpoint analysis was used to identify significant changes in trends. In the European Union (EU), male mortality rates rose by 2.1% per year between 1975 and 1984, by 1.0% between 1984 and 1993, and declined by 1.3% between 1993 and 2004, to reach an overall age‐standardized rate of 6.1/100,000 in 2000–2004. Mortality rates were much lower in women, and the rate in the EU rose by 0.9% per year up to 2000, and levelled off to 1.1/100,000 in 2000–2004. In France and Italy—which had the highest rates in the past—male rates have steadily declined during the last two decades (annual percent change, APC = ?4.8% in 1998–2004 in France and ?2.6% in 1986–2003 in Italy). Persisting rises were, however, observed in several central and eastern European countries, with exceedingly high rates in Hungary (21.1/100,000; APC = 6.9% in 1975–1993 and 1.4% in 1993–2004) and Slovakia (16.9/100,000; APC = 0.14% in 1992–2004). In middle aged (35 to 64) men, oral and pharyngeal cancer mortality rates in Hungary (55.3/100,000) and Slovakia (40.8/100,000) were comparable to lung cancer rates in several major European countries. The highest rates for women were in Hungary (3.3/100,000; APC = 4.7% in 1975–2004) and Denmark (1.6/100,000; APC = 1.3% in 1975–2001). Oral and pharyngeal cancer mortality essentially reflects the different patterns in tobacco smoking and alcohol drinking, including drinking patterns and type of alcohol in central Europe.     

Cancer incidence and mortality patterns in South Eastern Europe in the last decade: Gaps persist compared with the rest of Europe

IntroductionCancer registration coverage and cancer control programmes in South Eastern (SE) Europe, embracing about six new EU member states, remain thin, despite a relatively high incidence and mortality burden from avoidable cancers, particularly in males. We assembled the most recent cancer registry data to estimate the burden of the 17 most common cancers in the region, from Slovenia to Cyprus and Malta.MethodsData were made available for analysis from Bulgaria, Croatia, Cyprus, Malta, Romania (Cluj County), Serbia, Slovenia and Turkey (Antalya and Izmir provinces). We analysed incidence and mortality of the 17 most common cancers (counts and age-standardised rates, for the most recent year available and for the period 1999–2008). We used Joinpoint regression to quantify recent trends.FindingsFor much of SE Europe, there were no marked declines in overall cancer mortality rates during 1999–2008. In men, lung cancer incidence and mortality rates were high compared to other European countries (age-standardised rates (ASRW) of incidence being 50–60/100,000 in most of the countries), and still increasing in Bulgaria, Serbia and Turkey. Prostate cancer incidence rapidly increased throughout the region by 3–12% annually, largely without any clear declines in mortality. Colorectal cancer incidence increased throughout the region, as did mortality especially in Croatia, Serbia and Bulgaria (average annual percentage change (AAPC) 1.5–2%). In women, breast cancer mortality significantly declined in Slovenia, Croatia and Malta (Average Annual Percentage of Change [AAPC] –2%, –1% and –5%, respectively), but not elsewhere. Cervical cancer incidence rates remained very high in Romania, Serbia and Bulgaria (ASRW > 20/100,000).InterpretationOur data confirmed the North West to South East Europe gradient of increasing incidence and mortality rates of tobacco-related cancers, as well as increasing mortality rates of screen-detectable cancers. The lack of decline in overall cancer mortality also indicates suboptimal levels of cancer control in the region.     

European cancer mortality predictions for the year 2012

BackgroundEstimating current cancer mortality figures is important for defining priorities for prevention and treatment.Materials and methodsUsing logarithmic Poisson count data joinpoint models on mortality and population data from the World Health Organization database, we estimated numbers of deaths and age-standardized rates in 2012 from all cancers and selected cancer sites for the whole European Union (EU) and its six more populated countries.ResultsCancer deaths in the EU in 2012 are estimated to be 1 283 101 (717 398 men and 565 703 women) corresponding to standardized overall cancer death rates of 139/100 000 men and 85/100 000 women. The fall from 2007 was 10% in men and 7% in women. In men, declines are predicted for stomach (-20%), leukemias (-11%), lung and prostate (-10%) and colorectal (-7%) cancers, and for stomach (-23%), leukemias (-12%), uterus and colorectum (-11%) and breast (-9%) in women. Almost stable rates are expected for pancreatic cancer (+2–3%) and increases for female lung cancer (+7%). Younger women show the greatest falls in breast cancer mortality rates in the EU (-17%), and declines are expected in all individual countries, except Poland.ConclusionApart for lung cancer in women and pancreatic cancer, continuing falls are expected in mortality from major cancers in the EU.     

