Chest

Chest

Volume 123, Issue 1, Supplement, January 2003, Pages 21S-49S
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Epidemiology of Lung Cancer*

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In the United States, lung cancer remains the leading cause of cancer death in both men and women even though an extensive list of risk factors has been well-characterized. Far and away the most important cause of lung cancer is exposure to tobacco smoke through active or passive smoking. The reductions in smoking prevalence in men that occurred in the late 1960s through the 1980s will continue to drive the lung cancer mortality rates downward in men during the first portion of this century. This favorable trend will not persist unless further reductions in smoking prevalence are achieved.

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Temporal Trends

Because of the high case-fatality rate of lung cancer, the incidence and mortality rates are nearly equivalent, and, consequently, routinely collected vital statistics provide a long record of the occurrence of lung cancer. We are presently amid an epidemic of lung cancer that dates to the mid-20th century (Fig 1).192021 Lung cancer was rare until the disease began a sharp rise around 1930 that culminated by mid-century with lung cancer becoming the leading cause of cancer death among men.22

Overview

Although the causes of lung cancer are almost exclusively environmental, it is likely that there is substantial individual variation in the susceptibility to respiratory carcinogens. The risk of the disease can be conceptualized as reflecting the joint consequences of the interrelationship between (1) exposure to etiologic (or protective) agents and (2) the individual susceptibility to these agents. The term environment in its broadest sense may influence the risk of disease through direct

Overview

A single etiologic agent, cigarette smoking, is by far the leading cause of lung cancer, accounting for approximately 90% of lung cancer cases in the United States and other countries where cigarette smoking is common.45 Compared to never-smokers, smokers have about a 20-fold increase in lung cancer risk at present. Few exposures to environmental agents convey such risks for any disease. In general, trends of lung cancer occurrence closely reflect patterns of smoking, but rates of occurrence

Overview

Genetic susceptibility to lung cancer has long been postulated. Environmental agents, even cigarette smoking, cause lung cancer in only a minority of exposed persons, leading to the hypothesis that susceptibility is inherently determined. Epidemiologic studies showing that a family history of lung cancer predicts increased risk further support a genetic basis for lung cancer susceptibility. This long-postulated hypothesis is now being actively addressed using the approach of molecular

Conclusions

The path to preventing lung cancer is charted by the identification of numerous exposures that are causally associated with lung cancer. If steps can be taken to reduce or eliminate the population's exposure to these agents, this would be expected to reduce the population's risk of lung cancer. Preventive strategies can be pursued in the public policy arena or in public health interventions that are directed at individual behavior. Cigarette smoking provides a useful example to illustrate the

ACKNOWLEDGMENT

The authors thank Charlotte Gerczak for her assistance in preparing this manuscript.

References (310)

  • R Doll et al.

    The mortality of doctors in relation to their smoking habits: a preliminary report

    BMJ

    (1954)
  • R Doll et al.

    Lung cancer and other causes of death in relation to smoking: a second report on the mortality of British doctors

    BMJ

    (1956)
  • PA Wingo et al.

    Annual report to the nation on the status of cancer, 1973–1996, with a special section on lung cancer and tobacco smoking

    J Natl Cancer Inst

    (1999)
  • JM Samet

    Epidemiology of lung cancer

    (1994)
  • G Rosen

    A history of public health

    (1993)
  • US Department of Health, and Human Services (USDHHS)

    Reducing the health consequences of smoking: 25 years of progress; a report of the Surgeon General

    (1989)
  • RN Proctor

    The Nazi war on cancer

    (1999)
  • R Doll et al.

    Smoking and carcinoma of the lung

    BMJ

    (1950)
  • ML Levin et al.

    Cancer and tobacco smoking: a preliminary report

    JAMA

    (1950)
  • EL Wynder et al.

    Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma: a study of six hundred and eighty-four proved cases

    JAMA

    (1950)
  • US Department of Health Education, and Welfare (DHEW)

    Smoking and health: report of the Advisory Committee to the Surgeon General

    (1964)
  • Royal College of Physicians of London

    Smoking and Health: summary of a report of the Royal College of Physicians of London on smoking in relation to cancer of the lung and other diseases

    (1962)
  • US Department of Health and Human Services (USDHHS)

    The health consequences of involuntary smoking: a report of the Surgeon General

    (1986)
  • US Environmental Protection Agency (EPA)

    Respiratory health effects of passive smoking: lung cancer and other disorders

    (1992)
  • JM Samet

    Radon and lung cancer

    J Natl Cancer Inst

    (1989)

  • National Research Council(NRC),Committee on Health Risks of Exposure to Radon, Board on Radiation Effects Research.Health effects of exposure to radon (BEIR VI)

    (1998)
  • T Gordon et al.

    Cancer mortality trends in the United States, 1930–1955

    Natl Cancer Inst Monogr

    (1961)
  • FW Mckay et al.

    Cancer mortality in the United States: 1950–1977

    Natl Cancer Inst Monogr

    (1982)
  • LAG Ries et al.

    Cancer statistics review, 1973–1988

    (1991)
  • American Cancer Society

    Cancer facts and figures, 1999

    (1999)
  • A Jemal et al.

    Recent trends in lung cancer mortality in the United States

    J Natl Cancer Inst

    (2001)
  • DR Shopland

    Effect of smoking on the incidence and mortality of lung cancer

  • JW Horm et al.

    SEER program: cancer incidence and mortality in the United States, 1973–1981

    (1984)
  • National Cancer Institute

    National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER) Program

  • SS Devesa et al.

    Declining lung cancer rates among young men and women in the United States: a cohort analysis

    J Natl Cancer Inst

    (1989)
  • WD Travis et al.

    Lung cancer

    Cancer

    (1995)
  • US Department of Health and Human Services (USDHHS)

    Public Health Service. Centers for Disease Control and Prevention (CDC). Preventing tobacco use among young people: a report of the Surgeon General

    (1994)
  • MP Coleman et al.

    Trends in cancer incidence and mortality

    (1993)
  • FD Gilliland et al.

    Incidence and mortality for lung cancer: geographic, histologic, and diagnostic trends

    Cancer Surv

    (1994)

  • National Cancer Institute(NCI), Cancer Statistics Branch, Division of Cancer Prevention, and Control.Cancer rates and risks

    (1996)
  • DM Parkin et al.

    At least one in seven cases of cancer is caused by smoking: global estimates for 1995

    Int J Cancer

    (1994)
  • DM Parkin et al.

    Cancer incidence in five continents

    (1992)
  • P Boffetta et al.

    Cancer in developing countries

    CA Cancer J Clin

    (1994)
  • P Stocks et al.

    Lung cancer death rates among non-smokers and pipe and cigarette smokers: an evaluation in relation to air pollution by benzo[a]pyrene and other substances

    BMJ

    (1955)
  • WJ Blot et al.

    Geographic patterns of lung cancer: industrial correlations

    Am J Epidemiol

    (1976)
  • TJ Mason et al.

    Cancer mortality by county: 1950–1969

    (1973)
  • WJ Blot et al.

    Cancer among shipyard workers

  • WJ Blot et al.

    Changing patterns of lung cancer in the United States

    Am J Epidemiol

    (1982)
  • R Saracci et al.

    Interactions of tobacco smoking and other causes of lung cancer

  • WC Willett

    Diet, nutrition, and avoidable cancer

    Environ Health Perspect

    (1995)

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    Dr. Alberg is a recipient of a K07 Award (No. CA73790) from the National Cancer Institute.

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    Copyright © 2003 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.