Trends in the tobacco-related cancer epidemic in Europe.

Recent trends in mortality from lung cancer and other tobacco-related neoplasms in Europe are reviewed. During the last decade, overall lung cancer mortality in males showed no systematic pattern in northern and central Europe, but some modest decline started at younger ages in several countries. In southern Europe, lung cancer mortality started from lower values, but is still rising, and only in Italy is some flattening of rates at relatively high levels becoming apparent in middle age (35 to 64 years). The average change in lung cancer rates in southern Europe over the last decade for males was +24% at all ages and +22% in middle age. The upward trends were even more substantial in eastern European countries (+32% in middle age), which now have the highest lung cancer rates in young and middle-aged males. Over the last few decades, female lung cancer rates have risen in all European countries, but only in Denmark and Britain are overall rates now over 20/100,000. There is therefore still ample scope for urgent intervention aimed at controlling a major tobacco-related lung cancer epidemic among European women in the near future. Substantial rises have been observed for cancer of the oral cavity and pharynx in most European countries, and for cancers of the esophagus, larynx, and (to a lesser extent) of the bladder in eastern Europe. Thus, southern and mainly eastern Europe are becoming priority areas for a campaign for giving up smoking since the prevalence of tobacco smoking in the young is higher and high-tar dark-tobacco cigarettes are still common.