Key words: cancer mortality, cardio- vascular mortality, joinpoint analysis, Tuscany. Conflict of interest statement: the au- thors have no potential conflict of in- terest. Correspondence to: Dr Giuseppe Go- rini, Environmental and Occupational Epidemiology Unit, ISPO Cancer Pre- vention and Research Institute, via di S. Salvi 12, 50135 Florence, Italy. Tel +39-055-6268347; fax +39-055-6268385; e-mail g.gorini@ispo.toscana.it Received June 16, 2010; accepted October 21, 2010. Is cancer overtaking cardiovascular diseases as the killer number one in men in Tuscany? Lucia Giovannetti, Giuseppe Gorini, Andrea Martini, Elisabetta Chellini, Maria Grazia Fornai, Brunella Sorso, and Adele Seniori-Costantini Environmental and Occupational Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy ABSTRACT Aims and background. For the first time in 2006, cancer became the main cause of death in men in Italy, exceeding cardiovascular disease. The aim of the study was to verify whether the overtaking of cancer male mortality occurred also in Tuscany or in some of its 12 subregional areas and whether there was a geographical trend. Methods. Age-standardized mortality rates from the Tuscan Regional Mortality Reg- istry, 1987-2008, were calculated for neoplasms, cardiovascular diseases, and respira- tory diseases, considering the whole region and its 12 areas. Joinpoint analyses were carried out to study temporal trend. Results. Up to 2008, the number of male deaths for neoplasms (6,786) in Tuscany did not exceed deaths from cardiovascular disease (7,065). Instead, overtaking occurred in some subregional areas from 2004 onwards. When we compared age-standardized mortality rates, cancer became the first cause of death in Tuscany from 2004 onwards (age-standardized mortality rates for cancer 236.5 per 100,000; for cardiovascular dis- ease 227.8 per 100,000). Age-standardized mortality rates for cardiovascular disease recorded an annual 2.4% decrease until 1998, then a 3.5% decrease. Age- standardized mortality rates for all cancers recorded an annual 1.6% decrease in the whole period. Conclusions. Our study confirmed a geographical trend in cancer overtaking as the main cause of death in males: from the more urbanized areas in northern Tuscany, where the phenomenon occurred earlier, to the southern part. Free full text available at www.tumorionline.it Introduction Cardiovascular disease (CVD) is the leading cause of death worldwide, except for Africa 1 . In 2005, CVD represented the first cause of death in females in all European countries, and also the first cause of death in males, except for France, Netherlands, and Spain, where the first cause of death was neoplasms 2 . In Italy (about 58 million inhabitants, 2001 Census) in 2006 for the first time, neoplasms became the main cause of death for men, exceeding CVD 3 . Such a trend was confirmed in 2007 figures for men only 4 . In the Lombardy Region (about 10 million inhabitants, 2001 Census), male cancer deaths have exceeded CVD deaths since 1989 5 . In other Italian regions, above all in northern Italy, the trend occurred more recently: in Friuli-Venezia Giulia in 2000, in Veneto in 2001, in Piedmont, Aosta Valley, Liguria, Emilia-Romagna, Lazio, and Sardinia in 2006 6-11 . The aim of the present study was to verify whether the overtaking of cancer male mortality occurred also in Tuscany (about 3.5 million inhabitants, 2001 Census) or in some of its 12 subregional Local Health Authority areas (Figure 1), and whether there was a geographical and time trend in this phenomenon from the most industrialized northern Tuscany to the south. Tumori, 97: 14-18, 2011