Cancer the leading cause of death in France

From 2011 to 2021, mortality due to cancer fell regularly among men but at only half the rate of mortality due to cardiovascular diseases. Their standardized mortality rate for cancer fell by no more than 14%, slightly below that of the preceding decade, 2001 to 2011, when it fell by 16%. Among women, however, the downturn—already modest from 2001 to 2011 (-6%)—has been negligible over the last decade; in 2021 the standardized mortality rate for cancer was a mere -0.7% below the 2011 level. Cancer is the only major cause of death for which the decline in mortality was weaker for women than men, although women’s standardized cancer mortality rate is still much lower than men’s: 122 per 100,000, as against 203 for 100,000 for men, in 2021. It is also important to note that in 2021, cancer accounted for 34% of the standardized mortality rate for both sexes. Cancer has been the leading cause of death for men since 1980, and for women since 1999.

The main explanation for differential cancer trends by sex is differences in tobacco use. Between 1950 and 2000, the proportion of daily smokers among men in France aged 15 and over fell by more than half—from 70% to 34%—while among women over the same fifty-year period it rose, from below 10% to 26% (Guignard et al. 2015; Hill and Laplanche 2005; Pasquereau et al. 2021). After 2000, the proportion of daily smokers in France’s total population remained relatively stable for both men and women until 2016, when it began to head back down, to 28% of men and 21% of women in  2020. However, the decrease in women’s smoking is too recent to show up as a concomitant decrease in cancer-caused deaths.  

In fact, mortality due to cancerous tumors in the larynx, lungs, or bronchial tubes—the main causes of death among smokers—increased 13% among women from 2011 to 2021. This is still a much smaller increase than in the preceding decade, 2001-2011, when the figure rose by 52%. And tobacco-related cancer is the only type of cancer that has been rising sharply among women. In the twenty-year period 2001-2021, women’s standardized mortality rate due to smoker’s cancer rose from around 115 to 200 per 100,000. Among men, meanwhile, that rate has moved sharply in the opposite direction, over the last two decades, falling from over 715 to fewer than 490 per 100,000. The proportion of smokers or former smokers among men remains much higher than the corresponding proportion among women, which explains why men’s standardized mortality rate for this type of cancer is still three times higher than women’s. 

Among women, mortality due to the other main types of cancer has been falling since 2001. That decline is particularly marked in the case of stomach cancer, where the standardized rate fell by a third from 2001 to 2021. Next comes mortality due to colorectal cancer, down 21%; breast cancer, down 18%; and cancer of the upper aerodigestive tract, down 16%. However, declines in female mortality from uterine and esophageal cancer over the twenty-year period were slight: respectively -5% and -1%. At least part of these very weak downturns in deaths due to those two types of cancers can be attributed to the continuous increase in smoking over the period among women now aged 45 or over (Guignard et al. 2015). The World Health Organization (WHO) estimates that the time lag between the highest level of smoking in a given group or population and its epidemiological effects is around thirty years. Women who die today from cancer linked to their earlier tobacco use therefore belong to cohorts born before 1970. Around fifteen organs or parts of the body—breasts being the first where women are concerned, followed by the colon-rectum, lungs, and, to a lesser extent, the uterine cervix—are directly affected by smoking. Meanwhile, some of the adverse effects of smoking on mortality have been offset somewhat by progress in cancer diagnosis, screening, and treatment (Marant-Micallef et al. 2018; Grosclaude et al. 2016). The positive role of those factors has been amplified for men by the downward trends in their tobacco use, with the result that male mortality due to all the major types of cancer has fallen sharply since 2001. Specifically, male mortality due to upper aerodigestive tract cancer over that twenty-year period has decreased by 51%; deaths due to esophageal cancer are down 43%; to prostate cancer, -37%; to stomach cancer, -35%; to lung cancer, -32%; and to colorectal cancer, -26%. 

Source: Didier Breton, Magali Barbieri, Nicolas Belliot, Hippolyte d’Albis, Magali Mazuy, 2023, Recent Demographic Trends in France: A European Outlier?, Population 2023 n°3-4

Contacts: Didier Breton, Magali Barbieri, Nicolas Belliot, Hippolyte d’Albis, Magali Mazuy

Online: January 2020

Updated: March 2024