Fabio Levi

Even in populations with optimal structures for cancer diagnosis and certification, 3%–5% of neoplasms are classified as cancer of unknown primary (CUP) [1]. In the Vaud Cancer Registry, they account for 2%–3% of all neoplasms only [2].

BACKGROUND: In May 2004, 10 additional countries joined the European Union (EU), including a total of 75 million inhabitants. Most of these were from central and eastern European countries with comparably high cancer mortality rates and with relatively unfavorable trends. Therefore, it is important to provide updated mortality data regarding major cancers in various countries and to analyze trends for the current population of the EU.METHODS: The authors considered mortality rates (directly standardized to the world standard population) for all cancers and for 8 major cancer sites in the year 2000 in the 25 countries of the EU and analyzed corresponding trends since 1980 using data derived from the World Health Organization data base.RESULTS: For men, overall cancer mortality in the year 2000 varied by a factor > 2 between the highest rate of 258.5 per 100,000 men in Hungary and the lowest rate of 122.0 per 100,000 men in Sweden. Central and Eastern European accession countries had the highest rates not only for lung and other tobacco‐related cancers but also for gastrointestinal cancers and leukemias. The geographic pattern was different and the range of variation was smaller for women, i.e., between 136.7 per 100,000 women in Denmark and 76.4 per 100,000 women in Spain in the year 2000. In the EU as a whole, lung cancer mortality in men peaked at 55.4 per 100,000 men in 1988 and declined thereafter to 46.7 per 100,000 men in 2000. Gastric cancer steadily declined from 19.7 per 100,000 men in 1980 to 10.1 per 100,000 men in 2000. Other major sites showed moderately favorable trends over the last few years. In women, breast cancer peaked at 21.7 per 100,000 in 1989 and declined to 18.9 per 100,000 in 2000. Mortality from gastric, (cervix) uterus, and intestinal cancers demonstrated steady decreases, but lung cancer increased from 7.7 per 100,000 women in 1980 to 11.1 per 100,000 women in 2000. The increase in lung cancer mortality in women age < 55 years was 38% between 1990 and 2000 (from 2.16 per 100,000 women to 2.99 per 100,000 women), reflecting the spread of tobacco smoking among women in the EU over the last few decades.CONCLUSIONS: The priority for further reduction of cancer mortality in the EU remains tobacco control together with more widespread availability of modern diagnostic and treatment procedures for neoplasms that are amenable to treatment. Cancer 2004. © 2004 American Cancer Society.

Cancer mortality rates and trends over the period 1980–2000 for accession countries to the European Union (EU) in May 2004, which include a total of 75 million inhabitants, were abstracted from the World Health Organization (WHO) database, together with, for comparative purposes, those of the current EU. Total cancer mortality for men was 166/100 000 in the EU, but ranged between 195 (Lithuania) and 269/100 000 (Hungary) in central and eastern European accession countries. This excess related to most cancer sites, including lung and other tobacco-related neoplasms, but also stomach, intestines and liver, and a few neoplasms amenable to treatment, such as testis, Hodgkin's disease and leukaemias. Overall cancer mortality for women was 95/100 000 in the EU, and ranged between 100 and 110/100 000 in several central and eastern European countries, and up to 120/100 000 in the Czech Republic and 138/100 000 in Hungary. The latter two countries had a substantial excess in female mortality for lung cancer, but also for several other sites. Furthermore, for stomach and especially (cervix) uteri, female rates were substantially higher in central and eastern European accession countries. Over the last two decades, trends in mortality were systematically less favourable in accession countries than in the EU. Most of the unfavourable patterns and trends in cancer mortality in accession countries are due to recognised, and hence potentially avoidable, causes of cancer, including tobacco, alcohol, dietary habits, pollution and hepatitis B, plus inadequate screening, diagnosis and treatment. Consequently, the application of available knowledge on cancer prevention, diagnosis and treatment may substantially reduce the disadvantage now registered in the cancer mortality of central and eastern European accession countries.

Substantial rises in anal cancer incidence have been registered over the last few decades in the USA and a few Nordic countries. Incidence trends in the Swiss population of Vaud (about 602 000 inhabitants) over the period 1979–2001 were considered. Rates were around 0.3–0.5 per 100 000 men (age-standardized, world population) and 1.1–1.4 per 100 000 women, in the absence of any consistent trend over time. The epidemiology of anal cancer appears therefore different in this Swiss population as compared with North America and northern Europe.

We have considered trends in age-standardized mortality from gastric cancer in 25 individual European countries, as well as in the European Union (EU) as a whole, in six selected central-eastern European countries and in the Russian Federation over the period 1950–1999. Steady and persisting falls in rates were observed, and the fall between 1980 and 1999 was ∼50% in the EU, 45% in eastern Europe and 40% in Russia. However, the declines were greater in Russia and eastern Europe, since rates were much higher, in absolute terms. Joinpoint regression analysis indicated that the falls were proportionally greater in the last decade for men (–3.83% per year in the EU) and in the last 25 years for women (–3.67% per year in the EU) than in previous calendar years. Moreover, steady declines in gastric cancer mortality were observed in the middle-aged and the young population as well, suggesting that they are likely to persist in the near future. In terms of number of deaths avoided, however, the impact of the decline in gastric cancer mortality will be smaller, particularly in the EU.

