Going up or coming down? The changing phases of the lung cancer epidemic from 1967 to 1999 in the 15 European Union countries

Abstract

Lung cancer, the most common cause of cancer death in the European Union (EU), continues to have an enormous impact on the health experience of the men and women living in the constituent countries. Information on the course of the lung cancer epidemic is essential in order to formulate an effective cancer control policy. This paper examines recent trends in lung cancer mortality rates in men and women in each of the 15 countries, comparing cross-sectional rates of death in younger (aged 30-64 years) and older populations (aged 65 years or over), and the age, period of death, and birth cohort influences in the younger age group. The latter analysis establishes the importance of year of birth, related to modifications in the tobacco habit among recently born generations. The stage of evolution of the lung cancer epidemic varies markedly by sex and country in terms of the direction, magnitude, and phase of development of national trends. In males, there is some consistency in the direction of the trends between EU countries, declines are apparent in most countries, at least in younger men, with rates in older men either reaching a plateau, or also falling. In younger persons, a decreasing risk of lung cancer death reflects changes in successive birth cohorts, due to modifications in the smoking habit from generation to generation, although these developments are in very different phases across countries. Portugal is the exception to the male trends; there are increases in mortality in both age groups, with little sign of a slowing down by birth cohort. In women, there are unambiguous upsurges in rates seen in younger and older women in almost all EU countries in recent decades, and little sign that the epidemic has or will soon reach a peak. The exceptions are the United Kingdom (UK) and Ireland, where lung cancer death rates are now declining in younger women and stabilising in older women, reflecting a declining risk in women born since about 1950. It is too early to say whether the observed plateau or decline in rates in women born very recently in several countries is real or random. To ascertain whether recent trends in lung cancer mortality will continue, trends in cigarette consumption should also be evaluated. Where data are available by country, the proportion of adult male smokers has, by and large, fallen steadily in the last five decades. In women, recent smoking trends are downwards in Belgium, Denmark, Sweden and the Netherlands, although in Austria and Spain, large increases in smoking prevalence amongst adults are emerging. Unambiguous public health messages must be effectively conveyed to the inhabitants of the EU if the lung cancer epidemic is to be controlled. It is imperative that anti-tobacco strategies urgently target women living in the EU, in order to halt their rapidly increasing risk of lung cancer, and prevent unnecessary, premature deaths among future generations of women.