Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 142 No. 3334 (2012)

Cancer, a disease of aging (part 1) – trends in older adult cancer mortality in Switzerland 1991–2008

  • Kurt Schmidlin
  • Adrian Spoerri
  • Matthias Egger
  • Marcel Zwahlen
  • Andreas Stuck
  • Kerri M. Clough-Gorr
Cite this as:
Swiss Med Wkly. 2012;142:w13637


PRINCIPLES: It is crucial for aging societies to evaluate trends in cancer mortality rates of older adults. This study examined socio-demographic and regional characteristics specifically focused on the cancer mortality experience of older adults in Switzerland.

METHODS: This study included all individuals ≥65 years based on 1990/2000 censuses linked to mortality records to end of 2008 in the Swiss National Cohort. Gender-age-specific (<65, 65–74, 75–84, 85+ years) mortality rates were calculated as observed (cancer deaths/person years) and expected from Poisson models adjusted for changes in death record coding over follow-up.

RESULTS: Cancer mortality, except for lung cancer, increased with advancing age. Older men in all age groups had overall higher cancer mortality rates than older women and showed a consistent decline in all-cancer mortality (age 65–74 years 1991 rate ratio (RR) = 1.13 [95%CI 1.08, 1.19]; 2008 RR = 0.88 [95%CI 0.86, 0.90], compared to rates 2000). In contrast, older women in all age groups showed early declines with a levelling-off of all-cancer mortality beginning in 2000 (age 65–74 years 1991 RR = 1.20 [95%CI 1.14, 1.27]; 2008 RR = 0.96 [95%CI 0.93, 0.98], compared to rates 2000). For older men there appeared to be an education effect for all-cancer and lung cancer mortality; highest rates in older men with compulsory education. Younger old women living alone or in suburban areas had the most sharpest increase in lung cancer mortality rates.

CONCLUSION: This comprehensive epidemiological analysis of cancer mortality trends in older adults provides further evidence that in Switzerland (like other developed countries) cancer is a disease of aging with important gender-age-specific variations representing major public health challenges for aging societies.


