Recent Trends in Prostate Cancer Mortality in the European Union

To the Editor: Tarone et al1 describe and quantify a decrease in U.S. prostate cancer mortality in white men since 1992, with rates in 1997 below those of 1986, ie, the year when prostate specific antigen (PSA) testing was approved. In light of different incidence and mortality trends for prostate cancer worldwide, 2 we examined trends in the European Union (EU). Official death certification numbers for the 15 member states of the EU were derived from the World Health Organization (WHO) database for the calendar period between 1970 and 1996. 3 Three different revisions of the International Classification of Diseases (ICD) were used. Classifications of prostate cancer deaths were thus re-coded, for the whole calendar period considered and all countries, according to the ninth Revision (ICD-9). 4 Estimates of the resident population, based on official censuses, were obtained from the same WHO database. From the matrices of certified deaths and resident populations, we computed age-specific rates for each 5-year age group and calendar period. For age-standardization we used the world standard population. Overall age-standardized prostate cancer mortality peaked in 1992 (15.6/100,000), and declined subsequently reaching 15.4/100,000 in 1996. Figure 1 gives trends in age-standardized death certification rates from prostate cancer for EU men age 50 and over. In all age groups below age 80, prostate cancer mortality leveled off around 1992. FIGURE 1: Age-standardized mortality from prostate cancer per 100,000 men (world standard) in the European Union, 1970–1996.PSA testing was introduced—on a population level—in western Europe a few years later than in the United States (ie, around 1989–1990). Although no reliable data on prevalence of use and indication in the whole EU over the last few years is available in the absence of organized screening, the proportion of men aged 60 or over who had undergone PSA screening is probably much lower than what it is in several areas of the United States. 5–10 Fabio Levi Franca Lucchini Eva Negri Carlo La Vecchia