title: 40 years of progress in female cancer death risk: a Bayesian spatio-temporal mapping analysis in Switzerland.
abstract: BACKGROUND
  In the past decades, mortality of female gender related cancers declined in Switzerland and other developed countries. Differences in the decrease and in spatial patterns within Switzerland have been reported according to urbanisation and language region, and remain controversial. We aimed to investigate geographical and temporal trends of breast, ovarian, cervical and uterine cancer mortality, assess whether differential trends exist and to provide updated results until 2011.
  
  
  METHODS
  Breast, ovarian, cervical and uterine cancer mortality and population data for Switzerland in the period 1969-2011 was retrieved from the Swiss Federal Statistical office (FSO). Cases were grouped into <55 year olds, 55-74 year olds and 75+ year olds. The geographical unit of analysis was the municipality. To explore age- specific spatio-temporal patterns we fitted Bayesian hierarchical spatio-temporal models on subgroup-specific death rates indirectly standardized by national references. We used linguistic region and degree of urbanisation as covariates.
  
  
  RESULTS
  Female cancer mortality continuously decreased in terms of rates in all age groups and cancer sites except for ovarian cancer in 75+ year olds, especially since 1990 onwards. Contrary to other reports, we found no systematic difference between language regions. Urbanisation as a proxy for access to and quality of medical services, education and health consciousness seemed to have no influence on cancer mortality with the exception of uterine and ovarian cancer in specific age groups. We observed no obvious spatial pattern of mortality common for all cancer sites. Rate reduction in cervical cancer was even stronger than for other cancer sites.
  
  
  CONCLUSIONS
  Female gender related cancer mortality is continuously decreasing in Switzerland since 1990. Geographical differences are small, present on a regional or canton-overspanning level, and different for each cancer site and age group. No general significant association with cantonal or language region borders could be observed.
authors.affiliation: Cancer Registry St. Gallen-Appenzell, St Gallen, Switzerland. christian.herrmann@kssg.ch.|Department Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. christian.herrmann@kssg.ch.|University of Basel, Basel, Switzerland. christian.herrmann@kssg.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Herrmann
authors.affiliation: Cancer Registry St. Gallen-Appenzell, St Gallen, Switzerland. silvia.ess@kssg.ch.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ess
authors.affiliation: Department of Medical Oncology-Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland. beat.thuerlimann@kssg.ch.|Breast Centre, Kantonsspital St. Gallen, St. Gallen, Switzerland. beat.thuerlimann@kssg.ch.
authors.forename: Beat
authors.initials: B
authors.lastname: Thürlimann
authors.affiliation: Department Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. nicole.probst@unibas.ch.|University of Basel, Basel, Switzerland. nicole.probst@unibas.ch.
authors.forename: Nicole
authors.initials: N
authors.lastname: Probst-Hensch
authors.affiliation: Department Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. penelope.vounatsou@unibas.ch.|University of Basel, Basel, Switzerland. penelope.vounatsou@unibas.ch.
authors.forename: Penelope
authors.initials: P
authors.lastname: Vounatsou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D005843:Geography; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000453:epidemiology* / Q000266:history / Q000401:mortality; D012306:Risk; D062211:Spatio-Temporal Analysis; D013557:Switzerland / Q000453:epidemiology