Cancer mortality and prevention in the European Union

Are modern environments really bad for us?: revisiting the demographic and epidemiologic transitions

It is a common assumption that agriculture and modernization have been detrimental for human health. The theoretical argument is that humans are adapted to hunter-gatherer lifestyles, and that the agricultural and "modern" environments are novel and hence likely to be detrimental. In particular, changes in nutrition, and population size and distribution with the adoption of agriculture, are considered to increase the risk of infectious disease mortality. Similarly, changes due to modern lifestyles, notably changes in nutrition, smoking, exercise, and stress, are thought to be associated with an increased risk of degenerative disease mortality in the industrial environment. This paper reviews the available literature on the history and prehistory of total mortality (the demographic transition) and cause of death (the epidemiologic transition), and finds that neither agriculture nor modernization is associated with increases in mortality, i.e., declines in health. First, mortality does not appear to have increased during the transition to agriculture, or during the early phases of the industrial revolution. Clearly, infectious diseases have declined with modernization. Second, the empirical data, when uncorrected for misclassification of cause of death, do suggest an increase in degenerative disease mortality, at least until the mid 20th century, when these causes of death clearly began to decline. All studies that correct for misclassification of cause of death, however, find that the general decline in degenerative disease mortality began much earlier, perhaps as early as the 1850s in the developed countries. This is about the same time that infectious disease mortality began to decline in these countries. The exception is neoplasms, which increased with modernization until quite recently. Part of the increase in neoplasms may be attributable to increases in smoking during the course of modernization. Nevertheless, the overall risk of degenerative disease mortality appears to have declined with modernization. The fact that the decline in the risk of infectious disease mortality, and the decline in risk of degenerative disease mortality, are largely coordinated suggests that the causes of both declines may be related. Historical trends in morbidity, and potential causes of the decline in infectious and degenerative disease mortality, are briefly considered.

Trends and patterns of cancer mortality in European countries

This study aims at documenting differentials in the cancer mortality profile of European countries during the recent process of intense geo-political transformations. The World Health Organization Regional Office for Europe provided information on cancer mortality and several covariates for each country. In contrast with the European Union and Nordic countries, Central and Eastern Europe presented higher current levels and increasing trend of cancer mortality. Age-standardized rates for overall cancer mortality increased at an annual average of 2.43% in Central and Eastern European countries during the period from 1980 to 2001, while the European Union, Nordic countries and Switzerland underwent an average decrease of 7.27% per year. Trends in cancer death rates were associated with indices of welfare and socio-economic status at the country level: gross national product, health expenditure, unemployment, food intake, smoking habits and air pollution. Concurrent with this observation, we registered an extended gap in standings for these figures between richer and poorer European countries. These observations suggest that part of cancer mortality in Central and Eastern Europe could be prevented with current technology and health promotion. The drop of rates in Nordic and Western European countries indicates a progress in cancer control that, regrettably, does not hold for the whole Continent.

A situação do câncer de mama em Goiás, no Brasil e no mundo: tendências atuais para a incidência e a mortalidade

O câncer de mama apresenta elevada incidência e mortalidade em todo o mundo, representando um grave problema de saúde pública. A incidência dessa neoplasia vem aumentando nas últimas décadas, mesmo em áreas de tradicional baixa incidência, em grande parte devido às mudanças nos hábitos de vida e no perfil epidemiológico da população. Vários países desenvolvidos têm conseguido, apesar desse aumento na incidência, reduzir a sua mortalidade, através de um diagnóstico mais precoce e de um tratamento mais eficaz. Nesse artigo comentamos as tendências atuais para o câncer de mama em vários locais do mundo, de forma comparativa, bem como os possíveis fatores envolvidos nessas mudanças. Dispensamos particular atenção à situação do Brasil, e da cidade de Goiânia.