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Trends in mortality from breast cancer over the period 1970-2000 were analysed for 38 European countries and the European Union (EU). Age-standardized mortality rates were computed by the direct method, and joinpoint analysis was used to identify significant changes in rates. A favourable pattern in breast cancer mortality in the 25 countries of the EU (as defined in May 2004) was observed after 1989, leading to a fall in overall rates from 21.3/100,000 in 1990 to 18.9 in 2000. The annual percentage change in the EU was -2.1% between 1995 and 2000. Most northern European countries, including several Scandinavian countries and the UK, but also some central and southern European countries like Germany, Poland, the Czech Republic, Austria, Switzerland, Italy and Spain showed appreciable falls in rates (i.e. between 8 and 19% in the last 5 calendar years). The declines were larger below age 50, approaching 20% in several countries. The falls were smaller in France, Greece, Portugal and most eastern European countries. In the Russian Federation, all-age breast cancer mortality increased from 16.1 to 17.3/100,000 (+7.5% over the last 5 calendar years). These patterns reflect converging trends in breast cancer rates across Europe, which can be related to the more uniform reproductive and lifestyle habits. The fall in breast cancer mortality observed in most European countries over the last decade has to be attributed to earlier detection and improved treatment, although the definite reasons for the different trends in various countries remain at least in part unclear.

Histograms of age-standardized (world standard) death certification rates from 24 cancers or groups of cancers and total cancer mortality for the 5-year calendar period 1990-94 were provided for 55 countries of the world: 35 countries in Europe, two in North America, nine in Latin America, two in Africa, five in Asia and two in Oceania. The highest male lung cancer mortality rates worldwide were registered in Hungary (82/100 000), the Czech Republic and the Russian Federation, followed by other eastern European countries. Other major tobacco- (and alcohol)-related neoplasms also showed exceedingly high rates in Eastern Europe. For females, the highest lung cancer rates were in Scotland (29/100 000), the United States (26/100 000) and Denmark, reflecting the different spread of tobacco smoking in the two sexes. The highest rates for stomach cancer were in Latin America, the Russian Federation and Japan, and for colorectal cancer in the Czech Republic (37/100 000 males, 20/100 000 females) and Hungary. The highest breast cancer mortality rates were in Malta (30/100 000 females), followed by Denmark and Britain, and for cancer of the prostate in Norway (23/100 000), Switzerland and Sweden. With reference to total cancer mortality, the highest rates for males were in Hungary (262/100 000), the Czech Republic (238/100 000) and the Russian Federation (224/100 000), and the lowest ones in Israel (127/100 000), and Sweden (130/100 000). In females, the highest total cancer mortality rates were in Denmark (142/100 000), Scotland and Hungary, and the lowest ones in Greece (78/100 000), France and Spain. These patterns of total cancer mortality for the two sexes reflect the major impact of tobacco-related neoplasms, and underline the substantial excess rates in most eastern European countries. (C) 1999 Lippincott Williams & Wilkins.