Cancer mortality in France
Female cancer trends are a cause for concern
Cancer mortality has declined steadily for men but is falling more slowly (half as fast) than that of cardiovascular diseases. The standardized rate fell by just 15% between 2005 and 2015, at a pace similar to that observed during the previous decade (1995–2005). The decrease in female cancer mortality, already very small between 1995 and 2005 (−7%), became negligible in the last decade: in 2015, the standardized cancer mortality rate was just 3% lower than in 2005. This is the only major cause of death for which the decrease was much smaller for females than for males, even though the female standardized cancer mortality rate remains well below that of males, at 116 per 100,000 versus 211 per 100,000 in 2015. In 2015, cancers represented 37% of the standardized mortality rate for both males and females. Cancer has been the leading cause of death in France since the 1980s for males and since 1999 for females.
The differential trends by sex can be largely attributed to diverging smoking behaviours. While the proportion of regular smokers among men aged 15 and above decreased until 2010, from a level of 70% in the mid-1950s to slightly over 30% in 2010, it increased steadily among women, from below 10% to over 25% over the same period (Guignard et al., 2015; Hill and Laplanche, 2005). Since 2010, the proportion of male smokers has remained stable, with 32% of regular smokers in both 2010 and 2014. While the proportion among women fell from 26% to 24% over the same period, this decrease is too recent to produce a corresponding decline in female cancer deaths. Mortality from cancers of the larynx, lung, and bronchi, the main smoking-related causes of death, has increased by 37% among women over the last ten years, exactly as much as it did in the previous decade (1995–2005). This represents a doubling of the standardized mortality rate for this cause of death, from just over 100 per 100,000 in 1995 to almost 200 per 100,000 in 2015. For men, the rate has fallen by a quarter, from over 800 to less than 600 per 100,000 over the last two decades. The proportion of smokers or former smokers among men nonetheless remains much higher than that of women, and this explains why the male standardized mortality rate for this cancer is still three times higher than the female rate.
Cancers of the upper aerodigestive tract (UAT) and the oesophagus, also strongly linked to smoking, are also increasing sharply for women (4% increase in standardized rates since 2005 for UAT and 12% for the oesophagus) but not for men (decrease of around 25% for both rates). Last, the slower decline in breast cancer mortality (just 10% between 2005 and 2015 versus 12% between 1995 and 2005) and the lack of progress in uterine cancer mortality (after a 15% decrease in the standardized rate between 1995 and 2005) could be at least partly attributable to the ongoing increase in female smoking among the birth cohorts now aged 45 and over (Guignard et al., 2015). According to the World Health Organization, the time lag between peak rates of smoking in a population and its most severe epidemiological effects is around 30 years. The women now dying of cancers linked to their former smoking habits belong to the birth cohorts born before 1970. Around 15 cancer sites (for women, primarily breast, then colon-rectum and lung, and far behind, body of uterus) are directly concerned (Marant-Micallef et al., 2018).
Good progress has been achieved for other cancers, however, notably stomach cancer, for which the standardized mortality rate has fallen by 21% since 2005 for men and women, and male prostate cancer, with a 27% decrease over the same decade. Prostate cancer is the only cancer for which progress has accelerated over the last 20 years thanks to improved screening, diagnosis, and treatments, and to lower levels of smoking among men (Grosclaude et al., 2016).
Source: Didier Breton, Magali Barbieri, Nicolas Belliot, Hippolyte d’Albis, Magali Mazuy, 2019, Recent Demographic Trends in France: A European Outlier?, Population 2019-4.
Online : January 2020