Elsevier

European Journal of Cancer

Volume 36, Issue 17, November 2000, Pages 2266-2271
European Journal of Cancer

Cervical cancer mortality in young women in Europe: patterns and trends

https://doi.org/10.1016/S0959-8049(00)00346-4Get rights and content

Abstract

On the basis of overall national death certification data, it is not possible to analyse mortality from cervical cancer in Europe, since 20–65% of deaths from uterine cancer in largest countries are still certified as uterus, unspecified. We analysed, therefore, age-standardised death certification rates from uterine cancer between 1960 and 1998 in women aged 20–44 years, since most deaths from uterine cancer below the age of 45 years arise from the cervix. In all Western European countries, except Ireland, substantial declines in cervical cancer mortality in younger women were observed, although the falls were larger and earlier for some Nordic countries. The trends were irregular in the UK, with earlier declines between 1960 and 1970, followed by a rise between 1970 and 1985, and a subsequent fall. In Ireland, mortality from uterine cancer at age 20 to 44 years has been rising since the early 1980s, to reach 3.4/100 000 in 1995–1996. In Eastern Europe, some fall in mortality was observed in Hungary and Poland, while trends were upwards in Romania since 1980, and in Bulgaria. In all these countries, moreover, absolute rates remained appreciably higher than in most of Western Europe, and in the late 1990s there was over a 10-fold variation between the highest rates in Romania (10.6/100 000 women aged 20–44 years) and the lowest ones in Finland (0.5/100 000) or Sweden (0.9/100 000). Within the European Union, the variation was over 6-fold, the highest rates being registered in Ireland (3.4/100 000) and Portugal (3.2/100 000). The declines registered in cervical cancer mortality in young women were largely due to screening, and the persisting variations in mortality across Europe underline the importance of the adoption of organised screening programmes, with specific urgency in Eastern Europe.

Section snippets

Material and methods

Official death certification numbers for 24 European countries (including the Russian Federation, but excluding a few small countries such as Andorra and Liechtenstein) were derived from the World Health Organisation (WHO) database as available on electronic support [8]. During the calendar period considered (1960–1998), five different revisions of the International Classification of Diseases (ICD) were used 9, 10, 11, 12, 13. Classification of cancer deaths were thus re-coded, for all calendar

Results

Table 1 gives the average annual number of certified deaths from cervix, corpus uteri and unspecified uterus for selected European countries around 1960 and 1995. In 1960, the proportion of unspecified uterine cancers ranged between 6.0 in England and Wales, 10.6–12.5% in Switzerland and Norway, and 18.2–26.4% in the other Scandinavian countries to over 70% in France, Greece, Italy and Spain, with several countries showing proportions of unspecified uterine cancers of 35–50%. These figures

Discussion

Two main messages can be derived from the present systematic analysis of uterine cancer mortality in Europe: first, overall national death certification rates can not be used to obtain meaningful measures of patterns of trends in uterine cancer mortality, due to a substantial and variable proportion of deaths from unspecified uterine neoplasms and, second, death certification rates from uterine cancer in younger women (20–44 years) declined substantially in most Western European countries, but

Acknowledgements

Supported by the Swiss League against Cancer and the Italian Association for Cancer Research. The project received financial support from the European Commission (Contract grant sponsor: European Union, Commission of the European Communities, Directorate-General for Employment, Industrial Relations and Social Affairs; Contract grant number: SOC 97 201143).

Neither the European Commission nor any person acting on its behalf is liable for any use made of this information.

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