Lung Cancer 78 (2012) 171–178 Contents lists available at SciVerse ScienceDirect Lung Cancer j our na l ho me p age: www.elsevier.com/locate/lungcan Lung cancer mortality in European women: Trends and predictions Cristina Bosetti a,∗ , Matteo Malvezzi a,b , Tiziana Rosso a , Paola Bertuccio a,b , Silvano Gallus a , Liliane Chatenoud a , Fabio Levi c , Eva Negri a , Carlo La Vecchia a,b a Department of Epidemiology, Istituto di Ricerche Farmacologiche “Mario Negri”, 20156 Milan, Italy b Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy c Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland a r t i c l e i n f o Article history: Received 22 May 2012 Received in revised form 13 July 2012 Accepted 15 August 2012 Keywords: Cancer Europe Female Lung Mortality Projections Trends a b s t r a c t Female lung cancer mortality increased by 50% between the mid 1960s and the early 2000s in the Euro- pean Union (EU). To monitor the current lung cancer epidemic in European women, we analyzed mortality trends in 33 European countries between 1970 and 2009 and estimated rates for the year 2015 using data from the World Health Organization. Female lung cancer mortality has been increasing up to recent calendar years in most European countries, with the exceptions of Belarus, Russia, and Ukraine, with relatively low rates, and the UK, Iceland and Ireland, where high rates were reached in mid/late 1990s to leveled off thereafter. In the EU, female lung cancer mortality rates rose over the last decade from 11.3 to 12.7/100,000 (+2.3% per year) at all ages and from 18.6 to 21.5/100,000 (+3.0% per year) in middle- age. A further increase is predicted, to reach 14/100,000 women in 2015. Lung cancer mortality trends have been more favorable over the last decade in young women (20–44 years), particularly in the UK and other former high-risk countries from northern and central/eastern Europe, but also in France, Italy, and Spain where mortality in young women has been increasing up to the early 2000s. In the EU as a whole, mortality at age 20–44 years decreased from 1.6 to 1.4/100,000 (-2.2% per year). Although the female lung cancer epidemic in Europe is still expanding, the epidemic may be controlled through the implementation of effective anti-tobacco measures, and it will probably never reach the top US rates. © 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Lung cancer mortality in men has been declining since the late 1980s in most European countries, with a fall by 17% (from 55.4 to 44.0/100,000 men) in the European Union (EU) as a whole between the peak in 1988 and the rates in the early 2000s [1], and a pre- dicted additional 15% fall to 37.2/100,000 in 2012 [2]. In women, lung cancer mortality in Europe has been appreciably lower than in men [3], but upward trends were observed up to the early 2000s, with an approximate 50% increase since the mid 1960s in the EU (from 5.5 to 11.2/100,000 women overall and from 9.2 to 17.9/100,000 in middle-aged women) [4,5]. Earlier and particularly sharp increases were observed in Denmark, Germany, Hungary, Poland, and the UK. In England and Wales a leveling off in over- all rates was observed since the 1990s. Further, since the mid-late 1990s trends have been more favorable in young women from Abbreviations: APC, age–period-cohort; CI, confidence intervals; EAPC, esti- mated annual percent change; EU, European Union; ICD, International Classification of Diseases; OR, odds ratio; PI, prediction intervals; WHO, World Health Organization. ∗ Corresponding author. Tel.: +39 0239014 526; fax: +39 0233200231. E-mail address: cristina.bosetti@marionegri.it (C. Bosetti). many European countries, suggesting that female lung cancer epi- demic in Europe may not reach the rates found in the USA in the 1990s, i.e. over 25/100,000 women [6–8]. However, steady upward trends were still observed even in the youngest age groups in some southern European countries such as France and Spain [9]. To monitor the current and predict the future evolution of lung cancer epidemic in European women, we analyzed trends in mor- tality rates over the period 1970 and 2009 and provided estimates of lung cancer deaths and rates for the year 2015. 2. Material and methods We obtained official female death certification data for lung can- cer from the World Health Organization (WHO) database [10] for 33 European countries in the period 1970–2009. The EU was defined as the 27 Member States in January 2007, with the exclusion of Cyprus for which data were available for a limited number of most recent years only. In a few countries, mortality data were missing for one or more calendar years. No interpolation was made for missing data except for the definition of the EU rates: when data were not avail- able for one or more years within a country, the nearest available estimate (i.e., generally that of previous or subsequent year) was replicated. 0169-5002/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.lungcan.2012.08.008