Shifting incidence and survival of epithelial ovarian cancer (1995-2014): A SurvMark-2 study

The aim of the study is to provide a comprehensive assessment of incidence and survival trends of epithelial ovarian cancer (EOC) by histological subtype across seven high income countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the United Kingdom). Data on invasive EOC diagnosed in women aged 15 to 99 years during 1995 to 2014 were obtained from 20 cancer registries. Age standardized incidence rates and average annual percentage change were calculated by subtype for all ages and age groups (15-64 and 65-99 years). Net survival (NS) was estimated by subtype, age group and 5-year period using Pohar-Perme estimator. Our findings showed marked increase in serous carcinoma incidence was observed between 1995 and 2014 among women aged 65 to 99 years with average annual increase ranging between 2.2% and 5.8%. We documented a marked decrease in the incidence of adenocarcinoma “not otherwise specified” with estimates ranging between 4.4% and 7.4% in women aged 15 to 64 years and between 2.0% and 3.7% among the older age group. Improved survival, combining all EOC subtypes, was observed for all ages combined over the 20-year study period in all countries with 5-year NS absolute percent change ranging between 5.0 in Canada and 12.6 in Denmark. Several factors such as changes in guidelines and advancement in diagnostic tools may potentially influence the observed shift in histological subtypes and temporal trends. Progress in clinical management and treatment over the past decades potentially plays a role in the observed improvements in EOC survival.     

Increasing thyroid cancer incidence in Canada, 1970-1996: time trends and age-period-cohort effects.

We examined time trends in thyroid cancer incidence in Canada by age, time period and birth cohort between 1970 and 1996. Age-specific incidence rates by time period and birth cohort were calculated and age-period-cohort modelling used to estimate effects underlying the observed trends. Overall age-adjusted incidence rates of thyroid cancer doubled, from 3.3 and 1.1 per 100 000 in 1970-72 to 6.8 and 2.2 per 100 000 in 1994-96, among females and males respectively. Almost all the increase between 1970-72 and 1994-96 was due to papillary carcinoma of the thyroid. Age, birth cohort and period effects significantly improved the fit of the model for females, while age and birth cohort effects were significant determinants of the incidence among males. There were significant differences in the patterns/curvature for age, period and birth cohort effects between women and men. Our results suggest that the increases in thyroid cancer incidence in Canada may be associated with more intensive diagnostic activities and change in radiation exposure in childhood and adolescence. Temporal changes in reproductive factors among young women may explain some of the gender differences observed.     

Global Patterns and Trends in Lung Cancer Incidence: A Population-Based Study

IntroductionLung cancer (LC) has been the most common cancer worldwide for several decades. This study comprehensively examines recent geographic patterns and temporal trends in LC incidence from 1978 to 2012 in 43 countries and evaluates the effects of birth cohort and period on temporal trends.MethodsData were retrieved from the Cancer Incidence in Five Continents database. Joinpoint regression and age-period-cohort models were applied.ResultsThe age-standardized rate was highest in Turkey (69.3 per 100,000 person-years) for men and in Denmark (36.7) for women in the period 2008 to 2012. Sex disparities were noted in most countries. From 1978 to 2012, a total of 19 countries had significantly declining trends among men, whereas 26 countries had significantly increasing trends among women (all p < 0.05). Quasi-reversed V-shaped and U-shaped incidence rate ratio trends indicating birth cohort effects were detected in 26 countries for men, with the highest risks mainly occurring in the 1930 to 1950 birth cohorts. However, the risks among recent generations have moderately increased in the People’s Republic of China and Japan for men and sharply increased in Lithuania, Belarus, and Republic of Korea for women. Incidence rate ratio increases were steep among earlier birth cohorts and gradual among the post-1930s cohorts in 15 countries for women. Period effects were more evident than birth cohort effects in five countries for both sexes.ConclusionsDisparities in LC incidence and carcinogenic risk persist worldwide. Our findings identified high-risk target populations for primary prevention to reduce the LC incidence and highlighted the urgent need for etiologic studies to identify the reasons for pronounced cohort-specific risk increases in certain countries.     

