Mortality from Hodgkin's disease and other lymphomas in Europe, 1960-1990

Trends in mortality from Hodgkin's disease (HD) and non-Hodgkin's lymphomas (NHL) in the whole of Europe and in two broad European geographic areas (Western and Eastern Europe) were reviewed over the period of 1960-1990, on the basis of official death certifications derived from the World Health Organization database. Between the early 1960s and 1990, HD mortality in the whole of Europe declined from 2.1 to 0.9/100,000 males (-58%), and from 1.1 to 0.5/100,000 (-56%) females. The decline was larger in Western Europe (around 65%), but appreciably smaller in Eastern Europe (around 30%). In contrast, mortality from NHL increased in males from 2.2 to 4.2/100,000 (+93%), and in females from 1.2 to 2.6/100,000 (+112%). These upward trends were larger in Western (over 100%) than in Eastern Europe (around 80%). The declines in HD were larger and the increases in NHL were smaller in populations below age 65. When all lymphomas were considered together, an increase was observed in both sexes (from 4.3 to 5.1/100,000 males; from 2.4 to 3.1/100,000 females) that was comparable in various areas of the continent. These data confirm a major impact of newer integrated diagnostic and therapeutic approaches in reducing HD mortality, while indicating that this impact has been delayed and limited in Eastern Europe. The upward trends in mortality from NHL probably reflect both real increases in incidence and better case ascertainment and certification, but are inconsistent with a noticeable impact of newer therapies on mortality from NHL. It is also conceivable that the introduction of immunophenotypic and immunogenotypic characterization of lymphomas has selectively eliminated from HD a worse-prognosis subset previously classified on the basis of Sternbergoid cells, which has been subsequently classified as NHL. This would have increased survival and decreased mortality from HD, while increasing incidence and mortality from NHL to an extent which is unknown but worth considering.