Lung Cancer
Lung cancer remains the most commonly diagnosed cancer and the leading cause of cancer death worldwide because of inadequate tobacco control policies.
Globally, there were an estimated 2.1 million lung cancer cases and 1.8 million deaths in 2018. Incidence and mortality rates vary 20-fold between regions. (Figure 1) The variation is similarly large across countries. The highest incidence rates among men are in Europe, particularly in Eastern European countries such as Hungary (77 cases per 100,000 male population) as well as Western Asia (particularly in the former Soviet Union) and in certain countries in Asia such as Turkey and China. (Map 1a & b)
Figure 1. Lung cancer incidence and mortality rates, 2018. Age-standardized rate (world) per 100,000. In 2018, the lung cancer incidence and mortality age-standardized rates (world) per 100,000 were: Polynesia: 38.1 (incidence), 30.2 (mortality); Micronesia: 37.9 (incidence), 35.5 (mortality); North America: 34.5 (incidence), 22.3 (mortality); Eastern Asia: 34.1 (incidence), 28.6 (mortality); Western Europe: 33.9 (incidence), 24.6 (mortality); Northern Europe: 30.1 (incidence), 21.3 (mortality); Southern Europe: 28.3 (incidence), 22.7 (mortality); Central and Eastern Europe: 27.3 (incidence), 23.6 (mortality); Australia and New Zealand: 26.0 (incidence), 17.0 (mortality); Western Asia: 22.5 (incidence), 21.7 (mortality); World: 22.5 (incidence), 18.6 (mortality); Caribbean: 18.5 (incidence), 15.6 (mortality); South-Eastern Asia: 17.2 (incidence), 15.4 (mortality); Southern Africa: 16.0 (incidence), 15.2 (mortality); South America: 13.1 (incidence), 11.9 (mortality); Melanesia: 12.7 (incidence), 12.2 (mortality); Northern Africa: 9.9 (incidence), 9.6 (mortality); South-Central Asia: 6.4 (incidence), 6.0 (mortality); Central America: 5.8 (incidence), 5.0 (mortality); Middle Africa: 2.9 (incidence), 2.8 (mortality); Eastern Africa: 2.8 (incidence), 2.7 (mortality); Western Africa: 1.7 (incidence), 1.7 (mortality).
Among women, lung cancer incidence rates are highest in Hungary (38 cases per 100,000 female population), followed by other European countries, Northern America, Australia, and New Zealand. In general, the geographic patterns of lung cancer mortality are quite similar to those of incidence due to the relatively poor prognosis of the disease after diagnosis.
Historically, lung cancer mortality rates have been higher among males than females due to an earlier uptake of smoking in large numbers. (Figure 2)
Figure 2. Smoking and lung cancer mortality rate trends in men and women, United States. Cigarettes per capita increased from 54 in 1900 to a peak of 4,345 in 1963, followed by a steady decrease to 1,078 in 2015. Lung cancer mortality rates (age-standardized rate [world] per 100,000) in men increased from 4.3 in 1930 to a peak of 90.4 in 1991, followed by a steady decrease to 49.9 in 2015. Lung cancer mortality rates (age-standardized rate [world] per 100,000) in women increased from 2.6 in 1930 to a peak of 41.7 in 2002, followed by a gradual decline to 33.6 in 2015.
ACCESS CREATES PROGRESS
Since the United States Surgeon General’s Report on Smoking and Health in 1964, smoking prevalence among adults in the United States has decreased by half.
More recently, reports have noted a convergence in incidence and mortality rates between young men and women in Europe, North America, and Australia, due to a larger decrease in rates in men and a substantial rise (or slower decline) in women who acquired the smoking habit later than men. (Figure 3) In Asia, Latin America, and Africa, however, the lung cancer burden among men still largely exceeds that of women at all ages. (Figure 4) In the last few decades, mortality rates among men in these regions have started to decline, however, with rates among women often remaining low.
Figure 3. Converging lung cancer mortality rates among males and females, select high-income countries, 1952-2013. Lung cancer mortality rates (age-standardized rate [world] per 100,000) in UK men increased from 44 in 1952 to a peak of 74.1 in 1972, followed by a decrease to 31.1 in 2010. Lung cancer mortality rates (age-standardized rate [world] per 100,000) in UK women increased from 6.3 in 1952 to about 20 in 1984, followed by a plateau around 20 through 2010. Lung cancer mortality rates (age-standardized rate [world] per 100,000) in US men increased from 20.1 in 1952 to a peak of 56.5 in 1988, followed by a decrease to 34.7 in 2010. Lung cancer mortality rates (age-standardized rate [world] per 100,000) in US women increased from 3.7 in 1952 to about 26.6 in 1996, followed by a gradual decline to 22.8 in 2010. Lung cancer mortality rates (age-standardized rate [world] per 100,000) in Denmark men increased from 20.1 in 1954 to a peak of 54.9 in 1984, followed by a decrease to 33.9 in 2010. Lung cancer mortality rates (age-standardized rate [world] per 100,000) in Denmark women increased from 4.2 in 1954 to about 28 in 1996, followed by a plateau around 28 through 2010.
