The decline in cancer mortality in the European Union, 1988-1996

After the peak rate reached in 1988, moderate but steady declines were observed over the last decade in total cancer mortality rates in the European Union (EU). Such a decline was over 7% for both sexes combined over the period of 1988-1996 (i.e. from 147.0 to 136.4/100,000, world standard population). The declines in cancer mortality correspond to the avoidance of approximately 70,000 deaths in 1996 in the EU compared with the 1988 rates. The major determinants of these favourable trends were lung (-7.7%), stomach (-24.8%), intestines (-12.4%), breast (-7.1%), uterus, mainly cervix (-20.6%), and leukaemias (-8.3%) and, after 1992, a levelling off of prostate cancer rates.     

European cancer mortality predictions for the year 2015: does lung cancer have the highest death rate in EU women?

Total cancer mortality rates in the EU are predicted to fall 7.5% in men and 6% in women between 2009 and 2015. However, due to population aging, total number of cancer deaths will rise to 1 359 100. Cancer mortality outlook for 2015 remains favourable, except for pancreas in both sexes and female lung that is predicted to overtake breast becoming the female cancer with the highest rate (14.24/100 000).BackgroundCancer mortality statistics for 2015 were projected from the most recent available data for the European Union (EU) and its six more populous countries. Prostate cancer was analysed in detail.Patients and methodsPopulation and death certification data from stomach, colorectum, pancreas, lung, breast, uterus, prostate, leukaemias and total cancers were obtained from the World Health Organisation database and Eurostat. Figures were derived for the EU, France, Germany, Italy, Poland, Spain and the UK. Projected 2015 numbers of deaths by age group were obtained by linear regression on estimated numbers of deaths over the most recent time period identified by a joinpoint regression model.ResultsA total of 1 359 100 cancer deaths are predicted in the EU in 2015 (766 200 men and 592 900 women), corresponding to standardised death rates of 138.4/100 000 men and 83.9/100 000 women, falling 7.5% and 6%, respectively, since 2009. In men, predicted rates for the three major cancers (lung, colorectum and prostate) are lower than in 2009, falling 9%, 5% and 12%. Prostate cancer showed predicted falls of 14%, 17% and 9% in the 35–64, 65–74 and 75+ age groups. In women, breast and colorectal cancers had favourable trends (-10% and -8%), but predicted lung cancer rates rise 9% to 14.24/100 000 becoming the cancer with the highest rate, reaching and possibly overtaking breast cancer rates—though the total number of deaths remain higher for breast (90 800) than lung (87 500). Pancreatic cancer has a negative outlook in both sexes, rising 4% in men and 5% in women between 2009 and 2015.ConclusionsCancer mortality predictions for 2015 confirm the overall favourable cancer mortality trend in the EU, translating to an overall 26% fall in men since its peak in 1988, and 21% in women, and the avoidance of over 325 000 deaths in 2015 compared with the peak rate.     

European cancer mortality predictions for the year 2013

BackgroundEstimated cancer mortality statistics were published for the years 2011 and 2012 for the European Union (EU) and its six more populous countries.Patients and methodsUsing logarithmic Poisson count data joinpoint models and the World Health Organization mortality and population database, we estimated numbers of deaths and age-standardized (world) mortality rates (ASRs) in 2013 from all cancers and selected cancers.ResultsThe 2013 predicted number of cancer deaths in the EU is 1 314 296 (737 747 men and 576 489 women). Between 2009 and 2013, all cancer ASRs are predicted to fall by 6% to 140.1/100 000 in men, and by 4% to 85.3/100 000 in women. The ASRs per 100 000 are 6.6 men and 2.9 women for stomach, 16.7 men and 9.5 women for intestines, 8.0 men and 5.5 women for pancreas, 37.1 men and 13.9 women for lung, 10.5 men for prostate, 14.6 women for breast, and 4.7 for uterine cancer, and 4.2 and 2.6 for leukaemia. Recent trends are favourable except for pancreatic cancer and lung cancer in women.ConclusionsFavourable trends will continue in 2013. Pancreatic cancer has become the fourth cause of cancer death in both sexes, while in a few years lung cancer will likely become the first cause of cancer mortality in women as well, overtaking breast cancer.     

