Trends in Lung Cancer Incidence -- United States, 1973-1986

In 1973, the National Cancer Institute (NCI) initiated a population-based tumor registry reporting system for cancer incidence and survival. This system, the Surveillance, Epidemiology, and End Results (SEER) Program, receives reports from five states and four metropolitan areas* representing approximately 10% of the U.S. population. SEER data are used to assess the health burden of cancer, identify populations at increased risk, and measure the impact of cancer prevention and control efforts. This report describes trends in the incidence of cancer of the lung and bronchus during 1973-1986 based on the International Classification of Diseases for Oncology (ICD-O) categories 162.2-162.9 (1). Rates are age-adjusted by the direct method to the 1970 U.S. population.

From 1973 through 1986 (2), lung cancer incidence (Figure 1, page 511) increased for all race/sex groups except white males. Among white males, the incidence of lung cancer decreased for 2 consecutive years to 80.3 per 100,000 in 1986 (Table 1, page 511), the lowest level since 1977. Incidence rates in 1986 varied substantially by sex and race, with rates for white males (80.3) double those of white females (37.0) and rates for black males (128.1) triple those of black females (43.0). Incidence for black males was 60% higher than that for white males; in contrast, rates were similar for black females and white females.

Although overall incidence for males (range: 73.3-86.5) remained substantially higher than that for females (range: 18.3-36.4) during 1973-1986, the trend for males increased at an average of 1%-2% per year, compared with an average increase of 5%-6% for females. During 1982-1986, however, the annual rate of increase for white females was 2%, compared with greater than 8% for black females (Figure 1, Table 1).

The SEER Program also collects morphologic information (3) on each primary site according to ICD-O (Table 2). The histologic distributions among different sex/race groups suggest different exposure patterns in the occurrence of lung cancer. For example, squamous-cell carcinoma--the histologic type most commonly associated with smoking--is more prevalent in males than females. Reported by: LA Gloeckler Ries, MS, BK Edwards, PhD, EJ Sondik, PhD, Surveillance Program, and Smoking, Tobacco, and Cancer Program, Div of Cancer Prevention and Control, National Cancer Institute. Office on Smoking and Health, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note:

The peak exposure (per capita consumption) to tobacco among men occurred before 1952, whereas peak exposure among women occurred in the 1960s. Peak incidence and mortality rates due to lung cancer lag behind the peak exposure to tobacco by approximately 35 years (4). Because of a substantial recent decline in smoking prevalence among men (from 50.2% in 1965 to 31.7% in 1987) the rise in the age-adjusted death rate of lung cancer for men began to level off in the late 1970s. In comparison, the later peak exposure and the slower decline in prevalence among women between 1965 and 1987 (31.9% to 26.8%) has caused the age-adjusted lung cancer death rate among women to continue to climb. Lung cancer has surpassed breast cancer as the most common cause of cancer death among women (5).

Although almost half of all Americans who ever smoked have quit, greater than 50 million persons continue to smoke (6). The burden of lung cancer and other smoking-related chronic diseases will be substantially higher for eversmokers for many decades because of the long latency periods between exposure to tobacco and onset of these diseases. To reduce the incidence and mortality of smoking-related diseases, major public health interventions against smoking are necessary.

NCI has initiated two large-scale research and demonstration programs that are designed to help reduce the prevalence of smoking and ultimately lower cancer incidence and associated mortality. Both programs are part of the NCI Smoking, Tobacco, and Cancer Program, which is the focal point for NCI's research, disease prevention, and health promotion activities related to tobacco use and cancer.

One program, the Community Intervention Trial for Smoking Cessation (COMMIT), is evaluating a community-based intervention protocol in 11 communities in North America. Implemented in 1986 and scheduled to run through 1995, COMMIT is focusing on heavy smokers (greater than or equal to 25 cigarettes per day), a group that represents 27% of all smokers and accounts for nearly 50% of lung and other cancers among smokers. The COMMIT protocol employs the most promising interventions offered through physicians and dentists, the media, worksites, community organizations, schools, and cessation providers.

A second program, the American Stop Smoking Intervention Study (ASSIST), will use the results, materials, and protocols developed by COMMIT and other intervention studies to prevent or reduce smoking in 20 U.S. areas (either entire states or large metropolitan areas) involving nearly 50 million Americans. ASSIST will begin in 1993 and continue for 5 years in cooperation with the American Cancer Society (ACS). NCI funding will be awarded to various state and local health departments, which will work with ACS to form local coalitions. Interventions will be implemented through the health-care system; worksites; schools; civic, social, and religious organizations; the media; and existing state and local smoking policies. The goal of ASSIST will be to reduce smoking prevalence by nearly 50% in all 20 intervention areas by 1998.

References

1. World Health Organization. International classification of diseases for oncology. 1st ed. Geneva: World Health Organization, 1976.

2. National Cancer Institute. Cancer statistics review 1973-1986, including a report on the status of cancer control. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1989; NIH publication no. 89-2789.

3. Percy C, Sobin L. Surveillance, Epidemiology, and End Results lung cancer data applied to the World Health Organization's classification of lung tumors. JNCI 1983;70:663-6.

4. Walker WJ, Brin BN. U.S lung cancer mortality and declining cigarette tobacco consumption. J Clin Epidemiol 1988;41:179-85.

5. American Cancer Society. Cancer facts and figures--1989. Atlanta: American Cancer Soci ety, 1989.

6. CDC. Reducing the health consequences of smoking: 25 years of progress--a report of the Surgeon General, 1989. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411. *Iowa, New Mexico, Utah, Connecticut, and Hawaii; San Francisco/Oakland, Atlanta, Detroit, and Seattle/Puget Sound.

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