Figure 4. Lung cancer mortality rates among males and females, select countries in Asia, Africa, and Latin America, 1950-2013. Lung cancer mortality rates (age-standardized rate [world] per 100,000) in Japan men increased from 2.7 in 1950 to a peak of 32.5 in 1996, followed by a decrease to 27.2 in 2013. Lung cancer mortality rates (age-standardized rate [world] per 100,000) in Japan women increased from 1.0 in 1950 to about 8 in 1987, followed by a plateau around 8 through 2013. Lung cancer mortality rates (age-standardized rate [world] per 100,000) in Brazil men increased from 14.1 in 1979 to a peak of 18.7 in 1995, followed by a decrease to 15.3 in 2013. Lung cancer mortality rates (age-standardized rate [world] per 100,000) in Brazil women increased from 3.7 in 1979 to 7.9 in 2013. Lung cancer mortality rates (age-standardized rate [world] per 100,000) in South Africa men decreased from 28.5 in 1993 to 22.5 in 2013. Lung cancer mortality rates (age-standardized rate [world] per 100,000) in South Africa women decreased from 8.2 in 1993 to 6.8 in 2013.
In most parts of the world, tobacco use is the main cause of lung cancer, although other causes can be particularly important in selected countries. (Figure 5) Other established risk factors include secondhand smoke, air pollution, radon, and several occupational agents (see Environmental and Occupational Exposures). However, reducing tobacco smoking alone could prevent the majority of lung cancers. Screening for detection of the disease at an earlier stage for long-term heavy current and former smokers is available, but wide dissemination of the procedure is unlikely in the short term, even in high-income countries, because of the need for a more advanced and coordinated healthcare system.
Figure 5. Lung cancers related to tobacco smoking and air pollution in China and France. In China, 70% of lung cancers are related to tobacco smoking and 14% are related to air pollution. In France, 81% of lung cancers are related to tobacco smoking and 4% are related to air pollution.
Cause of lung cancer deaths:
The GBD Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1923–94.
Access creates progress:
US Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
Text:
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394–424.
Guo Y, Zeng H, Zheng R, et al. The burden of lung cancer mortality attributable to fine particles in China. Sci Total Environ. 2017;579:1460–6.
Jemal A, Miller KD, Ma J, et al. Higher lung cancer incidence in young women than young men in the United States. N Engl J Med. 2018;378(21): 1999–2009.
Lortet-Tieulent J, Soerjomataram I, Ferlay J, Rutherford M, Weiderpass E, Bray F. International trends in lung cancer incidence by histological subtype: adenocarcinoma stabilizing in men but still increasing in women. Lung Cancer. 2014;84(1):13–22.
Soerjomataram I, Shield K, Marant-Micallef C, et al. Cancers related to lifestyle and environmental factors in France in 2015. Eur J Cancer. 2018;105:103–13.
The GBD Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1923–94.
Thun M, Peto R, Boreham J, Lopez AD. Stages of the cigarette epidemic on entering its second century. Tob Control. 2012;21(2):96–101.
Wang JB, Fan YG, Jiang Y, et al. Attributable causes of lung cancer incidence and mortality in China. Thorac Cancer. 2011;2(4):156–63.
Map and Figure 1:
Ferlay J, Ervik M, Lam F, et al.. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/today.
Figure 2:
Death rates: US Mortality Volumes 1930 to 1959, US Mortality Data 1960 to 2015, National Center for Health Statistics, Centers for Disease Control and Prevention.
Cigarette consumption: 1900–1999: US Department of Agriculture; 2000–2015: Wang, TW et al. (2016). “Consumption of Combustible and Smokeless Tobacco – United States, 2000-2015.” MMWR Morbidity and Mortality Weekly Report. 65(48): 1357–1363.
Figure 3:
Rates smoothed using 5-year average.
World Health Organization Cancer Mortality Database, http://www-dep.iarc.fr/WHOdb/WHOdb.htm
Figure 4:
ibid.
Figure 5:
France: Soerjomataram I, Shield K, Marant-Micallef C, et al. Cancers related to lifestyle and environmental factors in France in 2015. Eur J Cancer. 2018;105:103–13.
China, air pollution: Guo Y, Zeng H, Zheng R, et al. The burden of lung cancer mortality attributable to fine particles in China. Sci Total Environ. 2017;579:1460–6.
China, smoking: Wang JB, Fan YG, Jiang Y, et al. Attributable causes of lung cancer incidence and mortality in China. Thorac Cancer. 2011;2(4):156–63.