Smoking is a major contributor to all-cause mortality in Europe and accounts for one-fifth of the cancer-related deaths. Monitoring the tobacco epidemic via an analysis of lung cancer trends is essential in helping countries arrest the effects of tobacco epidemic in the region. The study aims to provide a comprehensive and up-to-date overview of the temporal patterns of lung cancer mortality in Europe, emphasizing country-and sex-specific differences. National lung cancer mortality data were extracted from the WHO mortality databank by age, sex, year of death for 36 countries in Europe. Trends in lung cancer mortality in men have tended to decrease in many European countries during the last two decades, particularly in North and Western Europe. Among women, mortality rates are still increasing in many countries, although in a few populations, rates are beginning to stabilize, notably in the high-risk countries within Eastern Europe (Hungary, Poland and the Czech Republic), and in Northern Europe (Denmark, Iceland and the United Kingdom). Men and women are clearly in very different phases of the smoking epidemic, and, as reflected in the mortality rates by birth cohort, the stage varies widely by country within each European region. That lung cancer mortality trends in men are on a downwards path in most European countries while female rates continue to rise, points to an urgent need for national and European prevention strategies that target tobacco cessation and prevention among European women.Smoking is a major contributor to all-cause mortality in Europe, accounting for one-fifth of all cancer-related deaths, 1 with lung cancer a major component of this burden. The disease has now surpassed breast cancer as the leading cause of cancer death in a number of developed countries, including the United States, 2,3 Denmark, Sweden, The Netherlands, Poland and the United Kingdom. 4 The level of rates and temporal patterns of lung cancer incidence or mortality largely reflect the different phases of the smoking epidemic in men and women in different European countries. These tend to differ markedly from country to country, 5 but in general, the decreases or stabilizations of rates in men observed in many European countries in recent years, are in contrast to the uniformly increasing rates seen among women, often within the same country. [6][7][8] Careful monitoring of the trends of the smoking epidemic has been recently put forward by the WHO as one of six key policies in tobacco control. 9 The close relation between the temporal patterns of lung cancer mortality and smoking prevalence indicates the dissemination of trends in the former provides key information for the targeted primary prevention of cancer and other noncommunicable diseases.The aim of this study is to provide such a comprehensive and up-to-date overview of the temporal patterns of lung cancer mortality in the European region with an emphasis on the country-and sex-specific differences observed. The longestablished generational influence of tobacco co...