To provide an updated review of cancer mortality trends in Italy, cancer mortality and census data, from 1970 to 2007, were extracted from the WHO mortality database and analyzed using age-specific and standardized rates, and joinpoint regression. Total cancer mortality rates in men have been declining by 1.8% yearly since 1994, reaching a rate of 147 per 100 000 residents (world standard) in 2007. In women, total cancer mortality rates have been decreasing by 1.1% yearly since 1991, resulting in a standardized mortality rate of 85 per 100 000 residents in 2007. Avoided deaths, compared with rates of 1988, from lung, intestinal, stomach, and breast cancers amount to 30 646. In men, trends were driven by cancers of the lung and other tobacco-related sites, intestines, and stomach. Favorable trends for cancers of the breast, intestines, stomach, and uterus contributed to falls in mortality rate in women. Downward trends were seen in both sexes for Hodgkin's lymphoma, bone cancer, and leukemias. Lung cancer in women showed an upward trend, with mortality rates increasing by 2.6% yearly since 1997, becoming the second cause of cancer mortality in middle-aged women. Rising trends were seen in women for oral and pancreatic cancers, as well. The favorable trends in cancer mortality are related to reduced tobacco smoking and alcohol consumption in men, advancements in treatment and management for colorectal cancer, breast cancer, leukemias, and a few other rare treatable cancers, and improved diagnosis of colorectal, breast, and cervical cancers. The greater role of tobacco-related deaths in women suggests the need for targeted strategies.