Trends in cancer mortality in 15 industrialized countries, 1969-1986.

BACKGROUND: Assessing trends in cancer provides a means for gauging progress against the disease, estimating future demands for care and treatment, and suggesting clues about shifting causal factors that may account for the more recent changes. PURPOSE: This study was designed to evaluate trends in the major sites of cancer associated with high mortality rates in 15 industrialized countries. To highlight differences among regions, we grouped these countries into six geographic areas: United States, Eastern Europe, Western Europe, East Asia, Oceania, and Nordic countries. In addition, cancer mortality trends in these regions were compared with incidence patterns in the United States. METHODS: Data provided by the World Health Organization were used to evaluate age-specific mortality trends from 1969 through 1986 for lung, breast, prostate, stomach, and colorectal cancers and for all other sites considered as a group. We also assembled and analyzed data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute for the same sites and age groups from 1973 through 1986. RESULTS: Over the period 1969 through 1986, recorded cancer mortality in persons aged 45 years and older in the six regions studied has increased for lung, breast, and prostate cancers in most age groups, while the decline in stomach cancer mortality is substantial. The increase in lung cancer deaths in men aged 45-54 years has slowed greatly or reversed in all areas except Eastern Europe and East Asia. Trends for intestinal cancer vary by age and region. For all other sites considered as a group, increases have occurred for persons older than 64 years in most regions. In Eastern Europe, there are disturbingly high rates and rapid increases for several of the major forms of cancer in persons aged 45-54 years. In general, trends for cancer incidence in the United States parallel those for mortality. For intestinal cancer, however, incidence has increased while mortality has declined. CONCLUSIONS: The trends we report cannot be explained solely by changes in cigarette smoking or aging. Other causes of changes in cancer incidence and mortality need to be determined. IMPLICATIONS: The increasing and decreasing trends in mortality from and incidence of cancer that we found are important for health care planning and may also suggest opportunities for research in cancer prevention.     

Cancer mortality in Ireland, 1926-1995.

BACKGROUND: Investigation of long time series of cancer data can still be very useful in helping to identify Cancer Control priorities and achievements. Since the partition of Ireland into the independent Republic of Ireland and Northern Ireland, which remained part of the United Kingdom, cancer mortality data have been published in an essentially similar format in both countries. The information presented here will contribute to providing a basis for the collaborative Cancer Research programme initiated recently. PATIENTS AND METHODS: Cancer mortality data have been assembled and analysed separately for the Republic of Ireland and Northern Ireland: the data have then been combined to present mortality rates for the whole of Ireland, covering the period from 1926 to 1995. Several rubrics had to be aggregated to provide data continuously over the time span (e.g. colon and rectum and cervix and body of the uterus). When data were only available in 10-year classes of age, the EM algorithm was employed to obtain 5-year age-specific rates. All rates presented are age-standardised, employing the World Standard Population. RESULTS: In women, the death rate from all neoplasms combined increased very slightly from 117 per 100 000 in 1946-1950 to 120 per 100 000 in 1991-1995. In men, the death rate increased from 127 per 100 000 to 172 per 100 000 over the same time period. The overall cancer death rate in Ireland is currently similar to the European average in men, although in women it is among the top fifth of national cancer mortality rates in European countries. While cancer is a major cause of death in Ireland, there is no evidence of an evolving epidemic building up: the death rates from most forms of cancer are declining towards the end of the time period considered. CONCLUSIONS: As demonstrated by falling death rates from Hodgkin's disease and testicular cancer, major treatment advances appear to have been incorporated effectively into clinical practice in Ireland. Progress is apparent in tobacco control and further initiatives in this area must be undertaken since tobacco appears to be the only major new carcinogen introduced recently into the Irish environment during the period covered by this study. Effective population-based screening programmes for cervix and breast cancer and, more controversially, consideration of a National Prostate Cancer Screening programme, offer scope for further improvement in mortality. Examination of this long time series of mortality data from Ireland provides information about the evolving cancer pattern and provides the necessary background to evaluate the impact of the cross-border cancer research activities now being launched.     

Cancer Mortality Trends in Sweden 1960-1986

Time-related trends in age-standardized cancer mortality have been suggested to be the best single measure of the progress—or lack of progress—in cancer control measures. the paper presents data on trends in Sweden during 1960-1986. From the middle of the 1970s, total cancer mortality decreased significantly among both males and females. the estimated annual decrease between 1975 and 1986 was 0.5-1.2%. Current Swedish trends are thus in keeping with the goal stated in the European Community's action programme 'Europe against cancer': a 10-15% decrease in total age-standardized cancer mortality by the year 2000. This goal might even be too conservative, because most of the cancer control measures in 'Europe against cancer' will not be able to enhance the current downward trends until the early 1990s.     