Estimates of the worldwide mortality from 25 cancers in 1990.

We present here worldwide estimates of annual mortality from all cancers and for 25 specific cancer sites around 1990. Crude and age-standardised mortality rates and numbers of deaths were computed for 23 geographical areas. Of the estimated 5.2 million deaths from cancer (excluding non-melanoma skin cancer), 55% (2.8 million) occurred in developing countries. The sex ratio is 1.33 (M:F), greater than that of incidence (1.13) due to the more favourable prognosis of cancer in women. Lung cancer is still the most common cause of death from cancer worldwide with over 900,000 deaths per year, followed by gastric cancer with over 600,000 deaths and colorectal and liver cancers accounting for at least 400,000 deaths each. In men, deaths from liver cancer exceed those due to colo-rectal cancer by 38%. Over 300,000 deaths of women are attributed to breast cancer, which remains the leading cause of death from cancer in women, followed by cancers of the stomach and lung with 230,000 annual deaths each. In men, the risk of dying from cancer is highest in eastern Europe, with an age-standardised rate for all sites of 205 deaths per 100,000 population. Mortality rates in all other developed regions are around 180. The only developing area with an overall rate of the same magnitude as that in developed countries is southern Africa. All of eastern Asia, including China, has mortality rates above the world average, as do all developed countries. The region of highest risk among women is northern Europe (age-standardised rate = 125.4), followed by North America, southern Africa and tropical South America. Only south-central and western Asia (Indian subcontinent, central Asia and the middle-eastern countries) and Northern Africa are well below the world average of 90 deaths per 100,000 population annually. Our results indicate the potential impact of preventive practices. It is estimated that 20% of all cancer deaths (1 million) could be prevented by eliminating tobacco smoking. Infectious agents account for a further 16% of deaths.     

Cancer mortality predictions for 2019 in Latin America

We estimated mortality figures for 2019 in seven Latin American countries, with focus on breast cancer. We retrieved cancer death certification and population data from the WHO and PAHO databases. We obtained mortality statistics for Argentina, Brazil, Chile, Colombia, Cuba, Mexico and Venezuela for 1970–2015. We predicted current death numbers and age-standardised (world population) mortality rates using joinpoint regression models. Total cancer mortality is predicted to decline in all countries and both sexes, except Argentinian women. Cuba had the highest all cancer rates for 2019, 136.9/100,000 men and 90.4 women, while Mexico showed the lowest ones, 63.8/100,000 men and 61.9 women. Stomach cancer showed favourable trends over the whole period, while colorectal cancer only recently. Lung cancer rates declined in men, while in women they decreased slightly over the most recent years, only. In Cuban women, lung cancer rates overtook breast cancer ones. Breast cancer showed overall favourable trends, but rates are rising in young women. Prostate and uterine cancer had favourable trends. Pancreas, ovary, bladder and leukaemias showed slightly decreasing trends. Between 1990 and 2019, mortality from all neoplasms is predicted to fall by about 18% in Argentina, 26% in Chile, 14% in Colombia, 17% in Mexico and 13% in Venezuela, corresponding to almost 0.5 million avoided cancer deaths. No decline was observed in Brazil and Cuba. Of concern, the persisting high rates of (cervix) uterus cancer, the high lung cancer rates in Cuba, the possible increases in breast cancer in young women, and the lack of overall declines in Brazil, Cuba and Venezuelan men.     

Trends and patterns in prostate cancer mortality in Belgrade, Serbia: a join-point analysis.

The objective of this analysis was to examine recent changes in prostate cancer mortality among the male population of Belgrade, Serbia, during the period 1975-2002. Mortality data (official death certificates) for prostate cancer were gathered from published and unpublished material of the Municipal Institute of Statistics in Belgrade. Mortality rates were standardized according to the European standard population. Trends in mortality rates were assessed using join-point analysis. During the period from 1975 to 2002 in the population of Belgrade the average age-adjusted mortality rate from prostate cancer during this period was 17.5/100,000 (95% confidence interval, 15.4-19.6), ranging from 8.2/100,000 in 1984 to 31.2/100,000 in 2002. Since 1986 mortality rates among men aged 50 years and over have risen by nearly 6% per year, with the increases being slightly higher among older men (70 years and over 8% per year) compared to younger men (50-69 years, 4% per year). Mortality due to prostate cancer is rising quickly among men in Belgrade. This level of increase is the highest of any reported increase internationally and contrasts sharply with the widespread decrease in prostate cancer mortality in many developed countries.     

