Trends in cancer mortality in Switzerland, 1951-1984

Trends in overall age-standardized, truncated (35-64 years) and age-specific (40 to 49) cancer death certification rates in Switzerland from 1951 to 1984 were analysed. There was a substantial rise in lung cancer mortality in males, with an over 100% increase in overall rates. Thus, in the early 1980's, lung cancer alone accounted for 26% of all cancer deaths in Swiss males. However, male lung cancer rates tended to level off in subsequent cohorts starting from younger middle age in the late 1960's. In females, lung cancer mortality was approximately ten times lower than in males, but rates had been consistently rising since the late 1960's in all age groups. Declines were observed for several neoplasms of the digestive tract: besides stomach (overall decline 68% in males, 77% in females), trends were markedly downwards also for oesophageal cancer in males (-57%), and there was some moderate fall for intestinal sites in both sexes and gallbladder in females. Several trends for other common neoplasms were similar to those observed in other developed countries, such as the declines for (cervix) uteri, the general stability for breast cancer, or the increases in pancreatic cancer and (melanoma) of the skin. A peculiar feature of Swiss data, besides the marked decline in oesophageal cancer in males, was the consistent downward trend in thyroid cancer for both sexes. Thus, overall age-standardized total cancer mortality over the last three decades was moderately upwards in Swiss males, but consistently downwards in females. Male trends were more reassuring in middle age, chiefly in consequence of the flattening in lung cancer rises. Possible interpretations of these trends in terms of aetiological hypotheses (i.e., changes in alcohol drinking and improvements in diet for oesophageal cancer, or reduced prevalence of iodine deficiency for thyroid neoplasms) are discussed.