Mortality from 13 principal cancer sites, plus total cancer mortality at age 65-84 in 22 European countries, the United States, and Japan was analyzed. After earlier increases, total cancer mortality at age 65-84 has been declining between the late 1980s and the late 1990s in the European Union (-5.5% in males, -4.5% in females), in United States males (-2.3%), but not females (+4.4%), and in Japanese females (-5.6%), but not males (+6.3%). Cancer mortality in the elderly rose for both sexes in Eastern Europe between the late 1980s and the late 1990s. Gastric cancer mortality steadily declined in all the areas considered. Lung cancer rates at age 65-84 declined over the last decade by 8.5% in males in the European Union, and by 0.9% in the United States. Rates increased in Eastern Europe, in Japanese males, and in females in all areas. In women, an approximately threefold difference was evident between lung cancer rates of 67-77 per 100,000 in Japan and Europe in the late 1990s, and the rates of 212 per 100,000 in the United States. Likewise, pancreatic cancer mortality rates increased in the elderly of both sexes in the European Union and Japan up to the late 1980s, and in Eastern Europe up to the 1990s, whereas these rates decreased for United States males over more recent calendar periods, thus again reflecting the different spread of the tobacco-related cancer epidemic. After earlier increases in most areas, female breast cancer mortality in elderly women declined over the last decade by 8% in the United States and by 3% in the European Union, whereas it increased in Eastern Europe and Japan. Prostate cancer mortality declined in the European Union and the United States, whereas it rose in Eastern Europe and Japan. Most rates for breast, prostate, and ovarian cancers in the elderly remained comparatively low in Japan. Leukemia mortality in the elderly was stable in most areas, with some evidence of leveling off in the European Union. Mortality from multiple myeloma steadily increased by 10-20% over the last decade in both sexes in all geographic areas considered, and mortality from lymphomas increased, but improved diagnosis and certification may have played a relevant role in these trends.