Trends in cigarette sales and lung cancer mortality in four central European countries

Remarkable increases in lung cancer risk have recently been observed in the Central European (CE) area. This study examines the patterns of lung cancer mortality rates and cigarette sales in 1965-1989 in four CE countries with a total population of 64.2 million and 31,000 deaths from lung cancer in the last year under study. The patterns of increases in cigarette sales during the 1960s and 1970s were different by country, and, in the 1980s, the consumption in Hungary and Poland exceeded 3,000 pieces of cigarettes/year per adult (age 15 years and older). Among men, the lung cancer death rates in 1989 for the Czech Republic (75.8/100,000, age-adjusted to the world standard), Hungary (74.0), Poland (69.4) and Slovakia 68.7) ranked among the highest in Europe, the trends by country largely reflecting the varied prevalence and duration of smoking in previous decades. The age-adjusted lung cancer death rates for females of the same countries (9.3, 14.4, 9.4, and 6.8/100,000, respectively) were still much lower than in the most afflicted Western countries (Scotland, USA, Canada, England, Denmark), however, rapidly increasing. In more recent birth cohorts, there was some decline in lung cancer mortality rates among men, but not among women; these trends in young adult life are known to spread to older age groups in future years, and, therefore, have been suggested to predict future changes in older age groups. Hence, an increasing trend in lung cancer mortality can be predicted for the female population of the four countries under study which will continue probably well beyond the turn of the century. In most of these countries, the current increasing trend in men can be expected to reach a plateau (and later a decline) sooner than in women. This outlook underlines the urgent need for comprehensive lung cancer prevention with control of smoking in women as a priority.