Trends in cervical and breast cancer in Iceland. A statistical evaluation of trends in incidence and mortality for the period 1955-1989, their relation to screening and prediction to the year 2000

The time trends in incidence and mortality from cervical cancer and breast cancer in Iceland, from 1955 to 1989, were analyzed by fitting curvilinear regressions to the age-standardized rates. The effect of the screening was evaluated by comparing the curvature of the fitted regression lines and changes in screening activity. The incidence and mortality rates for both cancer types were predicted up to the year 2000. At the commencement of cervical cancer screening in 1964, both the incidence and mortality rates were on the increase. After 1970, both rates decreased significantly. Assuming that regular attendance at screening will be 85%, it is predicted that the incidence and mortality rates will level out at about 7.5 and 2 cases per 100,000 women per year, respectively, by the year 1995 and remain at that level. The incidence of breast cancer has increased steadily since 1955. A sharp rise has been observed since 1987, due to screening with mammography. The mortality rate has shown small but significant fluctuations with time. The incidence rate is predicted to increase at the same rate as before 1987 (i.e. at 1.1 cases per 100,000 women per year), but at a slightly higher level and is predicted to reach 84 cases per 100,000 women per year by the year 2000. Breast cancer mortality is predicted to decrease to about 17 cases per 100,000 women per year by 1995 and to remain at that level.     

Mortality from major cancer sites in the European Union, 1955-1998.

After long-term rises, over the last decade age-standardised mortality from most common cancer sites has fallen in the European Union (EU). For males, the fall was 11% for lung and intestines, 12% for bladder, 6% for oral cavity and pharynx, and 5% for oesophagus. For females, the fall was 7% for breast and 21% for intestines. There were also persisting declines in stomach cancer (30% in both sexes), uterus (mainly cervix, -26%) and leukaemias (-10%). Mortality rates for other common neoplasms, including pancreas for both sexes, prostate and ovary, tended to stabilise. The only unfavourable trends were observed for female lung cancer (+15%). Lung cancer rates in women from the EU are approximately one-third of those in the USA, and 50% lower than breast cancer rates in the EU. Lung cancer rates in European women have also tended to stabilise below the age of 75 years. Thus, effective interventions on tobacco control could, in principle, avoid a major lung cancer epidemic in European women.     

Laryngeal cancer mortality trends in European countries

After a steady increase between the 1950s and the 1970s, laryngeal cancer mortality has been levelling off since the early 1980s in men from most western and southern European countries and since the early 1990s in central and eastern Europe. To update trends in laryngeal cancer mortality, we analyzed data provided by the World Health Organization over the last two decades for 34 European countries and the European Union (EU) as a whole. For major European countries, we also identified significant changes in trends between 1980 and 2012 using joinpoint regression analysis. Male mortality in the EU was approximately constant between 1980 and 1991 (annual percent change, APC=?0.5%) and declined by 3.3% per year in 1991–2012. EU age‐standardized (world population) rates were 4.7/100,000 in 1990–91 and 2.5/100,000 in 2010–2011. Rates declined in most European countries, particularly over the last two decades. In 2010–11, the highest male rates were in Hungary, the Republic of Moldova, and Romania (over 6/100,000), and the lowest ones in Finland, Norway, Sweden, and Switzerland (below 1/100,000). In EU women, mortality was stable around 0.29/100,000 between 1980 and 1994 and slightly decreased thereafter (APC=?1.3%; 0.23/100,000 in 2000–01). We also considered male incidence trends for nine European countries or cancer registration areas. In most of them, declines were observed over recent decades. Laryngeal cancer mortality thus showed favourable trends over the last few decades in most Europe, following favourable changes in tobacco and, mostly for Mediterranean countries, alcohol consumption.     