Lung cancer incidence in young women vs. young men: A systematic analysis in 40 countries

Previous studies have reported converging lung cancer rates between sexes. We examine lung cancer incidence rates in young women vs. young men in 40 countries across five continents. Lung and bronchial cancer cases by 5-year age group (ages 30–64) and 5-year calendar period (1993–2012) were extracted from Cancer Incidence in Five Continents. Female-to-male incidence rate ratios (IRRs) and 95% confidence intervals (95%CIs) were calculated by age group and birth cohort. Among men, age-specific lung cancer incidence rates generally decreased in all countries, while in women the rates varied across countries with the trends in most countries stable or declining, albeit at a slower pace compared to those in men. As a result, the female-to-male IRRs increased among recent birth cohorts, with IRRs significantly greater than unity in Canada, Denmark, Germany, New Zealand, the Netherlands and the United States. For example, the IRRs in ages 45–49 year in the Netherlands increased from 0.7 (95% CI: 0.6–0.8) to 1.5 (95% CI: 1.4–1.7) in those born circa 1948 and 1963, respectively. Similar patterns, though nonsignificant, were found in 23 additional countries. These crossovers were largely driven by increasing adenocarcinoma incidence rates in women. For those countries with historical smoking data, smoking prevalence in women approached, but rarely exceeded, those of men. In conclusion, the emerging higher lung cancer incidence rates in young women compared to young men is widespread and not fully explained by sex differences in smoking patterns. Future studies are needed to identify reasons for the elevated incidence of lung cancer among young women.     

Diverging trends in incidence and mortality of testicular cancer in Denmark, 1943-1982

Between 1943 and 1982, 5,140 new cases of testicular cancer were diagnosed in Denmark. The age-standardized incidence rate more than doubled in the period. Striking variations is seen in the age-relationship over time with a four-fold increase in incidence for men aged 15-24 years while no increment was observed for those above 65 years of age. The increase with time in the risk could be accounted for by a cohort effect. The mortality rate did not parallel the incidence rate and a 50% decrease in mortality rate appeared in the period 1978-1982. Introduction of combination chemotherapy including cis-platinum is one of the main factors responsible for this beneficial development. The observed pattern of diverging trends in incidence and mortality of testicular cancer implies that mortality rates do not reflect the incidence and will accordingly be unsuited as a basis for aetiological considerations based on trends. The brisk increase in the risk of testicular cancer, especially among young men is in accordance with trends in other western countries, and prompts an enforced search for suspected or new risk factors.     

The influence of birth cohort and calendar period on global trends in ovarian cancer incidence

Ovarian cancer is the eighth most common cancer in women worldwide and incidence rates vary markedly by world region. Our study provides a comprehensive overview of ovarian cancer incidence trends globally, examining the influence of birth cohort and period of diagnosis on changing risk. We presented current patterns and trends of ovarian cancer incidence until 2012 using data from successive volumes of Cancer Incidence in Five Contents. The incidence of ovarian cancer is highest in northern and eastern European countries and in northern America. Declining trends were observed in most countries with the exception of a few central and eastern Asian countries. Marked declines were seen in Europe and North America for women aged 50–74 where rates have declined up to 2.4% (95% CI: −3.9, −0.9) annually in Denmark (DNK) over the last decade. Additionally, declines in the incidence rate ratio (IRR) were observed for generations born after the 1930s, with an additional strong period effect seen around 2000 in United States and DNK. In contrast, IRRs increased among younger generations born after the 1950s in Japan and Belarus. Overall, the favorable trends in ovarian cancer incidence is likely due to the increase use of oral contraceptive pills, and changes in the prevalence of other reproductive risk and protective factors for ovarian cancer over the years studied. Changes in disease classifications and cancer registry practices may also partially contribute to the variation in ovarian cancer incidence rates. Thus, continuous cancer surveillance is essential to detect the shifting patterns of ovarian cancer.     