Trends in cancer incidence,survival and mortality in northern sweden 1960-1986

The impact of cancer on a population may be measured in several ways. Incidence, relative survival and mortality are frequently utilized for this purpose. Incidence and relative survival are, however, often influenced by changes in the diagnostics of incident cancer, particularly by an altered rate of detection of non-fatal cancer. Mortality, as traditionally studied, is often influenced by changes of death causes diagnostics or of cocling routines. In an attempt to overcome some of these difficulties, the concept of excess mortality was suggested, which is independent of death cause diagnoses or cocling routines, as well as of the rate of detection of non-fatal cancer. In order to elucidate time trends in the overall effects of cancer we analysed incidence, survival and mortality from all cancer in the northern region of Sweden 1960—1986. An increasing age-adjusted cancer incidence was paralleled by an improvement in relative survival, whereas age-adjusted cancer mortality was mainly unchanged, at least when studied as excess mortality. We interpreted these finclings as due mainly to an increased detection of non-fatal cancer, and to an unchanged occurrence rate of fatal cancer.     

Trends in cancer incidence, survival and mortality in northern Sweden 1960-1986.

The impact of cancer on a population may be measured in several ways. Incidence, relative survival and mortality are frequently utilized for this purpose. Incidence and relative survival are, however, often influenced by changes in the diagnostics of incident cancer, particularly by an altered rate of detection of non-fatal cancer. Mortality, as traditionally studied, is often influenced by changes of death causes diagnostics or of coding routines. In an attempt to overcome some of these difficulties, the concept of excess mortality was suggested, which is independent of death cause diagnoses or coding routines, as well as of the rate of detection of non-fatal cancer. In order to elucidate time trends in the overall effects of cancer we analysed incidence, survival and mortality from all cancer in the northern region of Sweden 1960-1986. An increasing age-adjusted cancer incidence was paralleled by an improvement in relative survival, whereas age-adjusted cancer mortality was mainly unchanged, at least when studied as excess mortality. We interpreted these findings as due mainly to an increased detection of non-fatal cancer, and to an unchanged occurrence rate of fatal cancer.     

Cancer mortality in broad Italian geographical areas, 1975-1977

Death certification rates from various cancers or groups of cancers in broad Italian geographical areas (North/Center/South) over the period 1975-1977 were analyzed. In both sexes, there was a clear North/South gradient, with considerably higher rates in the North for total cancer mortality as well as for most common neoplasms. The geographical variation was more marked in males (North/South ratio for total cancer mortality = 1.75 at all ages and 1.70 truncated 35-64 years) than in females (ratio = 1.48 at all ages and 1.28 truncated 35-64). Although, in general terms, the present results confirm previous analyses of cancer mortality in Italy, a few interesting tendencies should be noted. First, the geographical differences in the mid-late 1970's were much more marked for tobacco-related cancers (a factor of over two in males in the North/South ratio) than for other chiefly epithelial carcinomas or nonepithelial cancers. In general, variations for nontobacco-related cancers tended to level off over more recent calendar periods. However, there was little tendency towards decreasing differences in gastric cancer mortality (which was markedly elevated in the North and Center), at least in males. During the 1970's death certification rates from cancer of the (cervix) uteri decreased in northern and central more than in southern Italy. This pattern of trends may have been influenced by a different impact of cervical screening in various areas of the country.     

Cancer mortality among Alaskan natives, 1960-69.

During 1960-69, 321 reported deaths among Alaskan natives (Eskimos, Indians, and Aleuts) were attributed to cancer. This number is not significantly different from the cancer mortality of U.S. Caucasians during this period, but is significantly higher than that of U.S. Indians. The mortality of Alaskan natives from cancers of the nasopharynx, esophagus, kidneys, and salivary glands was significantly increased. Among Alaskan Caucasians, only nasopharyngeal cancer was in excess in both sexes. Deficits in mortality among Alaskan Caucasians for cancers of other sites may be attributable, at least in part, to selection factors associated with the migration of healthy workers into the State.     

