Belgium and The Netherlands have fairly similar smoking prevalence patterns, but distinct tobacco control policies. It is our aim to use lung cancer death rates, especially among the youngest age groups (30–39 years), as indicators of past smoking behavioral patterns to evaluate recent tobacco control efforts in both countries. Lung cancer mortality rates from 1954 to 1997 and from 1950 to 2000 were investigated in Belgium and The Netherlands, respectively, using the joinpoint regression modeling technique (log-linear Poisson models) to calculate annual percent change in death rate. In the most recent period (1984–2000) overall male lung cancer death rates have been declining at a faster rate in The Netherlands than in Belgium. In contrast, overall female lung cancer death rates (between 1950 and 2000) have been increasing at a faster rate in The Netherlands than in Belgium. Since 1988, however, APCs in death rates among Dutch females have begun to level off. Interestingly, during this same period, a significant annual decline of 7.7% among the youngest Dutch women (30–39 years) has been observed. Tobacco use prevention and interventions seem to have an impact on smoking prevalence, especially among younger age groups. In The Netherlands, where aggressive anti-tobacco campaigns were introduced a few years earlier than in Belgium, male lung cancer mortality rates have been declining more rapidly, and female lung cancer mortality rates have begun to level off.