Cervical cancer mortality in young women in Europe: patterns and trends.

On the basis of overall national death certification data, it is not possible to analyse mortality from cervical cancer in Europe, since 20-65% of deaths from uterine cancer in largest countries are still certified as uterus, unspecified. We analysed, therefore, age-standardised death certification rates from uterine cancer between 1960 and 1998 in women aged 20-44 years, since most deaths from uterine cancer below the age of 45 years arise from the cervix. In all Western European countries, except Ireland, substantial declines in cervical cancer mortality in younger women were observed, although the falls were larger and earlier for some Nordic countries. The trends were irregular in the UK, with earlier declines between 1960 and 1970, followed by a rise between 1970 and 1985, and a subsequent fall. In Ireland, mortality from uterine cancer at age 20 to 44 years has been rising since the early 1980s, to reach 3.4/100000 in 1995-1996. In Eastern Europe, some fall in mortality was observed in Hungary and Poland, while trends were upwards in Romania since 1980, and in Bulgaria. In all these countries, moreover, absolute rates remained appreciably higher than in most of Western Europe, and in the late 1990s there was over a 10-fold variation between the highest rates in Romania (10.6/100000 women aged 20-44 years) and the lowest ones in Finland (0.5/100000) or Sweden (0.9/100000). Within the European Union, the variation was over 6-fold, the highest rates being registered in Ireland (3. 4/100000) and Portugal (3.2/100000). The declines registered in cervical cancer mortality in young women were largely due to screening, and the persisting variations in mortality across Europe underline the importance of the adoption of organised screening programmes, with specific urgency in Eastern Europe.