Cancer mortality in the European Union, 1970-2003, with a joinpoint analysis

Background: Cancer mortality peaked in the European Union (EU)in the late 1980s and declined thereafter. Materials and methods: We analyzed EU cancer mortality dataprovided by the World Health Organization in 1970–2003,using joinpoint analysis. Results: Overall, cancer mortality levelled off in men since1988 and declined in 1993–2003 (annual percent change,APC = –1.3%). In women, a steady decline has been observedsince the early 1970s. The decline in male cancer mortalityhas been driven by lung cancer, which levelled off since thelate 1980s and declined thereafter (APC = 2.7% in 1997–2003).Recent decreases were also observed for other tobacco-relatedcancers, as oral cavity/pharynx, esophagus, larynx and bladder,as well as for colorectal (APC = –0.9% in 1992–2003)and prostate cancers (APC = –1.0% in 1994–2003).In women, breast cancer mortality levelled off since the early1990s and declined thereafter (APC = –1.0% in 1998–2003).Female mortality declined through the period 1970–2003for colorectal and uterine cancer, while it increased over thelast three decades for lung cancer (APC = 4.6% in 2001–2003).In both sexes, mortality declined in 1970–2003 for stomachcancer and for a few cancers amenable to treatment. Conclusion: This update analysis of the mortality from cancerin the EU shows favorable patterns over recent years in bothsexes. Key words: cancer, European Union, mortality, trends Received for publication October 25, 2007. Revision received November 26, 2007. Accepted for publication December 14, 2007.     

Cancer risk among Chernobyl cleanup workers in Estonia and Latvia, 1986-1998

Two cohorts of Chernobyl cleanup workers from Estonia (4,786 men) and Latvia (5,546 men) were followed from 1986 to 1998 to investigate cancer incidence among persons exposed to ionizing radiation from the Chernobyl accident. Each cohort was identified from various independent sources and followed using nationwide population and mortality registries. Cancers were ascertained by linkage with nationwide cancer registries. Overall, 75 incident cancers were identified in the Estonian cohort and 80 in the Latvian cohort. The combined-cohort standardized incidence ratio (SIR) for all cancers was 1.15 (95% confidence interval (CI) = 0.98-1.34) and for leukemia, 1.53 (95% CI = 0.62-3.17; n = 7). Statistically significant excess cases of thyroid (SIR = 7.06, 95% CI = 2.84-14.55; n = 7) and brain cancer (SIR = 2.14, 95% CI = 1.07-3.83; n = 11) were found, mainly based on Latvian data. However, there was no evidence of a dose response for any of these sites, and the relationship to radiation exposure remains to be established. Excess of thyroid cancer cases observed may have been due to screening, the leukemia cases included 2 unconfirmed diagnoses, and the excess cases of brain tumors may have been a chance finding. There was an indication of increased risk associated with early entry to the Chernobyl area and late follow-up, though not statistically significant. Further follow-up of Chernobyl cleanup workers is warranted to clarify the possible health effects of radiation exposure.     

Trends in cancer mortality in the USSR, 1965–1990

Trends in age-specific and age-standardized mortality from 10 major cancer sites and total cancer mortality in the USSR were analyzed for the period 1965–1990, on the basis of the World Health Organization mortality database. Gastric cancer mortality declined substantially. Still, these rates were among the highest registered in the world, and in 1990 stomach cancer accounted for over 85, 000 deaths, being the second cause of cancer death (and the first one until 1980); further, there was some indication of a levelling of the declines in gastric-cancer rates for both sexes over most recent calendar years. Likewise, uterine-cancer mortality declined between 1965 and 1985, but there was no further decline over the last 5 years. Upward trends were registered for cancers of the intestine, of the breast and of the prostate. Mortality from these neoplasms, however, was still comparatively low by worldwide standards. Leukaemia rates were stable in both sexes. Substantial rises were observed for cancers of the oral cavity and pharynx, larynx and, chiefly, lung. Even more unfavourable was lung-cancer mortality in young and middle-aged males, since the truncated rate of 121/100, 000 in 1990 was higher than the values reached by countries like England and Wales or Finland even at the top of their epidemic in the 1960s, and trends in the USSR were still upwards. Thus, total cancer mortality was 176/100, 000 males in 1965, declined to 170 in 1970, but increased thereafter, particularly over the last decade, to reach 203/100, 000, i.e., one of the highest rates on a worldwide scale. Among females, the overall cancer mortality rate declined between 1965 and 1975, but rose thereafter to a value intermediate on a worldwide scale. These recent unfavourable trends of cancer mortality in the USSR indicate that, in the absence of adequate intervention, particularly on the tobacco-related cancer epidemic, overall cancer mortality will continue to rise in the foreseeable future. © 1994 Wiley-Liss, Inc.     

Cancer and other causes of death among Koreans in Fukuoka, Japan, 1976-1986

Mortalities from cancer and other causes among Koreans living in Fukuoka, Japan, between 1976 and 1986 were examined as compared with those of Japanese in the prefecture. Korean males had a marked excess in all-cause mortality, while the excess among females was less prominent. In both sexes, mortalities from liver cancer, liver cirrhosis, accident and suicide were markedly increased in the Korean population. These findings are in agreement with those observed among Koreans in Osaka. Although 20-30% lower-than-Japanese mortality from stomach cancer has been reported for Koreans in Osaka, those in Fukuoka had a risk of this cancer comparable to that of Japanese. A life-style survey of Koreans in Japan might provide a better understanding of the disease patterns observed in this population.     