European cancer mortality predictions for the year 2014

BackgroundFrom most recent available data, we projected cancer mortality statistics for 2014, for the European Union (EU) and its six more populous countries. Specific attention was given to pancreatic cancer, the only major neoplasm showing unfavorable trends in both sexes.Patients and methodsPopulation and death certification data from stomach, colorectum, pancreas, lung, breast, uterus, prostate, leukemias and total cancers were obtained from the World Health Organisation database and Eurostat. Figures were derived for the EU, France, Germany, Italy, Poland, Spain and the UK. Projected 2014 numbers of deaths by age group were obtained by linear regression on estimated numbers of deaths over the most recent time period identified by a joinpoint regression model.ResultsIn the EU in 2014, 1 323 600 deaths from cancer are predicted (742 500 men and 581 100 women), corresponding to standardized death rates of 138.1/100 000 men and 84.7/100 000 women, falling by 7% and 5%, respectively, since 2009. In men, predicted rates for the three major cancers (lung, colorectum and prostate cancer) are lower than in 2009, falling by 8%, 4% and 10%, respectively. In women, breast and colorectal cancers had favorable trends (-9% and -7%), but female lung cancer rates are predicted to rise 8%. Pancreatic cancer is the only neoplasm with a negative outlook in both sexes. Only in the young (25–49 years), EU trends become more favorable in men, while women keep registering slight predicted rises.ConclusionsCancer mortality predictions for 2014 confirm the overall favorable cancer mortality trend in the EU, translating to an overall 26% fall in men since its peak in 1988, and 20% in women, and the avoidance of over 250 000 deaths in 2014 compared with the peak rate. Notable exceptions are female lung cancer and pancreatic cancer in both sexes.     

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.     

European cancer mortality predictions for the year 2019 with focus on breast cancer

BackgroundTo overcome the lag with which cancer statistics become available, we predicted numbers of deaths and rates from all cancers and selected cancer sites for 2019 in the European Union (EU).Materials and methodsWe retrieved cancer death certifications and population data from the World Health Organization and Eurostat databases for 1970–2014. We obtained estimates for 2019 with a linear regression on number of deaths over the most recent trend period identified by a logarithmic Poisson joinpoint regression model. We calculated the number of avoided deaths over the period 1989–2019.ResultsWe estimated about 1 410 000 cancer deaths in the EU for 2019, corresponding to age-standardized rates of 130.9/100 000 men (−5.9% since 2014) and 82.9 women (−3.6%). Lung cancer trends in women are predicted to increase 4.4% between 2014 and 2019, reaching a rate of 14.8. The projected rate for breast cancer was 13.4. Favourable trends for major neoplasms are predicted to continue, except for pancreatic cancer. Trends in breast cancer mortality were favourable in all six countries considered, except Poland. The falls were largest in women 50–69 (−16.4%), i.e. the age group covered by screening, but also seen at age 20–49 (−13.8%), while more modest at age 70–79 (−6.1%). As compared to the peak rate in 1988, over 5 million cancer deaths have been avoided in the EU over the 1989–2019 period. Of these, 440 000 were breast cancer deaths.ConclusionBetween 2014 and 2019, cancer mortality will continue to fall in both sexes. Breast cancer rates will fall steadily, with about 35% decline in rates over the last three decades. This is likely due to reduced hormone replacement therapy use, improvements in screening, early diagnosis and treatment. Due to population ageing, however, the number of breast cancer deaths is not declining.     

Epidemiological research on cancer with a focus on Europe.

Cancer has been a growing public health problem throughout the last century. Cancer mortality rates in both sexes combined in the European Union (EU) reached a peak in 1988. Thereafter, they declined by 9.4% in 1998. Likewise, lung cancer rates in the EU for both sexes combined increased by 58% between 1960 and 1988, but declined by 14% in 1998. Over a third of the decline was accounted for by lung cancer alone and approximately half by the combination of tobacco-related neoplasms. About half of the decline in total cancer mortality not attributable to tobacco derived from the steady fall in mortality from gastric cancer. The remaining half, including favourable trends in colorectal, breast, testis and lymphoid neoplasms, can be at least in part attributed to advancements in cancer diagnosis and treatment. The major causes of cancer and hence the most important priorities for research will be reviewed, with a specific focus on European priorities for research.     

