Trends in cancer incidence and mortality in Vaud, Switzerland, 1974-1993

BACKGROUND:: Comparing incidence of and mortality from cancer within a givenpopulation yields several benefits. One of these is the opportunity,when trends in incidence differ from those in mortality, toderive inferences about the potential role of improved diagnosisin the rise of incidence rates, and about therapeutic advancementsin reducing mortality. MATERIALS AND METHODS:: Trends in incidence of and mortality from various cancers orgroups of cancers (comprising 55,682 new malignant tumours and26,528 certified cancer deaths) over the period 1974–1993were compared using, respectively, data from the Cancer Registryof the Swiss Canton of Vaud (with about 600,000 inhabitants)and those provided by the Swiss Federal Statistical Office. RESULTS:: The overall cancer incidence increased by 10% to 30% in bothsexes and various age groups, whereas mortality remained approximatelythe same. The sites primarily responsible for these divergenttrends were breast, prostate and colorectal, three sites wherecancers have been less frequently diagnosed since the adventof certain technical advancements and the introduction of screening.Other contributors to the divergent trends were testicular cancer,Hodgkin's disease and leukaemias, i.e., the sites for whichthe most substantial therapeutic advancements have been achieved. CONCLUSIONS:: These data are fairly reassuring, since they are inconsistentwith an ongoing cancer epidemic in this European population.However, they are also incompatible with the presence of majoradvancements in the prevention and treatment of cancer. cancer, epidemiology, incidence, mortality, registry, time trends     

Trends in cancer mortality in the European Union and accession countries, 1980-2000.

Cancer mortality rates and trends over the period 1980-2000 for accession countries to the European Union (EU) in May 2004, which include a total of 75 million inhabitants, were abstracted from the World Health Organization (WHO) database, together with, for comparative purposes, those of the current EU. Total cancer mortality for men was 166/100,000 in the EU, but ranged between 195 (Lithuania) and 269/100,000 (Hungary) in central and eastern European accession countries. This excess related to most cancer sites, including lung and other tobacco-related neoplasms, but also stomach, intestines and liver, and a few neoplasms amenable to treatment, such as testis, Hodgkin's disease and leukaemias. Overall cancer mortality for women was 95/100,000 in the EU, and ranged between 100 and 110/100,000 in several central and eastern European countries, and up to 120/100,000 in the Czech Republic and 138/100,000 in Hungary. The latter two countries had a substantial excess in female mortality for lung cancer, but also for several other sites. Furthermore, for stomach and especially (cervix) uteri, female rates were substantially higher in central and eastern European accession countries. Over the last two decades, trends in mortality were systematically less favourable in accession countries than in the EU. Most of the unfavourable patterns and trends in cancer mortality in accession countries are due to recognised, and hence potentially avoidable, causes of cancer, including tobacco, alcohol, dietary habits, pollution and hepatitis B, plus inadequate screening, diagnosis and treatment. Consequently, the application of available knowledge on cancer prevention, diagnosis and treatment may substantially reduce the disadvantage now registered in the cancer mortality of central and eastern European accession countries.     

Trends in cancer mortality in Mexico, 1970-1999.

BACKGROUND: Few data on cancer mortality have been published for Mexico over the last few decades. It is therefore of interest to conduct a systematic and updated analysis of cancer mortality in this country. PATIENTS AND METHODS: Age-standardised (world population) mortality rates, at all ages and truncated at age 35-64 years, from major cancers and all cancers combined were computed on the basis of certified deaths derived from the World Health Organization database for the period 1970-99. RESULTS: Mortality rates for all neoplasms showed an upward trend in men of all ages (from 58.2/100,000 in 1970-74 to 87.1/100,000 in 1995-99) and in middle-aged men (from 76.1 to 93.7/100,000, respectively). This reflects the rise until the early 1990s in lung cancer mortality (from 8.1/100,000 in 1970-74 to 15.6/100,000 in 1995-99) and prostate cancer (from 5.5 to 12.2/100,000, respectively). In women, overall mortality rates showed an increase between the early 1970s (75.4/100,000) and the late 1990s (82.3/100,000). Total cancer mortality rates remained low, however, compared with other American countries (e.g. 153.3/100,000 men and 108.6/100,000 women in 1999 in the United States). Truncated rates were stable (126.5/100,000 in 1970-74 and 125.8/100,000 in 1995-99), although they were much higher than overall rates, reflecting exceedingly high rates for uterine (mostly cervical) cancer mortality in middle-aged women (29.5/100,000 in 1995-99). CONCLUSIONS: Total cancer mortality in Mexico has remained comparably low on a worldwide scale, and the upward trends in mortality rates for lung and other tobacco-related neoplasms have tended to level off over the last decade. However, steady rises have been observed for other major cancers, including prostate and breast. Cervical cancer remains a major health problem in women.     

