The changing epidemiology of lung cancer in Europe.
BACKGROUND
Since the incidence and mortality of the histological subtypes of lung cancer in Europe has changed dramatically during the 20th century, we described the variation and changes in incidence, treatment modalities and survival of lung cancer.


METHODS
For geographical variation and changes in incidence, data of the European cancer incidence and mortality (EUROCIM) database were used, and data on survival were derived from the EUROCARE database. For trends in treatment modalities and survival, according to histology and stage, data of the Eindhoven Cancer registry were used.


RESULTS
Although the incidence of lung cancer among men in Denmark, Finland, Germany (Saarland), Italy (Varese), the Netherlands, Switzerland and the United Kingdom has been decreasing since the 1980s, the age-adjusted rate for men in other European countries increased at least until the 1990s. Among women the peak in incidence had not been reached in the 1990s. The proportion of adenocarcinoma has been increasing over time; the most likely explanation is the shift to low-tar filter cigarettes. In the 1990s more patients with localised non-small cell lung cancer received surgery than in the 1970s. Among patients with non-localised non-small cell lung cancer and among those with small cell lung cancer there was a trend towards more chemotherapy. There was fairly large variation in survival within Europe. Despite improvement in both the diagnosis and treatment, the overall prognosis for patients with non-small-cell lung cancer hardly improved over time. In contrast, the introduction and improvement of chemotherapy since the 1970s gave rise to an improvement in survival for patients with small-cell lung cancer.


CONCLUSIONS
The epidemic of lung cancer is not over yet, especially in southern and eastern Europe. Prevention remains the best policy, but improvement in the management of lung cancer also remains very important.
Janssen-Heijnen
Maryska L G
ML
Eindhoven Cancer Registry, Comprehensive Cancer Centre South, P.O. Box 231, 5600 AE Eindhoven, The Netherlands. m.janssen@ikz.nl
Coebergh
Jan-Willem W
JW
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology*; D018288:Carcinoma, Small Cell / Q000453:epidemiology*; D016208:Databases, Factual; D005060:Europe / Q000453:epidemiology; D005260:Female; D005843:Geography; D006291:Health Policy; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011315:Preventive Medicine; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D016019:Survival Analysis