CANCER MORTALITY IN EUROPE - EFFECTS OF AGE, COHORT OF BIRTH AND PERIOD OF DEATH

Death certification data for 19 cancers or groups of cancers, plus tot al cancer mortality, in 16 major European countries were analysed usin g a log-linear Poisson model with arbitrary constraints on the paramet ers to disentangle the effects of age, birth cohort and period of deat h. Three major patterns emerged including: first, the prominent role o f cohort of birth in defining trends in mortality from most cancer sit es (except testis or Hodgkin's disease, where newer treatments had a m ajor period of death effect); and second, the major role of lung and o ther tobacco-related neoplasm epidemics in determining the diverging p attern of cancer mortality, for each sex and in various European count ries and geographic areas. In most countries, the peak male cohort val ues were reached for generations born between 1900 and 1930. This was observed in women only for Denmark and the U.K., i.e. the two countrie s where lung and other tobacco-related neoplasm epidemics had already reached appreciable levels. This confirms the importance of cigarette smoking in subsequent generations as a major cause of cancer deaths in Europe. Further, there is a persistent rise in several cancer rates, again chiefly on a cohort basis, in Eastern Europe, which calls for ur gent intervention to control the cancer burden in these countries. (C) 1998 Elsevier Science Ltd.