European cancer mortality predictions for the year 2016 with focus on leukaemias

BackgroundCurrent cancer mortality statistics are important for public health decision-making and resource allocation. Age-standardized rates and numbers of deaths are predicted for 2016 in the European Union (EU).Patients and methodsPopulation and death certification data for stomach, colorectum, pancreas, lung, breast, uterus, prostate, leukaemias and total cancers were obtained from the World Health Organization database and Eurostat. Figures were derived for the EU, France, Germany, Italy, Poland, Spain and the UK. Projected numbers of deaths by age group were obtained for 2016 by linear regression on estimated numbers of deaths over the most recent time period identified by a joinpoint regression model.ResultsProjected total cancer mortality trends for 2016 in the EU are favourable in both sexes with rates of 133.5/100 000 men and 85.2/100 000 women (8% and 3% falls since 2011) corresponding to 753 600 and 605 900 deaths in men and women for a total number of 1 359 500 projected cancer deaths (+3% compared with 2011, due to population ageing). In men, lung, colorectal and prostate cancer have fallen 11%, 5% and 8%, respectively, since 2011. Breast and colorectal cancer trends in women are favourable (8% and 7% falls, respectively), but lung and pancreatic cancer rates have risen 5% and 4% since 2011 reaching rates of 14.4 and 5.6/100 000 women. Leukaemias show favourable projected mortality for both sexes and all age groups, with stronger falls in the younger age groups. All ages rates are 4.0/100 000 men and 2.5/100 000 women, with falls of 14% and 12% respectively.ConclusionThe 2016 predictions for EU cancer mortality confirm the favourable trends in rates particularly for men. Lung cancer is likely to be the leading site for female cancer rates. Continuing falls in mortality, larger in children and young adults, are predicted in leukaemias, essentially due to advancements in management and therapy, and their subsequent adoption across Europe.     

Continuing declines in cancer mortality in the European Union.

BACKGROUND: From 1988 to 1997 age-standardised total cancer mortality rates in the European Union (EU) fell by around 9% in both sexes. Available cancer mortality data in Europe up to 2002 allow a first check of the forecast of further declines in cancer mortality. PATIENTS AND METHODS: We considered trends in age-standardised mortality from major cancer sites in the EU during the period 1980-2002. RESULTS: For men, total cancer mortality, after a peak of 191.1/100,000 in 1987 declined to 177.8 in 1997 (-7%), and to 166.5 in 2002. Corresponding figures for females were 107.9/100,000, 100.5 and 95.2, corresponding to falls of 7% from 1987 to 1997, and to 5% from 1997 to 2002. Over the last 5 years, lung cancer declined by 1.9% per year in men, to reach 44.4/100,000, but increased by 1.7% in women, to reach 11.4. In 2002, for the first year, lung cancer mortality in women was higher than that for intestinal cancer (11.1/100,000), and lung cancer became the second site of cancer deaths in women after breast (17.9/100,000). From 1997 to 2002, appreciable declines were observed in mortality from intestinal cancer in men (-1.6% per year, to reach 18.8/100,000), and in women (-2.5%), as well as for breast (-1.7% per year) and prostate cancer (-1.4%). CONCLUSIONS: Despite the persisting rises in female lung cancer, the recent trends in cancer mortality in the EU are encouraging and indicate that an 11% reduction in total cancer mortality from 2000 to 2015 is realistic and possible.     

Cancer mortality in Europe, 2005–2009, and an overview of trends since 1980

BackgroundAfter a peak in the late 1980s, cancer mortality in Europe has declined by ∼10% in both sexes up to the early 2000s. We provide an up-to-date picture of patterns and trends in mortality from major cancers in Europe.MethodsWe analyzed cancer mortality data from the World Health Organization for 25 cancer sites and 34 European countries (plus the European Union, EU) in 2005–2009. We computed age-standardized rates (per 100 000 person-years) using the world standard population and provided an overview of trends since 1980 for major European countries, using joinpoint regression.ResultsCancer mortality in the EU steadily declined since the late 1980s, with reductions by 1.6% per year in 2002–2009 in men and 1% per year in 1993–2009 in women. In western Europe, rates steadily declined over the last two decades for stomach and colorectal cancer, Hodgkin lymphoma, and leukemias in both sexes, breast and (cervix) uterine cancer in women, and testicular cancer in men. In central/eastern Europe, mortality from major cancer sites has been increasing up to the late 1990s/early 2000s. In most Europe, rates have been increasing for lung cancer in women and for pancreatic cancer and soft tissue sarcomas in both sexes, while they have started to decline over recent years for multiple myeloma. In 2005–2009, there was still an over twofold difference between the highest male cancer mortality in Hungary (235.2/100 000) and the lowest one in Sweden (112.9/100 000), and a 1.7-fold one in women (from 124.4 in Denmark to 71.0/100 000 in Spain).ConclusionsWith the major exceptions of female lung cancer and pancreatic cancer in both sexes, in the last quinquennium, cancer mortality has moderately but steadily declined across Europe. However, substantial differences across countries persist, requiring targeted interventions on risk factor control, early diagnosis, and improved management and pharmacological treatment for selected cancer sites.     