Trends in cancer mortality in the Americas, 1970-2000.

BACKGROUND: Data and statistics on cancer mortality over the last decades are available for most developed countries, while they are more difficult to obtain, in a standardized and comparable format, for countries of Latin America. PATIENTS AND METHODS: Age standardized (world population) mortality rates around the year 2000, derived from the WHO database, are presented for 14 selected cancers and total cancer in 10 countries of Latin America, plus, for comparative purposes, Canada and the USA. Trends in mortality are also given over the period 1970-2000. RESULTS: In 2000, the highest total cancer mortality for males was observed in Argentina and Chile, with rates comparable to those of Canada and the USA, i.e. about 155/100,000. For women, Chile and Cuba had the highest rates in Latin America (114 and 103/100,000, respectively), again comparable to those of North America (around 105/100,000). These reflect the comparatively high mortality from cancer of the stomach (for Chile), lung and intestines (for Argentina) in men, and of stomach and uterus (for Chile), intestines and lung (for Cuba) in women. Colombia, Ecuador and Mexico had the lowest total cancer mortality for men, due to low mortality from stomach, colorectal and lung cancer. For women, the lowest rates were in Brazil and Puerto Rico, reflecting their low stomach and cervical cancer rates. In Argentina, Chile, Colombia, Costa Rica and Venezuela cancer mortality rates tended to decline, particularly in men. Rates were stable in Ecuador and Puerto Rico, and were increasing in Mexico and Cuba. CONCLUSIONS: Mortality from some common cancers (including colorectal and lung) is still low in Latin America compared with Canada and the USA, and decreasing trends have been observed in the last decades for some cancer sites (including stomach, uterus, lung and other tobacco-related cancers) in several countries. However, mortality from female lung and breast cancers has been increasing in most countries of Latin America, and several countries still show an extremely elevated mortality from cancer of the cervix. Selected neoplasms amenable to treatment, including testis and leukemias, also show unsatisfactory trends in Latin America.     

Trends in cancer mortality, France 1950-1985

Trends in mortality for main cancer sites in France between 1950 and 1985 are presented by sex. In the population aged 35-65, where long term trends can most reliably be assessed, an overall 1.1% mean annual increase is observed for males and a 0.6% mean annual decrease is observed for females. For males, this increase in total cancer mortality is mostly due to the sites associated with tobacco and alcohol. The important increase for lung cancer, and lesser increases for bladder, pancreas and kidney cancers are related to the increase in tobacco consumption from 4.7 g per adult per day in 1950 to 6.3 g in 1976. For cancer sites associated with alcohol and tobacco, namely oesophagus, pharynx, larynx, tongue and mouth, mortality is increasing similarly for males and for females, although these cancers are much less frequent among females. For females, the overall moderate decrease is mostly due to the decrease in cervix and stomach cancer mortality, uncompensated by the observed increase in breast cancer; there is no marked increase in lung cancer mortality for women, contrary to what is observed in other Western countries.     

Trends in lip cancer incidence in Vaud, Switzerland.

Recent trends in lip cancer incidence in the Swiss Canton of Vaud (approximately 600,000 inhabitants in 1990) were analysed over the period 1975-1990, when a total of 87 cases were registered. A steady and substantial decline was observed in both sexes, since age-standardised (world) rates declined from 1.8 to 0.6/100,000 males and from 0.14 to 0.02/100,000 females. These downward trends were evident across subsequent age groups. These trends were apparently not due to changes in registration or classification criteria in the study period and are discussed in terms of decreased occupational exposure to ultraviolet light, and reduced pipe and cigar smoking.     

Trends in testicular cancer incidence in Vaud, Switzerland.

