The cancer mortality patterns reflect, to a certain extent, some basic characteristics of the society, such as life-style factors, population awareness, screening programmes, accessibility to health care and efficiency of health care system. In Lithuania during the period of 1993–2004 the age-standardised cancer mortality rates were decreasing in male and female urban population and were stable in rural residents. The overall decreasing cancer mortality trends seems to be stronger related to the decreasing mortality rates among urban residents, than in rural. The main contrast for males in mortality rates in urban and rural residents was observed for cancers of lung, stomach and colorectal, for females – for the breast, colorectal and cervical cancers. In general, cancer mortality trends in Lithuanian urban residents seems to be more favourable than in rural. There were observed more rapid mortality decrease (all cancer sites, lung and stomach cancer in males, colorectal and breast cancer in females) or increase was less pronounced than in rural population (prostate in males and cervical cancer in females). Major reductions in cancer mortality and morbidity are believed to be dependent on the widespread adoption of cancer prevention behaviours and use of early detection services.
The change in overall cancer mortality is the result of balance of trends for the different cancer sites. In the most of western European countries the total cancer mortality decreases because of decline in lung cancer mortality for males, the decline in stomach cancer for both sexes, and of cervical cancer for women, as well as some decline in breast and colorectal cancers [7
]. In Lithuania decreasing mortality trend in urban population was contributed by decrease of the rates of lung and stomach cancer in male and breast, stomach and colorectal cancer in female. Mortality rates in both urban and rural population were increasing for prostate and cervical cancers.
In last decades the respiratory cancer deaths started to decline in other European countries [7
]. Lung cancer mortality rates among men in Lithuania during the period from 1965 to 1994 showed an increase in cohorts born before 1945. In the younger generations, born after 1945, the risk declined [8
]. The reduction in the number of lung cancer deaths among males was the major contributor to the overall decline in the number of cancer deaths in the Lithuania. Trends in lung cancer mortality mirror trends in smoking in the population. Thus, the progress in lung cancer mortality is due to the slow, but steady decline in smoking rates among men. Smoking rates appear to be dropping more slowly in rural residents. In contrast, the lack of progress in reducing smoking among females has led to stable lung cancer mortality among females.
Rates of mortality from breast cancer, the most common cancer in female in Lithuania recently have turned downward, probably at least in part because of better treatment. The fall in breast cancer mortality observed in most European countries over the last decade has to be attributed to earlier detection and improved treatment [9
]. The mammography screening programme in Lithuania started in the 2005 and has not contributed to the observed decline in breast cancer mortality in the period from 1993 to 2004. Treatment improvements probably contributed to the mortality reduction because a favourable trend appeared before the introduction of the screening program; further improvements are expected as a consequence of the screening introduction [10
Substantial decreases in mortality have occurred for stomach cancer in both sexes. The trend therefore corresponds to unplanned prevention through a changes in environmental factors occurring since the early 20th century. The exact causes of the decline of stomach cancer are not well understood, but must include improvements in diet, food storage (e.g., refrigeration) and, possibly, the decline of Helicobacter pylori
]. The stomach cancer should still be considered in Lithuania as a major public health problem, despite the substantial decrease during last decades.
In Europe from 1997 to 2002 appreciable declines were observed in mortality from intestinal cancer in male (-1.6% per year), and in female (-2.5%) [1
]. Colorectal cancer trends have been generally more favourable for female than for male. In Lithuania the mortality rates for males were stable and in females colorectal cancer mortality in urban population decreased, while in rural female residents mortality rates were stable. These temporal trends most probably reflect complicated interactions between early detection patterns and aetiological factors.
The cervical cancer mortality in Lithuania is the highest among the EU countries. The drop of the rates in cervical cancer mortality in Europe was largely due to screening. In Lithuania the national cervical cancer screening programme started in 2004 and has not yet contributed to the cervical cancer mortality rates. In Lithuania cervical cancer mortality rates were increasing in urban and rural female residents. The changes in the risk factors, such as in sexual behaviour and smoking habits, over the decades might partly explain trends in cervical cancer mortality.
Prostate cancer mortality from1997 to 2002 decreased in Europe by (-1.4%) per year [1
]. Prostate cancer mortality increase was observed for both rural and urban residents in Lithuania.
Studies in other countries have identified significant disparities in stages of diagnosis between residents of rural and urban areas, with a greater incidence of late stage diagnosis generally found in rural areas. This has been attributed to limited access to clinics and hospitals with the advanced technology needed to detect cancer in the early stage and may need to travel great distances to receive care [12
Most of the unfavourable cancer mortality patterns and trends in rural population are due to recognised, and hence largely avoidable, causes of cancer. Furthermore, there are high mortality rates for neoplasms related to inadequate screening, diagnosis and treatment. Rural residents tend to have lower income, higher poverty, less education. In rural settings no specialized services are available. The persistence of a wide variability in cancer mortality among urban and rural populations indicates that there is still wide area for prevention activities. The differences in cancer mortality among rural and urban residents in Lithuania are stimulating research to develop effective methods for cancer prevention and early detection services in rural populations.