Trends in oral cancer mortality in Europe

Mortality from oral cancer has been rising appreciably in most European countries up to the late 1980s, essentially for men. To update trends in oral cancer, death certification data from oral and pharyngeal cancer for 27 European countries were abstracted and analysed from the WHO mortality database over the period 1980-99. Oral cancer mortality in men has started to decline since the late 1980s in most western countries, although some persisting upward trends were registered for Belgium, Denmark, Greece, Portugal, or Scotland. Persisting rises were observed for most central and eastern Europe up to the mid 1990s, reaching exceedingly high rates in Hungary (20.2/100000 at all ages, 51.4 at age 35-64), Slovakia, Slovenia, and the Russian Federation. Some levelling of rates in some countries, such as Poland or the Czech Republic, was observed over more recent calendar years. Oral cancer was low, but moderately upwards in European women, mainly from central and eastern Europe. These trends should be essentially interpreted in terms of patterns and changes in exposure to alcohol and tobacco, and call for urgent control of these factors, as well as for improved diagnosis and management of oral cancer in central and eastern Europe.     

Patterns and trends in esophageal cancer mortality and incidence in Europe (1980–2011) and predictions to 2015

BackgroundOver the last few decades, esophageal cancer incidence and mortality trends varied substantially across Europe, with important differences between sexes and the two main histological subtypes, squamous cell carcinoma (ESCC) and adenocarcinoma (EAC).Patients and methodsTo monitor recent esophageal cancer mortality trends and to compute short-term predictions in the European Union (EU) and selected European countries, we analyzed data provided by the World Health Organization (WHO) for 1980–2011. We also analyzed incidence trends and relative weights of ESCC and EAC across Europe using data from Cancer Incidence in Five Continents.ResultsLong-term decreasing trends were observed for male esophageal cancer mortality in several southern and western European countries, whereas in central Europe mortality increased until the mid-1990s and started to stabilize or decline over the last years. In some eastern and northern countries, the rates were still increasing. Mortality among European women remained comparatively low and showed stable or decreasing trends in most countries. Between 2000–2004 and 2005–2009, esophageal cancer mortality declined by 7% (from 5.34 to 4.99/100 000) in EU men, and by 3% (from 1.12 to 1.09/100 000) in EU women. Predictions to 2015 show persistent declines in mortality rates for men in the EU overall, and stable rates for EU women, with rates for 2015 of 4.5/100 000 men (about 22 300 deaths) and 1.1/100 000 women (about 7400 deaths). In northern Europe, EAC is now the predominant histological type among men, while for European women ESCC is more common and corresponding rates are still increasing in several countries.Conclusion(s)The observed trends reflect the variations in alcohol drinking, tobacco smoking and overweight across European countries.     

Epidemiology of Kaposi's sarcoma in the Nordic countries before the AIDS epidemic.

Based on data from the Nordic cancer registries, time-related trends in incidence of Kaposi''s sarcoma (KS) were analysed in four ethnically similar populations before the AIDS epidemic. Data were available for different time periods in Denmark (1970-79), Sweden (1958-79), Finland (1953-79) and Norway (1953-79). KS was more common among men than among women aged 60 years or more, whereas no differences were observed for younger persons. The incidence of KS differed significantly between the four countries (P = 0.0001); Sweden having the highest and Denmark the lowest rates. Similarly, regional differences in incidence were observed within Sweden, rates being higher in the northern than in the southern areas (Ptrend = 0.002). Overall, in Nordic men the world standardised incidence rose from 0.5/1,000,000 person-years in the period 1953-57 to 1.8/1,000,000 person-years in 1978-79; in Nordic women, the corresponding rates were 0.2/1,000,000 person-years and 0.8/1,000,000 person-years respectively. The rate of increase was similar in Sweden, Finland and Norway (P = 0.14), whereas the short period of observation in Denmark precluded precise assessment of time-related incidence trends. These observations cannot be explained by registrational procedures or known risk factors for KS, and argue that environmental factors play an important role in the development of the disease.     

