Tobacco.org

• Lung cancer mortality trends in 36 European countries: secular trends and birth cohort patterns by sex and region 1970-2007 

This study represents a comprehensive and up-to-date analysis of the time trends of lung cancer mortality in Europe, taking into consideration the major differentials across 36 countries in 4 regions by sex and the components of time (age, calendar period and birth cohort). The article serves to highlight the varying phases of the lung cancer epidemic in different European countries and the disparities in rates and time trends between the sexes. These observations reflect the smoking habits of generations of men and women born from the late 19th century onwards, but also point to the relative successes or failures of smoking prevention and cessation efforts over the continent in the last few decades.

Men and women are clearly in very different phases of the smoking epidemic, and these may differ considerably between neighboring countries. The trends in lung cancer mortality in men are largely encouraging, in that there are general declines in most European countries, particularly during the last one or 2 decades, and among successive birth cohorts born as early as 1900 (the United Kingdom) or as late as 1955 (France and Italy). While the overall male rates are still increasing in parts of Southern Europe (Portugal and the Republic of Macedonia), and in Eastern Europe (Bulgaria, Romania, and the Republic of Moldova), the declines observed in recent birth cohorts indicate an overall decline may emerge in the next years.

Among women, lung cancer mortality rates have reached a plateaux or are beginning to decline in a number of Eastern European countries (notably in the high-risk countries of Hungary, Poland and the Czech Republic), and in Northern Europe (in particular Denmark, Iceland and the United Kingdom). This is reflected in the generational trends and successive declines in risk among females born predominantly after 1950 in these regions. While there are increasing trends in the all-ages rates among women in the Nordic countries of Sweden, Norway and Finland, declines may be anticipated in the future assuming that the successive decreases in risk among female cohorts born after the Second World War adequately reflect recent changes in smoking habits. More concerning are the continuing generational increases in risk among Bulgarian and Romanian women.

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