Monitoring the decrease in breast cancer mortality in Europe.

Trends in mortality from breast cancer over the period 1970-2000 were analysed for 38 European countries and the European Union (EU). Age-standardized mortality rates were computed by the direct method, and joinpoint analysis was used to identify significant changes in rates. A favourable pattern in breast cancer mortality in the 25 countries of the EU (as defined in May 2004) was observed after 1989, leading to a fall in overall rates from 21.3/100,000 in 1990 to 18.9 in 2000. The annual percentage change in the EU was -2.1% between 1995 and 2000. Most northern European countries, including several Scandinavian countries and the UK, but also some central and southern European countries like Germany, Poland, the Czech Republic, Austria, Switzerland, Italy and Spain showed appreciable falls in rates (i.e. between 8 and 19% in the last 5 calendar years). The declines were larger below age 50, approaching 20% in several countries. The falls were smaller in France, Greece, Portugal and most eastern European countries. In the Russian Federation, all-age breast cancer mortality increased from 16.1 to 17.3/100,000 (+7.5% over the last 5 calendar years). These patterns reflect converging trends in breast cancer rates across Europe, which can be related to the more uniform reproductive and lifestyle habits. The fall in breast cancer mortality observed in most European countries over the last decade has to be attributed to earlier detection and improved treatment, although the definite reasons for the different trends in various countries remain at least in part unclear.     

Cancer mortality in Europe, 1995-1999, and an overview of trends since 1960

Mortality data, abstracted from the World Health Organization database, are presented in tabular form for 26 cancer sites or groups of sites, plus total cancer mortality, in 36 European countries during the period 1995-1999. Trends in mortality are also given in graphic form for 23 major countries plus the European Union as a whole over the period 1960-1999. In the European Union, total cancer mortality declined by 7% for both sexes over the last 5 years considered. The fall since the late 1980s was 10% in both sexes, corresponding to the avoidance of over 90000 deaths per year, as compared to the rates of the late 1980s. For the first time, over the last few years, some leveling of mortality was reported also in the Russian Federation, the Czech Republic, Poland, Hungary and other Eastern European countries, although cancer rates in those areas remain exceedingly high. The overall favorable pattern of cancer mortality over recent years is largely driven by the decline of tobacco-related cancer mortality in men. However, important components of the trends are also the persistence of substantial falls in gastric cancer, mainly in Russia and Eastern Europe, the recent decline in intestinal cancer in both sexes and of breast cancer in women, together with the long-term falls in uterine (cervical) cancer, leukemias, Hodgkin's disease and other neoplasms amenable to advancements in diagnosis and treatment. Female lung cancer mortality has been declining in the Russian Federation, but is still rising in other areas of the continent. Thus, urgent intervention is needed to bring under control the tobacco-related lung cancer epidemic in European women before it reaches the high level observed in North America. Supplementary material for this article can be found on the International Journal of Cancer website at http://www.interscience.wiley.com/jpages/0020-7136/suppmat/index.html     

Trends in oesophageal cancer incidence and mortality in Europe

To monitor recent trends in mortality from oesophageal cancer in 33 European countries, we analyzed the data provided by the World Health Organization over the last 2 decades, using also joinpoint regression. For selected European cancer registration areas, we also analyzed incidence rates for different histological types. For men in the European Union (EU), age-standardized (world population) mortality rates were stable around 6/100,000 between the early 1980s and the early 1990 s, and slightly declined in the last decade (5.4/100,000 in the early 2000s, annual percent change, APC = -1.1%). In several western European countries, male rates have started to level off or decline during the last decade (APC = -3.4% in France, and -3.0% in Italy). Also in Spain and the UK, which showed upward trends in the 1990 s, the rates tended to level off in most recent years. A levelling of rates was observed only more recently in countries of central and eastern Europe, which had had substantial rises up to the late 1990 s. Oesophageal cancer mortality rates remained comparatively low in European women, and overall EU female rates were stable around 1.1-1.2/100,000 over the last 2 decades (APC = -0.1%). In northern Europe a clear upward trend was observed in the incidence of oesophageal adenocarcinoma, and in Denmark and Scotland incidence of adenocarcinoma in men is now higher than that of squamous-cell carcinoma. Squamous-cell carcinoma remained the prevalent histological type in southern Europe. Changes in smoking habits and alcohol drinking for men, and perhaps nutrition, diet and physical activity for both sexes, can partly or largely explain these trends.     

