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Current Trends Decrease in Lung Cancer Incidence among Males -- United States, 1973-1983

Analysis of lung cancer data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (SEER)* (1) indicates that the incidence rate of lung cancer for white males increased at annual rates of up to 10% per year until the 1970s. In the early 1980's, the rate of increase slowed, then leveled. This was followed by a 4% decrease in rates from 1982 to 1983 (2). It is estimated that the leveling and subsequent decrease in lung cancer incidence has resulted in over 7,000 fewer cases in 1983 alone. This estimate was developed by fitting an exponential model to the incidence data for 1973 through 1978 and extrapolating the expected numbers from the model to 1983.

Both incidence and mortality due to lung cancer have been decreasing for men under 45 years of age since at least 1973, and for men between 45 and 54 years of age, since 1978. For men over 54 years of age, the rates have leveled. Data for black males show age-adjusted incidence rates that are approximately 50% higher than for whites; however, the trends in rates are similar in the two groups. Lung cancer mortality data for U.S. men have leveled to an age-adjusted rate of 71.2 in 1983. Mortality rates for black males have leveled to an age-adjusted rate of 97.3 in 1983. Because survival from lung cancer is poor, it is expected that decreases in lung cancer mortality will be noted in the 1984 data.

Lung cancer incidence and mortality rates for females continued to increase markedly during the same period. Age-adjusted incidence and mortality rates of 32.6 and 24.3, respectively, represented over 41,000 new cases of lung cancer and over 35,000 deaths among U.S. women in 1983. Reported by JW Horm, MS, LG Kessler, PhD, Surveillance and Operations Research Br, LP Boss, PhD, Cancer Control Applications Br, Div of Cancer Prevention and Control, National Cancer Insititute.

Editorial Note

Editorial Note: Approximately 15% of all invasive cancers diagnosed annually are cancer of the lung, and roughly 149,000 new cases and 130,000 deaths are expected in 1986 (3). It has long been established that cigarette smoking is the primary cause of lung cancer in the United States. The Surgeon General's report on smoking and health, published in 1964, was followed in 1966 with congressionally mandated warning labels on cigarette packages and in advertising. Smoking prevalence among adult males in the United States decreased from 52% before the Surgeon General's report to about 35% in 1983. Such considerable decreases in smoking prevalence have not been observed among females; the smoking prevalence among women was 34% in 1965 and 29% in 1983 (4,5). Although smoking prevalence rates for women have never been as high as those for men, their rate of decline is about half that for men. Unfortunately, the percentage of smokers who smoke 25 or more cigarettes per day was 13% in 1965 and 25% in 1980, suggesting that the bulk of smoking cessation may have been among lighter smokers. During the 1960s, smokers began to use filter-tipped cigarettes and, in the 1970s, low-tar and -nicotine cigarettes (6). Both the decrease in prevalence and the changing types of cigarettes smoked have been suggested as major reasons for declines in age-specific and age-adjusted lung cancer rates.

Reports from the Surgeon General's Office on the health consequences of smoking have continued for almost 2 decades and have led to formation of policy on smoking reduction as a major element of the health promotion and disease prevention objectives for 1990 (7). Recently, the National Cancer Institute defined cancer prevention and control objectives for the year 2000, which include the following risk-factor reduction objectives: (1) the proportion of adults who smoke should be reduced to 15% or less; and (2) the proportion of children and youth aged 12-18 years who smoke should be reduced to 3% or less. The attainment of these goals will result in more than a 40% reduction in deaths due to lung cancer than would be expected if the current rates of smoking prevalence continue into the next century.

References

  1. Young JL, Jr, Percy CL, Asire AJ, eds. Surveillance, Epidemiology, and End Results Program: incidence and mortality data, 1973-1977. Natl Cancer Inst Monogr 1981;57:1-1082.

  2. Horm JW, Kessler LG. Falling rates of lung cancer in men in the United States. Lancet 1986;I:425-6.

  3. American Cancer Society. 1986 cancer facts & figures. New York: American Cancer Society, 1986:1-32.

  4. Office on Smoking and Health. The health consequences of smoking: cancer. A report of the Surgeon General. Rockville, Maryland: Public Health Service, US Department of Health and Human Services, 1982. DHHS publication no. (PHS) 82-50179:1-322.

  5. National Center for Health Statistics. Health--United States 1985. Washington, DC: Public Health Service, 1985. DHHS publication no. (PHS) 86-1232.

  6. Shopland DR, Brown C. Area review: current trends in smoking control. Ann Behavioral Med 1985;7:5-8.

  7. U.S. Public Health Service. Promoting health/preventing disease: objectives for the nation. Washington, DC: 1980:61-5. *SEER data are monitored routinely for trends in cancer incidence. SEER incidence data covers the population of the states of Connecticut, Hawaii, Iowa, New Mexico, and Utah and the metropolitan areas of Atlanta, Detroit, San Francisco-Oakland, and Seattle and represent approximately 10% of the U.S. population.

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