Educational differences in cancer mortality among women and men: a gender pattern that differs across Europe

We used longitudinal mortality data sets for the 1990s to compare socioeconomic inequalities in total cancer mortality between women and men aged 30-74 in 12 different European populations (Madrid, Basque region, Barcelona, Slovenia, Turin, Switzerland, France, Belgium, Denmark, Norway, Sweden, Finland) and to investigate which cancer sites explain the differences found. We measured socioeconomic status using educational level and computed relative indices of inequality (RII). We observed large variations within Europe for educational differences in total cancer mortality among men and women. Three patterns were observed: Denmark, Norway and Sweden (significant RII around 1.3-1.4 among both men and women); France, Switzerland, Belgium and Finland (significant RII around 1.7-1.8 among men and around 1.2 among women); Spanish populations, Slovenia and Turin (significant RII from 1.29 to 1.88 among men; no differences among women except in the Basque region, where RII is significantly lower than 1). Lung, upper aerodigestive tract and breast cancers explained most of the variations between gender and populations in the magnitude of inequalities in total cancer mortality. Given time trends in cancer mortality, the gap in the magnitude of socioeconomic inequalities in cancer mortality between gender and between European populations will probably decrease in the future.     

Statistical modelling of breast cancer incidence and mortality rates in Scotland.

The interpretation of time trends in disease rates can be facilitated using estimable contrasts from age-period-cohort models. Cohort and period trends in breast cancer incidence and mortality rates in Scotland were investigated using contrasts that measure the changes in the linear trends. These contrasts were compared with estimates obtained from mortality rates in the USA and Japan. A significant moderation of both breast cancer incidence and mortality rates was observed in Scotland, associated with cohorts of women born after the Second World War compared with women born between the two world wars. The moderation of breast cancer mortality among cohorts born after 1925 compared with cohorts born before 1925 that was observed in the USA and Japan was also observed in this study. This moderation is not present in the incidence rates. The relative decline in the risk of breast cancer seen in younger cohorts seems to be contradictory to the temporal pattern present among breast cancer risk factors. It may well be that the alteration of eating patterns as a result of rationing in the wartime and immediate post-war period, and the subsequent influence on certain breast cancer risk factors probably produced by such changes, may have had some influence on the development of healthier girls and women. Such speculation could be addressed in a well-designed epidemiological study. There have been no changes in the mortality rate trends with period in Scotland, although the changes in the incidence rate trends with period are consistent with an increase in registration coverage.     

Recent trends and future directions for lung cancer mortality in Europe

Lung cancer mortality patterns throughout Europe are very heterogeneous and largely reflect past smoking habits. In order to clarify the changing patterns of lung cancer in Europe we have plotted the overall lung cancer trends among men and women for 20 countries from 1950 up to 1998. Furthermore, using a Bayesian age-period-cohort approach, we have calculated 5 year projections of lung cancer rate up to 2003. Finally, we make some comments on probable future trends by analysing recent trends in adults aged <55 years. Lung cancer mortality rates up to age 75 years portray a general trend of decreasing lung cancer rates among men and increasing lung cancer rates among women. Exceptions to this decrease among men include Hungary where not only are current mortality rates much higher than previously observed in any other country (at 76.7 out of 100,000 in 1998) but they are projected to increase further in the short term. Rates among adults aged <55 years have recently peaked, indicating that overall rates are likely to peak in the next decade. Among women, rapid increases have been observed in Denmark, Netherlands, Hungary, Ireland and UK. Whereas Ireland and UK rates have started to decrease and are projected to continue falling, rates in the other three countries are projected to increase further. Trends in women aged <55 years indicate that rates in Danish women will peak in the next decade, whereas lung cancer rates among Dutch women are likely to continue increasing. Rates in Hungarian women are likely to increase and will surpass the current high rate observed in Denmark.     

