The fall in breast cancer mortality in Europe

Abstract

Between 1981 and 1997, breast cancer mortality at age 20–69 years has decreased by 22% in the UK and 19% in the USA, and a 25% decline has been projected to the year 2000 [1]. In the European Union as a whole, overall age-standardised mortality from breast cancer declined by 7% between 1988 and 1996 [2]. Since the largest advances in breast cancer diagnosis and treatment have been obtained in women below the age of 70 years, and the adoption of various interventions responsible for some reduction in breast cancer mortality has not been homogeneous across various European countries [2], it is therefore of interest to consider recent trends in breast cancer mortality in different countries and in separate age groups. Data were abstracted from the World Health Organization (WHO) database, re-coded according to the Ninth Revision of the International Classification of Diseases (ICD), and standardised by quinquennia of age using the world standard population [3], for comparative purposes with other areas of the world. The pattern of trends described was in any case similar using the European standard population. Table 1 gives age-standardised breast cancer death certification rates around 1988 and 1998 in three separate age groups (20–49, 50–69, 70–79 years) for 32 European countries, and in the European Union (EU) as a whole. In all Western European countries, except Belgium (whose data, were not available after 1994), breast cancer mortality at age 20–49 years declined. The overall decline in the EU was 16.3%, from 12.3 to 10.3/ 100 000, and most countries — including the largest ones — had a rate close to 10/100 000. The decline was larger in the UK, but the absolute value in 1998 (11.6) was still comparatively high. The pattern was inconsistent for the Eastern European countries considered (i.e. former non-market economy European countries), which however had considerably lower breast cancer rates in the 1980s [3]. Likewise, in the age group 50–69 years, most Western European countries, except Norway, showed a fall in breast cancer mortality, for an average of 8.6% in the European Union (from 73.1 to 66.8/100 000). France, Germany and Italy had rates very close to 65/100 000, while the UK showed a larger decline, but still had a higher death rate (74.4). In Eastern Europe, rates started from lower values, but were generally stable or upwards. At age 70–79 years, the overall decline in the EU was 4%, from 116.5 to 111.8/100 000. France, Germany and Italy had rates between 101.9 and 115.3, while the UK had a larger decline ( 15.1%), but still a higher absolute value in 1998 (129.0). Fig. 1 gives a global figure of trends in breast cancer mortality at age 20–69 years in 22 selected European countries, providing meaningful and comparable data from the early 1960s onwards, plus the Russian Federation and Ukraine for which data were available since the early 1980s. Fig. 2 gives comparable data for the whole EU, and six selected Eastern European countries providing meaningful data since the early 1986s. The former Czechoslovakia, since 1992, includes the Czech Republic and Slovakia; data for other Eastern European countries were not available in a comparable format in the 1980s. In the EU, breast cancer mortality rates at age 20–69 years rose from 23.8/100 000 in 1960–1964 to reach a peak of 29.7 in 1985–1989, and subsequently fell to 27.3, i.e. a rate comparable to that registered in the mid-1970s. In Eastern Europe, comparable rates rose from 14.4 in 1960–1964 to 24.1 in 1990–1994, and subsequently stabilised in 1995–1997 (24.2/100 000). Table 2 gives breast cancer mortality rates for the same geographical areas and selected calendar periods and at age 70 years or over, and 20–69 years, over the