  1. The population of Switzerland 2009. In: Neuchâtel, Switzerland: Federal Department of Home Affairs, Swiss Federal Statistical Office 2010.
  2. Switzerland statistics of cancer incidence1984–2008. In: Zurich, Switzerland: National Institute for Cancer Epidemiology and Registration 2010.
  3. Switzerland statistics of cancer mortality 1984–2008. In: Zurich & Neuchâtel, Switzerland: National Institute for Cancer Epidemiology and Registration & Swiss Federal Statistics Office 2010.
  4. Levi F, La Vecchia C, Randimbison L. Cancer mortality in Switzerland, 1990–1994. Soz Praventivmed. 1997;42:37–54.
  5. Levi F, Lucchini F, La Vecchia C. Trends in cancer mortality in Switzerland, 1980–2001. Eur J Cancer Prev. 2006;15:1–9.
  6. Levi F, Lucchini F, Negri E, La Vecchia C. Trends in mortality from major cancers in the European Union, including acceding countries, in 2004. Cancer. 2004;101:2843–50.
  7. Karim-Kos HE, de Vries E, Soerjomataram I, Lemmens V, Siesling S, Coebergh JW. Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s. Eur J Cancer. 2008;44:1345–89.
  8. Bray F, Sankila R, Ferlay J, Parkin DM. Estimates of cancer incidence and mortality in Europe in 1995. Eur J Cancer. 2002;38:99–166.
  9. Jatoi I, Chen BE, Anderson WF, Rosenberg PS. Breast cancer mortality trends in the United States according to estrogen receptor status and age at diagnosis. J Clin Oncol. 2007;25:1683–90.
  10. Hansen J. Common cancers in the elderly. Drugs Aging. 1998;13:467–78.
  11. Spoerri A, Zwahlen M, Egger M, Bopp M. The Swiss National Cohort: a unique database for national and international researchers. Int J Public Health. 2010;55:239–42.
  12. Bopp M, Spoerri A, Zwahlen M, Gutzwiller F, Paccaud F, Braun-Fahrländer C, et al. Cohort profile: the Swiss National Cohort – a longitudinal study of 6.8 million people. Int J Epidemiol. 2009;38:379–84.
  13. Fair M. Generalized record linkage system – Statistics Canada’s record linkage software. Austrian J Stat. 2004;33:37–53.
  14. Fellegi IP, Sunter AB. A theory of record linkage. Journal of the American Statistical Association. 1969;64:1183–210.
  15. Renaud A. Methodology report – coverage estimation for the Swiss population census 2000. In. Neuchâtel, Switzerland: Swiss Federal Statistical Office 2004.
  16. Doria-Rose VP, Marcus PM. Death certificates provide an adequate source of cause of death information when evaluating lung cancer mortality: an example from the Mayo Lung Project. Lung Cancer. 2009;63:295–300.
  17. Doria-Rose VP, Marcus PM, Miller AB, Bergstralh EJ, Mandel JS, Tockman MS, et al. Does the source of death information affect cancer screening efficacy results? A study of the use of mortality review versus death certificates in four randomized trials. Clin Trials. 2010;7:69–77.
  18. Schmidlin K, Clough-Gorr KM, Spoerri A, Eggers M, Zwahlen M. Impact of unlinked deaths and coding changes on mortality estimates in the Swiss National Cohort. BMC Med Inform Decis. Submitted.
  19. Lutz JM, Pury P, Fioretta G, Raymond L. The impact of coding process on observed cancer mortality trends in Switzerland. Eur J Cancer Prev. 2004;13:77–81.
  20. Data Analysis and Statistical Software (STATA). In 11.1 Edition. College Station, TX: StataCorp LP 2009.
  21. Levi F, Lucchini F, Negri E, Boyle P, La Vecchia C. Changed trends of cancer mortality in the elderly. Ann Oncol. 2001;12:1467–77.
  22. Chiolero A, Gervasoni JP, Rwebogora A, Mkamba M, Waeber B, Paccaud F, et al. Discordant prevalence of hypertension using two different automated blood pressure measurement devices: a population-based study in Dar es Salaam (Tanzania). Blood Press Monit. 2004;9:59–64.
  23. World Health Organization (WHO) cancer mortality database. In: World Health Organization 2011.
  24. Yang L, Fujimoto J, Qiu D, Sakamoto N. Trends in cancer mortality in the elderly in Japan, 1970–2007. Ann Oncol. 21:389–96.
  25. Bray F, Tyczynski JE, Parkin DM. Going up or coming down? The changing phases of the lung cancer epidemic from 1967 to 1999 in the 15 European Union countries. Eur J Cancer. 2004;40:96–125.
  26. Gandini S, Botteri E, Iodice S, Boniol M, Lowenfels AB, Maisonneuve P, et al. Tobacco smoking and cancer: a meta-analysis. Int J Cancer. 2008;122:155–64.
  27. Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M; Comparative Risk Assessment collaborating group (Cancers). Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet. 2005;366:1784–93.
  28. La Vecchia C, Levi F, Decarli A, Wietlisbach V, Negri E, Gutzwiller F. Trends in smoking and lung cancer mortality in Switzerland. Prev Med. 1988;17:712–24.
  29. Bosetti C, Levi F, Lucchini F, Negri E, La Vecchia C. Lung cancer mortality in European women: recent trends and perspectives. Ann Oncol. 2005;16:1597–604.
  30. Forey B, Hamling J, Haming J, Lee P. International smoking statistics: A collection of worldwide historical data – Switzerland. In: International Smoking Statistics, 2nd Edition. Sutten, U.K.: Wolfson Institute of Preventive Medicine 2007.
  31. Borras JM, Fernandez E, Gonzalez JR, Negri E, Lucchini F, La Vecchia C, Levi F. Lung cancer mortality in European regions (1955–1997). Ann Oncol. 2003;14:159–61.
  32. Owonikoko TK, Ragin CC, Belani CP, Oton AB, Gooding WE, Taioli E, et al. Lung cancer in elderly patients: an analysis of the surveillance, epidemiology, and end results database. J Clin Oncol. 2007;25:5570–7.
  33. Towe TP, O’Toole E, Engelhardt K, Nagaiah G, Berger NA. Changing healthcare practice for older adults with late-stage non-small cell lung cancer: practical considerations of targeted therapy in primary care and oncology. J Am Geriatr Soc. 2009;57(Suppl 2):S253–8.
  34. Parsons A, Daley A, Begh R, Aveyard P. Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis. BMJ. 2010;340:b5569.
  35. Schmidlin K, Spoerri A, Egger M, Zwahlen M, Stuck A, Clough-Gorr KM, et al. Cancer a disease of aging - part 2 - Risk factors for older adult cancer mortality in Switzerland 1991–2008. Swiss Med Wkly. 2012;142:w13637.
  36. Fisch T, Pury P, Probst N, Bordoni A, Bouchardy C, Frick H, et al. Variation in survival after diagnosis of breast cancer in Switzerland. Ann Oncol. 2005;16:1882–8.
  37. Bulliard JL, La Vecchia C, Levi F. Diverging trends in breast cancer mortality within Switzerland. Ann Oncol. 2006;17:57–9.
  38. Ess S, Savidan A, Frick H, Rageth Ch, Vlastos G, Lütolf U, et al. Geographic variation in breast cancer care in Switzerland. Cancer Epidemiol. 2010;34:116–21.
  39. Galit W, Green MS, Lital KB. Routine screening mammography in women older than 74 years: a review of the available data. Maturitas. 2007;57:109–19.
  40. Nattinger AB. Older women, mammography, and mortality from breast cancer. Am J Med. 2000;108:174–5.
  41. Schootman M, Jeffe DB, Lian M, Aft R, Gillanders WE. Surveillance mammography and the risk of death among elderly breast cancer patients. Breast Cancer Res Treat. 2008;111:489–96.
  42. McCarthy EP, Burns RB, Freund KM, Ash AS, Shwartz M, Marwill SL, et al. Mammography use, breast cancer stage at diagnosis, and survival among older women. J Am Geriatr Soc. 2000;48:1226–33.
  43. Schopper D, de Wolf C. How effective are breast cancer screening programmes by mammography? Review of the current evidence. Eur J Cancer. 2009;45:1916–23.
  44. de Gelder R, Bulliard JL, de Wolf C, Fracheboud J, Draisma G, Schopper D, et al. Cost-effectiveness of opportunistic versus organised mammography screening in Switzerland. Eur J Cancer. 2009;45:127–38.
  45. Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005;353:1784–92.
  46. Hellquist BN, Duffy SW, Abdsaleh S, Björneld L, Bordás P, Tabár L, et al. Effectiveness of population-based service screening with mammography for women ages 40 to 49 years: evaluation of the Swedish Mammography Screening in Young Women (SCRY) cohort. Cancer. 2011;117:714–22.
  47. Herzog TN, Scheuren FJ, Winkler WE. Data quality and record linkage techniques. NewYork, New York: Springer 2007.
  48. Berrino F, Verdecchia A, Lutz JM, Lombardo C, Micheli A, Capocaccia R; EUROCARE Working Group. Comparative cancer survival information in Europe. Eur J Cancer. 2009;45:901–8.

Most read articles by the same author(s)

1 2 > >>