International trends in the incidence of cervical cancer: I. Adenocarcinoma and adenosquamous cell carcinomas

Time trends in the incidence of cervical adenocarcinoma and adenosquamous cell carcinomas during the period 1973–1991 were examined using data provided by 60 population-based cancer registries from 32 defined populations in 25 countries. Three components of the incidence trend were studied: age, calendar period of diagnosis and birth cohort. Cumulative incidence rates per 1,000 for 2 groups with age ranges 25–49 and 50–74 years were calculated from the model that best described the incidence data. There was a significant increase in the cumulative incidence of cervical adenocarcinomas in women born in the mid-1930s and in successive cohorts thereafter in some populations in the United States (whites and Hispanic women), Australia, New Zealand (non-Maori), England, Scotland, Denmark, Slovenia, Slovakia and Japan (Osaka) and among Chinese women in Singapore, with a general decline in the incidence in women born in earlier periods. In Sweden and Slovenia there is a suggestion of an increasing trend in both age groups. A decrease in incidence in both age groups was apparent in Finland, France and Italy. There were no changes in incidence in 24 registries covering other European, Asian and black populations in the United States. Part of the increase may be attributable to an increasing prevalence of human papillomavirus infection, and part to improvements in screening. Int. J. Cancer 75:536–545, 1998.© 1998 Wiley-Liss, Inc.     

Incidence trends of adenocarcinoma of the cervix in 13 European countries.

Rapid increases in cervical adenocarcinoma incidence have been observed in Western countries in recent decades. Postulated explanations include an increasing specificity of subtype-the capability to diagnose the disease, an inability of cytologic screening to reduce adenocarcinoma, and heterogeneity in cofactors related to persistent human papillomavirus infection. This study examines the possible contribution of these factors in relation with trends observed in Europe. Age-period-cohort models were fitted to cervical adenocarcinoma incidence trends in women ages <75 in 13 European countries. Age-adjusted adenocarcinoma incidence rates increased throughout Europe, the rate of increase ranging from around 0.5% per annum in Denmark, Sweden, and Switzerland to >/=3% in Finland, Slovakia, and Slovenia. The increases first affected generations born in the early 1930s through the mid-1940s, with risk invariably higher in women born in the mid-1960s relative to those born 20 years earlier. The magnitude of this risk ratio varied considerably from around 7 in Slovenia to almost unity in France. Declines in period-specific risk were observed in United Kingdom, Denmark, and Sweden, primarily among women ages >30. Whereas increasing specificity of subtype with time may be responsible for some of the increases in several countries, the changing distribution and prevalence of persistent infection with high-risk human papillomavirus types, alongside an inability to detect cervical adenocarcinoma within screening programs, would accord with the temporal profile observed in Europe. The homogeneity of trends in adenocarcinoma and squamous cell carcinoma in birth cohort is consistent with the notion that they share a similar etiology irrespective of the differential capability of screen detection. Screening may have had at least some impact in reducing cervical adenocarcinoma incidence in several countries during the 1990s.     

Trends in smoking-related cancer incidence in Tarragona, Spain, 1980–96

Objectives: To analyze recent trends (1980–96) in the incidence of smoking-related cancers among men and women in Tarragona, Spain. Methods: Data were obtained from a population-based cancer registry. Age-standardized incidence rates were computed. Secular trends, between 1980 and 1996, were estimated using a Poisson regression model. From these figures, age, period, and cohort effects were assessed using the method proposed by Holford. Results: The incidence of all smoking-related cancers combined increased significantly in both sexes. The annual increase was 3.0% in men and 4.5% in women. By sites the annual increase was 4.3% in oral cavity, 5.1% in pancreas, 2.5% in lung, 3.2% in bladder, and 7.7% in kidney cancers among men. Among women the corresponding increments were 7.0% in oral cavity, 7.3% in pancreas, 3.1% in lung, 2.1% in bladder, and 6.9% in kidney cancers. The increasing incidence of lung cancer in women was mostly due to the adenocarcinoma histological type. No increase was observed in esophagus and larynx cancer either in men or women. It was not possible to determine whether the increases are due to a period or cohort effect since the curvature analysis was found to be non-significant. Conclusions: All smoking-related cancers combined, except larynx and esophagus, are increasing in both sexes. The effect of tobacco, alcohol, and occupational exposure to carcinogens could explain the high rates of larynx, bladder, and upper digestive tract cancer in men. The rising incidence rates of lung cancer observed in younger women indicate a change in recent trends that is consistent with changes observed in smoking prevalence. Unless recent upward smoking trends in young women can be reversed, lung cancer in women will rise rapidly in the next few years. New smoking prevention strategies aimed at Spanish women, especially in the younger age groups, should be developed.     