Upward trends in testicular cancer incidence have been reported in Europe and North America, particularly for seminomas. We considered incidence data between 1974 and 1999 from the Swiss cancer registry of Vaud, i.e. one of the highest incidence areas on a worldwide scale, including a total of 731 cases. Testicular cancer incidence was around 8.5/100 000 between the mid-1970s and the late 1980s, and increased to around 10/100 000 in the 1990s. Corresponding figures at age 15-44 were around 16/100 000 between the mid-1970s and the late 1980s, and about 19/100 000 thereafter. No evidence of persisting upward trends was evident over the last few years. The rise in testicular cancer incidence in the 1990s was apparently restricted to seminomas, whose rates increased from about 4 to 5.7/100 000 at all ages, and from 7 to over 11/100 000 at age 15-44. No consistent pattern of trends was observed for malignant teratomas and for other and unspecified histotypes. Testicular cancer in Vaud has shown no tendency to further rising over the last decade, thus re-opening the issue of a probable asymptote of testicular cancer incidence in this population.     

Testicular cancer mortality in the Americas, 1980-2003

BACKGROUND: Testicular cancer is generally curable if appropriate treatment is given. Data and statistics on testicular cancer mortality over the last decades are available from the US and Canada, but are more difficult to find, in a standard and comparable format, for Central and South American countries. The objective of the study was to compare death rates and trends over the 1980-2003 period in all the American countries that provide data. METHODS: Overall and 20 to 44 years age-standardized (world population) mortality rates from testicular cancer, derived from the World Health Organization (WHO) database, are presented for the most recent available calendar years in 10 American countries. Trends in mortality for selected countries of the Americas are also given over the period 1980-2003. RESULTS: In the early 1980s the highest testicular cancer mortality rates were observed in Chile (1.7/100,000 at all ages, 3.6/100,000 at 20-44 years) and Argentina (0.9/100,000 at all ages, 1.7/100,000 at 20-44 years), as compared with 0.4/100,000 for all ages and 0.6/100,000 at 20 to 44 years in Canada, and 0.3/100,000 for all ages and 0.7/100,000 at 20 to 44 years in the US. In 2001-2003, testicular cancer mortality had fallen to 0.2/100,000 in men aged 20 to 44 years in Canada, and to 0.4/100,000 in the US. Conversely, rates were still 1.6/100,000 in Argentina, 2.2/100,000 in Chile and 1.2/100,000 in Mexico, and were around 0.5-0.6/100,000 in most other Latin American countries that provide data. CONCLUSIONS: Mortality from testicular cancer in (young) men remains exceedingly high in most Latin American countries. Urgent intervention is required to provide treatment (essentially modern integrated platinum-based chemotherapy) for this largely curable neoplasm in young men.     

Trends in cancer mortality in Italy, 1955-1978

Trends in age-specific and age-standardized cancer death certification rates in Italy from 1955 to 1978 were analyzed. In males total cancer mortality rates increased in all age groups. However, when respiratory and other tobacco-related neoplasms were excluded, death certification rates were roughly stable up to age 64. Moderate decreases in overall cancer mortality have been apparent at younger ages (35-44) since the early 1970's. In females, all the age-specific and the age standardized, under-65 death certification rates decreased; the downward trends were more pronounced (-18.5%) in the younger age group considered (35-44 years). Respiratory cancer mortality increased sharply in males: lung cancer death rates reached a plateau in the early 1970's in the 35-44-year age group, but increased at all subsequent ages. In females, the increase in lung cancer mortality was about 50% in the 45-54 and 55-64-year age groups, but no upward trend was evident in younger women. Other tobacco-related cancers (mouth or pharynx, larynx, esophagus, pancreas, kidney and bladder) also rose considerably. In both sexes, gastric cancer mortality dropped about 50% below age 65, but mortality rates from cancer of the stomach were still considerably higher than in other Western countries. Likewise, mortality from cancer of the (cervix) uteri decreased markedly, mostly in younger age groups. Upward trends in death certification rates were evident for cancers of the bowel (colon and rectum, about 50% in males, and 35% in females below age 65), and of the breast in females. However, these trends have levelled off since the late 1960's, at least in the younger age groups. Certified death rates from cancer of the skin (melanoma) increased over all the periods considered in the young of both sexes. Cancer mortality rates showed marked increases in older (greater than or equal to 65) males, but this can be partially explained in terms of better case ascertainment and more accurate death certification.     

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.     

