Worldwide trends in cancer mortality in the elderly, 1955-1992

Trends in age-standardised mortality for all cancers and 21 cancers or groups of cancers over the period 1955-1992 were analysed for 33 countries from four continents in a population aged 65-84 years. Mortality from all neoplasms in the elderly showed heterogeneous patterns in various countries and in the two sexes. Trends were generally more favourable for females than for males, reflecting essentially the earlier and more extensive impact of the lung cancer (and other tobacco-related neoplasms) epidemic in elderly males, in addition to the earlier decline of gastric cancer and a widespread decline of cervical cancer rates in females. In several countries, particularly from western Europe, but also Japan, cancer mortality trends were more favourable over the last two decades than in earlier calendar periods. Some countries of northern and central Europe (including Finland, Germany, Austria and Switzerland) showed stable or even downward trends over time for total cancer mortality in both sexes, particularly in males. This reflects the different patterns of the tobacco-related (lung) cancer epidemic in various countries, and the impact of a few other major neoplasms, including in particular the systematic downward trends in stomach cancer. In contrast, rates were moderately upwards in males in North America, and several countries of southern and eastern Europe, where cancer mortality in the elderly was comparatively low in the 1950s, showed appreciable upward trends, mostly in males. Thus, there was a generalised tendency towards a levelling of the differences in certified cancer mortality in the elderly population in various areas of the world. Although there are substantial limits and uncertainties in the reliability and validity of cancer death certification and their trends in the elderly, there is no widespread and generalised upward trend in cancer mortality, with a major exception of lung and other tobacco-related neoplasms. Furthermore, in several countries, cancer mortality trends over the last four decades have been favourable for elderly women.