The first comprehensive picture of female lung cancer mortality trends in Europe shows rates are still rising in most countries. But, the research does indicate that there is some room for cautious optimism in the longer term due to decreases or smaller rates of increase in some countries and a more favourable trend among younger women in many countries.
The Italian and Swiss authors, writing in Annals of Oncology (Wednesday 13 July), conclude that the lung cancer epidemic among women in Europe will probably not reach the levels experienced in the USA, where it is the leading cause of cancer death among women. However, Europe will still have to implement effective ways of controlling smoking if it is to avoid a major female lung cancer epidemic.
Lead author Dr Cristina Bosetti, a senior epidemiologist and biostatistician at Istituto di Ricerche Farmacologiche Mario Negri in Milan, said: "Although trends in lung cancer mortality in various European countries have been published before, this is the first comprehensive picture of female trends and we have been able to include the most recent available data and, in particular, focus on patterns among younger women."
The study examined trends over the lasts four decades in 33 countries (including the 25 EU states as of May 2004) to provide world aged-standardised rates per 100,000 at all ages and for two (overlapping) age groups – 20 to 44 and 35 to 64.
In the 25 EU countries mortality rose by over a fifth (23.8%) between the early 1980s and the early 1990s – up from 7.8 to 9.6 per 100,000. From the early 1990s it rose by a further 16% to reach 11.2 per 100,000 in the year 2000–2001. [Rates for women in the USA had reached 24 per 100,000 in the year 2000 and few European countries have comparably high rates].
Only six European countries – England, Wales, Latvia, Lithuania, Russia and Ukraine – showed a fall over the last decade although in several countries the upward trend was slowing.
What pleasantly surprised the authors was the finding that although trends among the 20–44-year-olds were less clear because of the smaller numbers of deaths, they appeared to be more favourable than those in the combined aged groups and among middle-aged women (35-64 years).
Said Dr Bosetti: "We saw steady long-term declines among younger women in Ireland and the UK since the late 1960s. In a number of others, including Austria, Hungary, Italy, the Netherlands, Poland, Sweden and Switzerland, the rates among younger women have also tended to fall in the last few years. This is a major finding of the present analysis, particularly in those countries where a peak in lung cancer mortality has already been reached, because it suggests that overall trends are likely to be more favourable in the future. Trends for young adults are an early indicator of the recent and potential future impact of changes in the prevalence of risk factors."
Dr Bosetti said that because the smoking by women had begun later in the twentieth century than in the USA and was not so widespread among Europe overall, the lung cancer mortality epidemic should be more limited than in the USA.
"However, this will depend on us being able to control smoking among European women. Unless we manage to do that with effective interventions we could still face a major female lung cancer epidemic in Europe in the near future."
 Lung cancer mortality in European women: recent trends and perspectives. Annals of Oncology. doi:10.1093/annonc/mdi313.
Annals of Oncology is the monthly journal of the European Society for Medical Oncology. Annals of Oncology website: http://www.annonc.oupjournals.org
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