BACKGROUND: Lung cancer mortality in men has been declining since the late 1980s in most European countries. In women, although rates are still appreciably lower than those for men, steady upward trends have been observed in most countries. To quantify the current and future lung cancer epidemic in European women, trends in lung cancer mortality in women over the last four decades were analyzed, with specific focus on the young. PATIENTS AND METHODS: Age-standardized (world standard) lung cancer mortality rates per 100 000 women--at all ages, and truncated 35-64 and 20-44 years--were derived from the WHO for the European Union (EU) as a whole and for 33 separate European countries. Joinpoint regression analysis was used to identify points where a significant change in trends occurred. RESULTS: In the EU overall, female lung cancer mortality rates rose by 23.8% between 1980-1981 and the early 1990-1991 (from 7.8 to 9.6/100 000), and by 16.1% thereafter, to reach the value of 11.2/100 000 in 2000-2001. Increases were smaller in the last decade in several countries. Only in England and Wales, Latvia, Lithuania, Russia and Ukraine did female lung cancer mortality show a decrease over the last decade. In several European countries, a decline in lung cancer mortality in young women (20-44 years) was observed over the last decade. CONCLUSIONS: Although female lung cancer mortality is still increasing in most European countries, the more favorable trends in young women over recent calendar years suggest that if effective interventions to control tobacco smoking in women are implemented, the lung cancer epidemic in European women will not reach the levels observed in the USA. [Authors]