Background: Processed meat has been related to the risk of digestive tract neoplasms but the evidence remains inconclusive. We examined data from a network of case–control studies conducted between 1992 and 2002 in the Swiss Canton of Vaud. Patients and methods: We studied 316 patients with incident, histologically confirmed oral and pharyngeal cancer, 138 patients with oesophageal cancer, 91 patients with laryngeal cancer and 323 patients with colorectal cancer. Controls were 1271 subjects admitted to the same hospital for a wide spectrum of acute non-neoplastic conditions, unrelated to long-term modification of diet. Results: There were strong direct trends in risk between consumption of processed meat and the various neoplasms considered: the multivariate odds ratios for the highest quartile of intake compared to the lowest were 4.7 for oral and pharyngeal cancer, 4.5 for oesophageal cancer, 3.4 for laryngeal cancer and 2.5 for colorectal cancer. The association was stronger in younger subjects, in moderate drinkers and in non-smokers. Conclusion: Processed meat represents a strong indicator of unfavourable diet for digestive tract and laryngeal cancer risk in this population.

BACKGROUND: Mortality from prostate cancer (CaP) has increased throughout Europe until the early 1990s. Trends in 24 European countries, the European Union (EU), six selected Central and Eastern European countries, and the Russian Federation have been updated to 1999.METHODS: Cancer death certification data for CaP were abstracted from the World Health Organization database.RESULTS: In the EU, the peak rate (15.7/100,000) was reached in 1993, followed by a leveling off and a decline to 14.1/100,000 in 1999. Age‐standardized analysis for each subsequent age group of men aged 50 or over showed larger absolute falls in the elderly. CaP rates were lower in Central and Eastern European countries providing data, but showed a rise from 9.7/100,000 in 1980 to 11.3 in 1996, and leveled off thereafter. Rates were originally lower, but the rises larger in the Russian Federation (from 5.1/100,000 in 1980 to 8.1/100,000 in 1999). In the late 1990s, there was a threefold difference between the highest rates of 22/100,000 in Norway and those of 7.7 in Russia or 7.3 in Ukraine. Such a difference was, however, restricted to the elderly, since at age 35–64 the Russian rate (6.7/100,000) was the same as that of Norway, and only Greece and Italy had appreciably lower rates.CONCLUSION: The pattern of trends in CaP rates observed across Europe is consistent with a favorable role of improved diagnosis, but mainly of advancements of therapy (including more widespread adoption of radical prostatectomy and androgen blockage) on CaP mortality in Western Europe.

Objective: To analyse trends in mortality from suicide over the period 1965–99.Method: Data were derived from the WHO database, including data for 47 countries.Results: In the European Union (EU), all age suicide mortality peaked at 16.1/100 000 in men in 1980–84, and declined thereafter to 14.4/100 000 in 1995–98. In females, the fall was 29% to reach 4.6/100 000. A similar pattern of trends was observed in several eastern European countries. In contrast, mortality from suicide rose substantially in the Russian Federation, from 37.7/100 000 in males in 1985–89 to 58.3/100 000 in 1995–98 (+55%), and to 9.5/100 000 (+12%) in females. In the USA and most other American countries providing data, no consistent pattern was evident for males, but falls were observed in females. Steady declines were registered for Japan, starting from the highest suicide rates worldwide in the late 1950s. Suicide rates were upwards in Ireland, Italy, Spain, the UK, Cuba, Australia and New Zealand. Substantial rises were observed in a few countries (Ireland, Cuba, Mexico, Australia and New Zealand) for young males.Conclusion: In spite of mixed trends, suicide remains a significant public health problem worldwide.

Upward trends in testicular cancer incidence have been reported in Europe and North America, particularly for seminomas. We considered incidence data between 1974 and 1999 from the Swiss cancer registry of Vaud, i.e. one of the highest incidence areas on a worldwide scale, including a total of 731 cases. Testicular cancer incidence was around 8.5/100 000 between the mid-1970s and the late 1980s, and increased to around 10/100 000 in the 1990s. Corresponding figures at age 15–44 were around 16/100 000 between the mid-1970s and the late 1980s, and about 19/100 000 thereafter. No evidence of persisting upward trends was evident over the last few years. The rise in testicular cancer incidence in the 1990s was apparently restricted to seminomas, whose rates increased from about 4 to 5.7/100 000 at all ages, and from 7 to over 11/100 000 at age 15–44. No consistent pattern of trends was observed for malignant teratomas and for other and unspecified histotypes. Testicular cancer in Vaud has shown no tendency to further rising over the last decade, thus re-opening the issue of a probable asymptote of testicular cancer incidence in this population.