Cancer mortality in Europe in 2015 and an overview of trends since 1990

BackgroundCancer mortality in Europe has been decreasing since the late 1980s or 1990s in some countries with different patterns in many areas. In this study, we updated trends in cancer mortality in Europe.Materials and methodsWe extracted data from the World Health Organization mortality database for 24 cancer sites, 36 European countries and the European Union (EU) as a whole over the 1990–2017 period. We computed age-standardized death rates per 100 000 person-years, and we carried out a joinpoint regression analysis of mortality trends from all cancers and selected major neoplasms. The estimated annual percent change (APC) for each identified linear segment, and the weighted average APC (AAPC) over the entire study period were provided as summary measures of the changes in rates over the time period.ResultsIn 2015, the age-standardized mortality rates from all cancers in the EU were 137.5 deaths per 100 000 in men and 85.7 in women. Eastern European countries showed the highest rates with values over 150 deaths per 100 000 in men and over 100 deaths per 100 000 in women. Mortality from all cancers in the EU declined annually by 1.5% in men since 2006 and by 0.8% in women since 2007. Most cancer sites showed decreasing trends, with steady declines over the whole period for cancers of stomach, intestines, lung in men, breast and prostate. Unfavourable mortality trends persisted for cancers of liver, lung in women, pancreas, besides skin and kidney in men.ConclusionsThe downward trends in total cancer mortality in Europe still continue over the last decade. However, the trends were less favourable in most eastern European countries. Tobacco control in men (but not in women), improvements in diagnosis and therapy were the main underlying factors of these trends.     

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.     

Declining mortality from kidney cancer 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.     

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.     

Global trends in nasopharyngeal cancer mortality since 1970 and predictions for 2020: Focus on low‐risk areas

Nasopharyngeal cancer (NPC) mortality shows great disparity between endemic high risk areas, where non‐keratinizing carcinoma (NKC) histology is prevalent, and non‐endemic low risk regions, where the keratinizing squamous cell carcinoma (KSCC) type is more frequent. We used the World Health Organization database to calculate NPC mortality trends from 1970 to 2014 in several countries worldwide. For the European Union (EU), the United States (US) and Japan, we also predicted trends to 2020. In 2012, the highest age‐standardized (world standard) rates were in Hong Kong (4.51/100,000 men and 1.15/100,000 women), followed by selected Eastern European countries. The lowest rates were in Northern Europe and Latin America. EU rates were 0.27/100,000 men and 0.09/100,000 women, US rates were 0.20/100,000 men and 0.08/100,000 women and Japanese rates were 0.16/100,000 men and 0.04/100,000 women. NPC mortality trends were favourable for several countries. The decline was ?15% in men and ?5% in women between 2002 and 2012 in the EU, ?12% in men and ?9% in women in the US and about ?30% in both sexes in Hong Kong and Japan. The favourable patterns in Europe and the United States are predicted to continue. Changes in salted fish and preserved food consumption account for the fall in NKC. Smoking and alcohol prevalence disparities between sexes and geographic areas may explain the different rates and trends observed for KSCC and partially for NKC. Dietary patterns, as well as improvement in management of the disease, may partly account for the observed trends, too.     

Cancer epidemiology and trends in Switzerland

Trends in cancer mortality in Switzerland over the period 1980-2001 and of incidence in the Swiss Canton of Vaud (640,000 inhabitants) over the period 1974-2003 are reviewed and discussed. Steady declines in cancer mortality were observed, over the last decade, particularly from the mid-1980's, with falls in overall mortality of 11% in men and 8% in women. The fall was of 20 % in male lung, whereas lung cancer has steadily increased in women by 47 %. Substantial declines were observed for stomach and colorectum in both sexes, (cervix) uteri and breast in women. Declines were also 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. With reference to incidence in the Vaud population between 1979 and 2003, all major tobacco-related neoplasms have declined by 19% in men aged 35 to 64, but increased by 69% in all age women. In both sexes, age-adjusted incidence of all non-tobacco-related cancers has substantially increased, mostly in younger-middle age (+ 70% in men, + 33% in women). Trends are discussed in the perspective of the European Commission's target of a 15% reduction in total cancer mortality between 2000 and 2015.