Worldwide patterns of cancer mortality, 1985-89

Histograms of all age-standardized death certification rates from 26 cancers or groups of cancers and total cancer mortality for the most recent calendar quinquennium (generally 1985-89) were produced for 55 countries: 26 in Europe, the former Soviet Union (USSR), three in North America, 13 in Latin America and the Caribbean, two in Africa, eight in Asia and two in Oceania, providing interpretable data to the World Health Organization database. Major differences were observed for all common cancer sites, including stomach (49/100,000 males in Costa Rica, 38 in the USSR and Japan vs 5/100,000 in the United States), intestines (over 25/100,000 males in Czechoslovakia, Hungary and New Zealand vs 10-15/100,000 in Japan and Southern Europe and less than 5/100,000 in most Latin American and Asian countries), lung (over 70/100,000 in Belgium, Scotland, The Netherlands, Czechoslovakia and Hungary, and less than 20/100,000 in most Latin American and Asian countries; over 20/100,000 females in Britain, Hong Kong, the United States and Denmark vs less than 5/100,000 in France, Spain and again most areas of Asia and Africa providing data; breast (over 25/100,000 females in Great Britain, New Zealand, Belgium, The Netherlands and Uruguay, vs less than 10/100,000 in Japan, Hong Kong and most Latin American countries). Thus, there was over a fivefold variation in total cancer mortality for both sexes, the highest rates being in Hungary (237/100,000) and Czechoslovakia (229/100,000) for males, and in Denmark (142/100,000) and Scotland (138/100,000) for females. Although problems of validity and reliability of cancer death certification, mostly in developing countries, may in part explain this variation, these substantial differences are at least in part real and essentially reflect, besides the impact of breast cancer in females and of stomach and colorectal cancer in both sexes, the different spectrum of the tobacco-related lung cancer epidemic in the two sexes and in various areas of the world.