FAST TRACK CANCER MORTALITY IN EUROPE, 1995–1999, AND AN OVERVIEW OF TRENDS SINCE 1960 Fabio LEVI 1 * , Franca LUCCHINI 1 , Eva NEGRI 2 , Peter BOYLE 3 and Carlo LA VECCHIA 1,2,4 1 Unite ´ d’E ´ pide ´miologie du Cancer and Registres Vaudois et Neucha ˆtelois des Tumeurs, Institut Universitaire de Me ´decine Sociale et Pre ´ventive, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland 2 Istituto di Ricerche Farmacologiche “Mario Negri,” Milano, Italy 3 Division of Epidemiology and Biostatistics, European Institute of Oncology, Milano, Italy 4 Istituto di Statistica Medica e Biometria, Universita ` Degli Studi di Milano, Milano, Italy 1 Mortality data, abstracted from the World Health Orga- nization database, are presented in tabular form for 26 can- cer 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 coun- tries 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 consid- ered. The fall since the late 1980s was 10% in both sexes, corresponding to the avoidance of over 90,000 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, al- though 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 can- cer 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 treat- ment. 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 Euro- pean 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/supp- mat/index.html. © 2004 Wiley-Liss, Inc. Key words: cancer; mortality; time trends; Europe In Western Europe, cancer mortality rates peaked in the late 1980s, and the fall in cancer mortality in the European Union (EU) between 1988 and 1997 has been approximately 10%. 1,2 Over more recent years, 1 mortality from lung and other tobacco–related neoplasms, but also a few other common sites, has started to level off and decline among males in Central and Eastern Europe, too. 3 These trends in major European areas, however, concealed different patterns of trends for various cancer sites, countries and age groups. 4–6 We systematically analyzed trends in mortality from 26 cancer sites, besides total cancer, in 24 major European countries over the period 1955–1994. 6,7 The present update report has the major aim of providing a summary description and documentation of the global pattern of trends in cancer mortality in Europe until the late 1990s. Only a few general comments, and a selected number of references, are included to assist reading and interpretation of trends for major cancer sites. Since long-term trends in cancer mortality include useful information in order to understand recent patterns and to project most likely future trends, 8,9 the present article also gives a summary overview of previous trends since 1960. MATERIAL AND METHODS Official death certification numbers for 36 European countries (including the Russian Federation but excluding a few smaller countries such as Andorra and Liechtenstein) were derived from the World Health Organization (WHO) database as available on electronic support (www3.who.int/whosis/menu.cfm). 10 Besides the United Kingdom as a whole, data were presented also for England and Wales, Scotland and Northern Ireland. For Belgium, data were available only for 1995–1996; for Iceland, for 1995– 1997; and for Denmark, for 1995–1998. The EU was defined as the 15 member states in 1999 (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, The Netherlands, Portugal, Spain, Sweden and the United Kingdom). Accession (in 2004) and applicant states were not included. During the calendar period considered (1960 –1999), 4 different revisions of the International Classification of Diseases (ICD) were used. 11-14 Classification of cancer deaths was recoded, for all calendar periods and countries, according to the ninth revision. 13 To improve validity and comparability of data throughout different countries, we pooled together all intestinal sites, including rectum, all uterine cancers (cervix and endometrium), all skin neoplasms (melanoma and nonmelanomatous) and some relatively uncom- mon cancers (all connective and soft tissue sarcomas, all non- Hodgkin’s lymphomas). Neoplasms of the brain or nerves are not presented, since it was not possible to pool together consistently subsequent revisions of the ICD. Estimates of the resident population, generally based on official censuses, were obtained from the same WHO database. From the matrices of certified deaths and resident populations, age-specific rates for each 5-year age group (from 0 – 4 to 80 – 84 and  85 years) and calendar period were computed. Age-standardized rates per 100,000 population, at all ages and truncated 35– 64 years, were computed using the direct method and based on the world standard population. 15 In a few countries, data were missing for part of one or more calendar years. 6 No extrapolation was made for missing data. Grant sponsor: the Swiss League Against Cancer; Grant sponsor: the Italian Association for Cancer Research. *Correspondence to: Registre Vaudois des Tumeurs, CHUV-Falaises 1, CH 1011 Lausanne, Switzerland. Fax: +41-21-323-03-03. E-mail: fabio.levi@hospvd.ch Received 3 July 2003; Revised 13 October, 25 November 203; Accepted 2 December 2003 DOI 10.1002/ijc.20097 Published online 19 February 2004 in Wiley InterScience (www. interscience.wiley.com). Int. J. Cancer: 110, 155–169 (2004) © 2004 Wiley-Liss, Inc. Publication of the International Union Against Cancer