Trends in the incidence of nonmelanoma skin cancer in Denmark 1978–2007: Rapid incidence increase among young Danish women

Nonmelanoma skin cancer (NMSC) is the most common cancer among Caucasian populations worldwide, and incidence rates are increasing. However, NMSC data are not routinely collected by cancer registries, but Denmark has extensive registration of NMSC in two nationwide population‐based registries. We assessed incidence trends of NMSC in Denmark from 1978 to 2007. Data for basal cell carcinoma ( BCC) and squamous cell carcinoma (SCC) were obtained from the Danish Cancer Registry and the Danish Registry of Pathology. For both genders, age‐specific incidence rates and overall incidence rates, age‐adjusted according to the World standard population were calculated based on combined data from the two registries. For both genders, a high increase in both BCC and SCC incidence was observed over time. Between 1978 and 2007, the age‐adjusted BCC incidence increased from 27.1 to 96.6 cases per 100,000 person‐years for women and from 34.2 to 91.2 cases for men. The SCC incidence increased from 4.6 to 12.0 cases per 100,000 person‐years for women and from 9.7 to 19.1 cases for men. For both BCC and SCC, women experienced a higher average annual percentage incidence change than men. Furthermore, the average annual percentage change in BCC incidence among persons below 40 years was significantly higher compared to older persons, especially for women. These trends may lead to an alarming NMSC incidence increase over time as population ages and will have major implications for future healthcare services. Our findings underline the need for improved preventive strategies to hamper the increasing NMSC incidence.     

Pleural mesothelioma incidence in Europe: evidence of some deceleration in the increasing trends

Objective: To summarize the geographical and temporal variations in incidence of pleural mesothelioma in Europe, using the extensive data available from European general cancer registries, and consider these in light of recent trends in asbestos extraction, use and import in European countries. Material and methods: The data were extracted from the European Cancer Incidence and Mortality database (EUROCIM). The inclusion criteria was acceptance in Volume VII of Cancer Incidence in Five Continents. Truncated age-standardized rates per 100,000 for the ages 40–74 were used to summarise recent geographical variations. Standardized rate ratios and 95% confidence intervals for the periods 1986–1990 and 1991–1995 were compared to assess geographical variations in risk. To investigate changes in the magnitude of most recent trends, regression models fitted to the latest available 10-year period (1988–1997) were compared with trends in the previous decade. Fitted rates in younger (40–64) and older adults (65–74) in the most recent period were also compared. Results: There was a great deal of geographical variation in the risk of mesothelioma, annual rates ranging from around 8 per 100,000 in Scotland, England and The Netherlands, to lower than 1 per 100,000 in Spain (0.96), Estonia (0.85), Poland (0.85) and Yugoslavia, Vojvodina (0.56) among men. The rank of the rates for women was similar to that observed for men, although rates were considerably lower. Between 1978 and 1987, rates in men significantly increased in all countries (excepting Denmark). In the following 10 years, there was a deceleration in trend, and a significant increase was detectable only in England and France. In addition, the magnitude of recent trends in younger men was generally lower than those estimated for older men, in both national and regional cancer registry settings. Conclusions: While mesothelioma incidence rates are still rising in Europe, a deceleration has started in some countries. A decrease may begin in the next few years in certain European populations considering the deceleration of observed trends in mesothelioma and asbestos exposure, as well as the recent ban on its use.     

