Going up or coming down? The changing phases of the lung cancer epidemic from 1967 to 1999 in the 15 European Union countries
Introduction
Lung cancer is the most common cause of death from cancer in the European Union (EU). Over 180 000 deaths were estimated in 1997 [1], representing nearly one-third of the total cancer mortality experienced in the 15 constituent countries. Over three-quarters of these deaths were in men. Tobacco smoking has long been established as the principal cause of lung cancer 2, 3, 4, 5, and in 1995, was estimated to account for 90% of lung cancer deaths among men, and around 60% in women, although a great deal of variation was present between countries [6].
The lung cancer epidemic continues to have an enormous impact on the health experience of the men and women living in the EU countries. The public health resources required to meet these needs are correspondingly large. Information on the evolution of the lung cancer epidemic is therefore essential to formulate effective cancer control policies. Previous studies have revealed the divergent trends in lung cancer mortality rates across EU countries 7, 8, 9. The variation is related primarily to the prevalence and intensity of cigarette smoking in different countries, the main form of tobacco consumed in the EU.
This paper describes the key characteristics of the current lung cancer epidemic in each of the 15 countries in the EU, using an analysis of time trends in national mortality between 1967 and 1999. The independent effects of age, period of death and generation of birth (cohort) on the evolution of trends are evaluated in men and women aged between 30 and 64 years at the time of death. The emphasis on the evolution of death rates in younger populations highlights the change in risk between recent generations, related to changes in tobacco consumption patterns. As Muir and colleagues [10] rationalise, such trends are “uncomplicated by the effect of changes in the prevalence of carcinogenic agents in the distant past, which may have a major effect on the trends in the old”. This overview provides an indication of the overall effectiveness of national and regional prevention strategies within the EU. On the basis of these and recent trends in the prevalence of smoking, the potential future development of the disease burden in the EU is discussed.
Section snippets
Data sources
Mortality from malignant neoplasms of the trachea, bronchus and lung were extracted from the World Health Organization (WHO) Mortality Databank for each EU country, by 5-year age group and sex, using the rubric 162 according to the ICD-8 and ICD-9 revisions. Data were available covering a 30-year span for the following countries: Austria (1970–1999), Denmark (1967–1996), Finland (1969–1998), France (1968–1997), Greece (1969–1998), Ireland (1968–1997), Italy (1968–1997), The Netherlands
Results
In the text that follows the terms ‘younger’ and ‘under 65 years’ are used as synonyms for persons aged from 30 to 64 years; and ‘older’, for persons aged 65 years or above.
Discussion
This paper brings together the most recent trends in lung cancer mortality rates in the 15 countries of the EU. The focus is on a systematic analysis of the cross-sectional trends by age in men and women, and, subsequently, how the joint effects of age, period and cohort influence lung cancer mortality trends in persons (aged under 65 years). The objectives of such a synthesis were to identify the major changes in trends, highlighting the successes and failures of lung cancer prevention efforts
Acknowledgements
The Comprehensive Cancer Monitoring Programme in Europe (CaMon) project is funded by the European Commission, Agreement No. Sl2.327599 (2001CVG3-512).
References (41)
- et al.
Variation in survival of patients with lung cancer in Europe, 1985–1989
Eur. J. Cancer
(1998) - et al.
The prevalence of smoking in Austria
Prev. Med.
(1998) - et al.
Trends in cigarette smoking in Spain by social class
Prev. Med.
(2001) - et al.
Lung cancer, smoking and diet among Swedish men
Lung Cancer
(1996) - et al.
Lifestyle, environmental pollution and lung cancer in cities of Liaoning in northeastern China
Lung Cancer
(1996) - et al.
EUCAN: Cancer Incidence, Mortality and Prevalence in the European Union 1997, version 4.0. IARC CancerBase No. 4
(1999) Smoking and Health Now: A New Report and Summary on Smoking and Its Effect on Health, from the Royal College of Physicians of London
(1971)Smoking or Health: The Third Report from the Royal College of Physicians of London
(1977)The Health Consequences of Smoking. Cancer. A Report of the Surgeon General
(1982)Tobacco Smoking. Evaluation of Carcinogenic Risks to Humans, Vol. 38
(1986)
Changes in tobacco consumption and lung cancer riskevidence from national statistics
IARC Sci. Publ.
Progress in the fight against cancer in EC countrieschanges in mortality rates, 1970–1990
Eur. J. Cancer Prev.
Characterization of the lung cancer epidemic in the European Union (1970–1990)
Cancer Epidemiol. Biomarkers Prev.
The interpretation of time trends
Cancer Surv.
Summarising indices for comparison of cancer incidence data
Int. J. Cancer
International study of time trends. Some methodological considerations
Ann. N. Y. Acad. Sci.
Models for temporal variation in cancer rates. Iage-period and age-cohort models
Stat. Med.
Models for temporal variation in cancer rates. IIage-period-cohort models
Stat. Med.
The estimation of age, period and cohort effects for vital rates
Biometrics
Cited by (102)
Cancer burden in four countries of the Middle East Cancer Consortium (Cyprus; Jordan; Israel; Izmir (Turkey)) with comparison to the United States surveillance; epidemiology and end results program
2016, Cancer EpidemiologyCitation Excerpt :Among females, breast cancer has the highest proportion in all countries including US, which supports the importance of international efforts in breast cancer prevention and control efforts. Smoking is the leading cause of cancer especially lung cancer [10–12]. Due to high smoking prevalence in Middle East countries, it was important to examine the relationship of lung cancer incidence rate and smoking patterns.
Twenty-five year trends in prevalence of chronic bronchitis and the trends in relation to smoking
2014, Respiratory MedicinePollution in the working place and social status: Co-factors in lung cancer carcinogenesis
2014, Lung CancerCitation Excerpt :This is below the WHO estimate for Europe of 35% [14,15]. The proportion of smokers among males (96.3%) and females (81.3%) in the sample were above those estimated in current literature [1,16–20]. The high impact of smoking may lead to under-estimation of other co-factors involved in the etiology of the disease.
Serum markers in small cell lung cancer: Opportunities for improvement
2013, Biochimica et Biophysica Acta - Reviews on CancerCitation Excerpt :One of the main reasons for this steep rise in frequency is tobacco usage, which has been identified as the major cause of lung cancer. It was estimated to account for circa 90% of lung cancer deaths among men and approximately 60% in woman, although a strong variation exists between countries [4,5]. Tobacco smoke contains a variety of carcinogenic compounds, among which polyaromatic hydrocarbons (PAH).
Advanced lung adenocarcinoma in an EGFR-positive patient treated with Erlotinib for 52 months
2013, Respiratory Medicine Case Reports