Decline of childhood cancer mortality in Italy, 1955-1980

The decline in childhood cancer mortality in Italy from 1955 to 1980 has been evaluated through (1) comparison of age-specific and age-standardized (0-14 years) rates for the periods 1955-1960 and 1979-1980 and (2) computation of expected numbers of deaths by application of the age-specific rates for the period 1955-1960 to the population structure of subsequent periods. Certified mortality fell by 35% for leukaemias, 90% for Hodgkin's disease, 30% for non-Hodgkin's lymphomas, 40% for bone sarcomas, 30% for kidney (Wilms') tumours, 65% for retinoblastoma. No clear trend was reported for other neoplasms, including neuroblastoma. About 300 cancer deaths per year were avoided in the period 1979-1980 compared with the expected number based on the 1955-1960 rates (170 for leukaemias alone). Although clearly encouraging, these trends are substantially less favourable than those from several other developed countries. It is therefore likely that several dozen other deaths from childhood cancer could be avoided each year through earlier (or more accurate) application of effective therapies, particularly for neoplasms requiring radiotherapy or surgical treatment.     

Trends in childhood cancer mortality in Italy, 1955-78

Trends in childhood cancer death rates in Italy from 1955 to 1978 were analyzed. All cancer age-standardized mortality below age 15 fell about 20%, with a clear downward trend since the early 1970's. Declines were evident for leukemias (-25%), Hodgkin's disease (-56%), non-Hodgkin's lymphomas (-27%), kidney cancer (-25%), retinoblastoma (-50%), and bone sarcomas (-31%), for a total number of about 200-250 fewer deaths per year in the late 1970's compared to the expected values using rates of the 1950's. The observed fall was apparently confined within the first age group considered (0-4 years), but the age-specific patterns of trend were partly influenced by simple postponement of some deaths to older age groups. Comparisons with similar data in other developed countries suggest that, although there has undoubtedly been some progress, there is still wide scope for further reduction in childhood cancer mortality in Italy, simply through more rational use of currently available diagnostic and therapeutic knowledge.     

Incidence of anal carcinoma in Vaud, Switzerland, 1979-2001.

Substantial rises in anal cancer incidence have been registered over the last few decades in the USA and a few Nordic countries. Incidence trends in the Swiss population of Vaud (about 602,000 inhabitants) over the period 1979-2001 were considered. Rates were around 0.3-0.5 per 100,000 men (age-standardized, world population) and 1.1-1.4 per 100,000 women, in the absence of any consistent trend over time. The epidemiology of anal cancer appears therefore different in this Swiss population as compared with North America and northern Europe.     

Trends in childhood cancer incidence and mortality in Catalonia, Spain, 1975-1998.

Childhood cancer mortality has sharply declined in most economically developed countries over the last years, whereas no substantial changes in the incidence have been observed. In Catalonia (Spain), childhood cancer mortality showed a considerable decline until 1992, but incidence trends have not been analysed in this population. To assess both recent incidence and mortality trends in this population, we analysed childhood (0-14 years) cancer data from the population-based Tarragona Cancer Registry and from the Mortality Registry of Catalonia (Spain) from 1980 to 1998. All cancer mortality decreased by -2.6% annually in boys (95% confidence interval, 95% CI -3.7, -1.6) and -3.7% in girls (95% CI -4.9, -2.5). Mortality due to leukaemia decreased annually -3.0% in boys (95% CI -4.7, -1.4) and -4.4% in girls (95% CI -6.3, -2.4). Mortality for brain tumours showed a reduction of -3.2% in boys (95% CI -5.5, -0.9) and of -4.4% in girls (95% CI -6.3, -2.4). No significant trend in incidence rates, either in boys or in girls, was observed (annual per cent of change for all cancers -0.5%, 95% CI -3.5, 2.7, in boys and 1.7%, 95% CI -1.9, 5.5, in girls). These results suggest an improvement in both childhood cancer diagnosis and treatment, which may explain current higher childhood cancer survival rates.     

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.     

Trends in breast cancer mortality in Asturias, Spain.

While breast cancer mortality rates are subsiding or beginning to decline in many western countries, in Spain they are increasing. We have studied breast cancer mortality rates in Asturias (Spain) by using the age-period-cohort model for the period of 1975-1994. There was an increase in the adjusted rates. The increase of relative risk of death in the period 1990-1994, in relation to that in 1975-1979, was 43%. There is a tendency for successive cohorts to have higher age-specific rates than previous cohorts. Trends in breast cancer mortality rates have been driven predominantly by birth cohort rate trends over the last decades in Asturias, suggesting that the changes in breast cancer mortality have been largely influenced by changes in aetiological factors.