Transition in cancer patterns among Turks residing in Germany

Cancer mortality among the 2.1 million Turks residing in Germany is assumed to change from a pattern typical for a developing country towards one of an industrialised country. To test this hypothesis, we compared age-standardised cancer mortality rates among Turkish residents and (West) Germans using death registration data. In addition, we assessed proportional cancer incidence ratios among Turkish cases (n=144) in a German population-based cancer registry. All-cancer mortality 1992-1997 (per 100000) was 34.8 (n=4192) among Turkish men (Germans: 72.3) and 21.5 (n=1862) among Turkish women (Germans: 52.4). Over time, gastric and lung cancer mortality increased among Turkish men, as did breast cancer mortality among Turkish women. The proportional cancer incidence (PCIR) for stomach cancer among men was 2.9 (95% Confidence Interval (CI): 1.7-4.8), and that for breast cancer among women was 0.7 (95% CI: 0.4-1.1). Turks had an increased proportional incidence ratio for non-Hodgkin's lymphoma. Our findings partly support a transition of cancer patterns among Turks in Germany.     

Monitoring falls in gastric cancer mortality in Europe.

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.     

Declining incidence is greater for esophageal than gastric cancer in Shanghai, People's Republic of China.

Temporal trends in the incidence of esophageal and gastric cancers during 1972 to 1989 were addressed in urban Shanghai, the location of China''s longest standing cancer registry. Over the 18 year study period, esophageal cancer rates decreased more than 50% from 28.8/100,000 person-years in 1972-74 to 13.3/100,000 in 1987-89 among men and from 11.3/100,000 to 5.4/100,000 among women. Reductions were apparent in each age group, but most pronounced among younger generations, with more than a 75% decline in incidence among those under age 55 years. The incidence rate for stomach cancer among men decreased 20% from 62.0/100,000 in 1972-74 to 50.1/100,000 in 1987-89. The reduction among women, however, was minor, from 23.9/100,000 to 23.2/100,000. The patterns varied by age, with declines among persons 45-64 years and increases among those in older and younger age groups. The determinants of these trends are not clear, but appear related in part to dietary changes.     

Trends in lung cancer among young European women: the rising epidemic in France and Spain

Lung cancer mortality in young women in the European Union (EU) has steadily increased until the mid 1990 s and has levelled off thereafter, but trends have been heterogeneous in various countries. We analyzed therefore age-standardized trends in lung cancer mortality in young women (20-44) for the 6 major European countries, using joinpoint regression. In the early 1970s the highest lung cancer mortality in young women was in the UK (2.1/100,000). UK rates, however, steadily declined and in 2000-2004 they were the lowest of all 6 major EU countries (1.2/100,000). The second lowest rate in 2000-2002 was in Italy, whose rates remained around 1.1/100,000 between 1970 and 1994, and increased to 1.4 thereafter. In Germany and Poland, lung cancer rates in young women rose from 0.8-1.0/100,000 in the early 1970s to 1.7-1.9 in the mid 1990 s and levelled off during the last decade. Major rises over recent years were observed in France (from 0.8/100,000 in 1985-1989 to 2.2 in 2000-2003) and in Spain (from 0.8 in the 1985-1989 to 1.7 in 2000-2004). Thus, France showed both the highest rate observed over the last 3 decades and the largest rise over the last 2 decades. Since recent trends in the young give relevant information to the likely future trends in middle age, the female lung cancer epidemic is likely to expand in southern Europe from the current rates of 5.0/100,000 in Spain and 7.7 in France to approach 20/100,000 within the next 2-3 decades. Urgent interventions for smoking cessation in women are therefore required.     

Ovarian Cancer Incidence in the Multi-Ethnic Asian City-State of Singapore 1968-2012

Purpose: We investigate ovarian cancer incidence between 1968 and 2012 in Singapore, a multiethnic Asian city state. Methods: Aggregated data of ovarian epithelial cancer numbers and estimated person-years from 1968 to 2012 were obtained from Singapore Cancer Registry. Age-Period-Cohort modelling was performed. Results: The age-standardised incidence rate of ovarian cancer increased from 5.8 to 12.5 per 100,000 per year between 1968 and 2012, while the age-standardised mortality rate has remained stable. This increase was higher among Malays (5.1 to 14.0 per 100,000 per year), compared to Chinese and Indians.  Serous carcinoma showed the greatest increase in incidence from 0.4 to 3.4 per 100,000 per year.  Period effects were seen in the ovarian cancer incidence trend in Chinese women, but not Malay and Indian women. Clear cell and mucinous carcinoma subtypes were more common in Chinese than in Malay and Indian women. Stage at diagnosis for the years 2003-2010 differed by subtype, and the majority of patients with serous carcinomas presented at a later stage compared to those with clear cell or mucinous carcinomas. Conclusion: Ovarian cancer incidence rates have doubled in 40 years in Singapore. There were ethnic differences in incidence rates and ovarian cancer subtypes.