Comparison of cancers of the oral cavity and pharynx worldwide: etiological clues

We assessed separate and combined sex-specific incidence rates of oral and pharyngeal cancer for 1988-92 and oral/pharyngeal ratios from 49 different cancer registries in five continents. Incidence trends over a period of approximately 30 years were evaluated in 16 long active registries for men and four for women. Cancers of the lip, salivary glands, and nasopharynx were excluded. The incidence of both oral and pharyngeal cancer among men is highest in northern France, southern India, a few areas of central and eastern Europe, and Latin America. Among women, the highest incidence is observed in India. Oral/pharyngeal ratio is everywhere systematically lower in men compared to women. Recent trends for oral cancer are more favourable than those for pharyngeal cancer in developing countries. In developed countries, trends in oral cancer appears to be more closely correlated to changes in alcohol consumption than those of pharyngeal cancer.     

Variations in survival from breast cancer in Europe by age and country, 1978–1989

The objective of this study, part of the wider EUROCARE II collaborative project, was to examine variations by age and country in the relative survival of women from breast cancer in Europe, based on data for 145 000 cases in 1985–1989 and trends based on (245 000) cases for 1978–1989. Data were supplied by 42 cancer registries in 17 countries to a common protocol. Results for some countries where the participating registries covered only small proportions of the total population may not be representative of the whole country. In 1985–1989 there were wide differences among the 17 countries: survival was above the European average in Iceland, Finland, Sweden, Switzerland, France and Italy; around average in Denmark, The Netherlands, Germany and Spain; below average in Scotland, England and Slovenia; and well below average in Slovakia, Poland and Estonia. In France, Spain and Italy, but not in the U.K., there were wide differences in survival among the participating registries. Survival generally declined with age, particularly in the elderly (75 years and over)—this was most marked in Denmark, Scotland and England. Over the period 1978–1989, 1-year survival improved by 2% overall and 5-year survival by 6%. There were improvements in 5-year survival in all countries except Iceland, Germany, Switzerland and Estonia, and in all age groups except the youngest (15–44 years). It is likely that differences in the access to and quality of care in the various countries played a large part in explaining the differences in survival.     

The changing epidemiology of lung cancer in Europe

BACKGROUND: Since the incidence and mortality of the histological subtypes of lung cancer in Europe has changed dramatically during the 20th century, we described the variation and changes in incidence, treatment modalities and survival of lung cancer. METHODS: For geographical variation and changes in incidence, data of the European cancer incidence and mortality (EUROCIM) database were used, and data on survival were derived from the EUROCARE database. For trends in treatment modalities and survival, according to histology and stage, data of the Eindhoven Cancer registry were used. RESULTS: Although the incidence of lung cancer among men in Denmark, Finland, Germany (Saarland), Italy (Varese), the Netherlands, Switzerland and the United Kingdom has been decreasing since the 1980s, the age-adjusted rate for men in other European countries increased at least until the 1990s. Among women the peak in incidence had not been reached in the 1990s. The proportion of adenocarcinoma has been increasing over time; the most likely explanation is the shift to low-tar filter cigarettes. In the 1990s more patients with localised non-small cell lung cancer received surgery than in the 1970s. Among patients with non-localised non-small cell lung cancer and among those with small cell lung cancer there was a trend towards more chemotherapy. There was fairly large variation in survival within Europe. Despite improvement in both the diagnosis and treatment, the overall prognosis for patients with non-small-cell lung cancer hardly improved over time. In contrast, the introduction and improvement of chemotherapy since the 1970s gave rise to an improvement in survival for patients with small-cell lung cancer. CONCLUSION: The epidemic of lung cancer is not over yet, especially in southern and eastern Europe. Prevention remains the best policy, but improvement in the management of lung cancer also remains very important.