Cancer mortality trends in Canada: breast cancer, 1925-1982

Breast cancer is the number one cause of death in Canadian women aged 20-74 years (for all 5-year age groups) and the second leading cause for those aged 75 years and over. To assess the long-term mortality of this disease, we collected and analyzed data from 1925 to 1982. A 3-year base period was used to obtain person-years exposure using Newton-Cotes' method. All rates were standardized to the 1956 Canadian population for age and sex using the direct method. Standard errors of age-standardized death rates (ASDR) were computed using Chiang's method. Mortality from breast cancer has been quite stable during the study period (at about 23.7 deaths/100,000 population). The lowest ASDR occurred in 1926 (at 17.5 deaths/100,000 population); the highest occurred in 1946 (when it reached 26.6 deaths/100,000 population). During 1951-1981, the ASDR fluctuated between 22.8 and 24.0 deaths/100,000 population. Examination of age sex-specific rates revealed a steady trend for 25-44-year-old females and a rise in mortality in the older age groups. It is suggested that part of this rise may be associated with changes in environment, life-style, and therapy.     

Cancer mortality in Italy, 1998

This short report provides data and statistics of cancer mortality in Italy in 1998, updating previous work on the issue. The material and methods of this report are similar to those previously described. Briefly, cancer death certification numbers by cause and estimates of the resident population in 1998, stratified by sex and quinquennia of age, were abstracted from data provided by the Istituto Nazionale di Statistica (ISTAT). All cancers or groups of cancers, classified according to the standard International Classification of Diseases (ICD), Ninth Revision, were grouped in 31 categories, besides total cancer mortality and other and unspecified sites. We grouped together all intestinal sites, melanomas and non-melanomatous skin neoplasms, all uterine neoplasms (cervix and corpus), all neoplasms of the brain and nerves (benign and malignant), all leukemias, and all non-Hodgkin's lymphomas. Eight tables were produced, including the following statistics: 1) number of deaths, crude and age-standardized death certification rates, and percentages of all cancer deaths for population at all ages and truncated 35-64 years (Table 1 for males and Table 2 for females). Two different standards were used: i) the 1971 Italian census population, corrected for census undercount and subdivided into 16 quinquennia of age from 0-4 to 75-79, plus 80 and over, and ii) the world standard population, for purposes of comparison with other countries; 2) age-specific death certification rates for each sex and quinquennium of age from 0-4 to 75-79, plus 80 and over (Table 3 for males and Table 4 for females); 3) total number of registered deaths for each cancer or group of cancers, sex and age group (Table 5 for males and Table 6 for females); 4) percentage of all cancer deaths for each sex and age group (Table 7 for males and Table 8 for females). A few comments are included, mainly in order to assist reading and interpretation of data for major cancer sites, and to recall underlying long-term tendencies. Any inference should in any case be based on age-standardized rates, and, essentially, on detailed inspection of age-specific rates.     

Cancer incidence and mortality in young adults in vaud,Switzerland, 1974-1992

Trends in cancer incidence and mortality in young adults (aged 20 to 44 years) over the period 1974-1992 were analyzed using data from the Vaud Cancer Registry, Switzerland. A total of 1,497 cancers were registered in males, after excluding non melanomatous skin cancers. The most common neoplasms were testis, lymphomas, lung, skin melanoma and oral cavity and pharynx. The overall age-standardized (world population) incidence was 750 per million males, and increased from 676 in 1974-1979 to 808 in 1986-1992. These upward trends were due mainly to cancers of the oral cavity and pharynx, lung, skin melanoma and colorectum, while testicular cancer rates remained stable. For females, a total of 1,899 malignant neoplasms was notified, corresponding to an overall age-standardized incidence of 914 per million. The overall rate increased from 818 in 1974-1979 to 1,003 in 1986-1992. The most frequent neoplasms were breast, skin melanoma, ovary, thyroid and lymphomas. The major types of cancer responsible for these upward trends were breast cancer, skin melanoma and lung cancer. In the period studied there were 458 cancer deaths in males and 408 in females, corresponding to an overall age-standardized rate of 227 per million males and 193 per million females. Death rates in males tended to decline, to reach 194 per million in 1986-1992, but no consistent trend was observed in females. The decline in males was essentially due to the fall in rates for testicular cancer and Hodgkin's disease. In females, falls in death rates were observed for cancer of the cervix uteri, ovary and Hodgkin's disease. Death rates were upwards for lung cancer in both sexes, and for skin melanoma and breast cancer in females. © 1995 Wiley-Liss, Inc.