Lung Cancer and Smoking Trends in the United States Over the Past 25 Years

Abstract

Lung cancer is the leading cause of cancer incidence and death in the United States. The American Cancer Society estimated that there will be 157,000 new cases of lung cancer diagnosed in 1990 and 142,000 deaths.' Death rates in men have shown a remarkableincreasein the last 5Oyears paralleling arise in cigarette smoking20 years earlier.Age-adjustedlungcancerdeathratesinmenin theunited Statesgrew from 11 per 100,000 population in 1940 to 73 per 100,000 in 1982. Since then the rate has leveled off. In 1986, it was 74. The lung cancer rate in women started to rise in the early 1960s from 6 per 100,000 to 25 per 100,000 in 1986 adjusted to the total U.S. population in 1970. Lung cancer rates in young men age 35-44 started to decline in the 1970s and in men age 45-54 in the early 1980s. There has been a leveling off of mortality rates in men aged 5544. It is only in the oldest age groups that a steady increase in rates has been observed through 1986 (FIG. 1). These trends indicate that there should be a decrease in the overall lung cancer mortality rate in men by the early 1 9 9 0~.~ Among women the age-specific rates continue to increase, except for age group 35-44, where adecrease has beenseenstartingintheearly 1980s,andalevelingofratesin agegroup 45-54 (FIG. 2).In addition to a decrease in mortality trends, the incidence of lung cancer has also declined. Studies of lung cancer incidence by the SEER Program of the National Cancer Institute reveal that the annual percent increasein men between 1975 and 1979 was l.6%, but between 1982 and 1986, there was an annual percent decrease in incidence rate of 0.8% .3 The rate in whites decreased by 0.9% annually during this period but increased by 0.8% in blacks. Among women the annual rate of increase diminishedfrom6. 3% inthe 1975-1979period to2.8% in 1982-1985. In black women however, there was no change in the annual rate of increase in the two periods, 8.4% and 8.57'0, respectively.Cigarette consumption per capita in persons age 18 and older measures total cigarette consumption divided by the estimated population and includes nonsmokers and exsmokers as well as smokers in the denominator. The index rose steadily from 1,085 in 1925 to 3,886 in 1952. Following publication of the smoking-health reports in the early 1950s, the index dropped 9% to 3,546 in 1954. It then continued to rise until 146 GARFINKEL & SILVERBERG: LUNG CANCER AND SMOKING TRENDS 147 1963 when it reached 4,345. With the publication of the first Surgeon General's Report on smoking in 1964, the index dropped 4.5% to 4,194. It rose again to 4,287 in 1966. During 1969-1971, another drop of 5% accompanied the anti-smoking advertising on television. When these ads were removed the index climbed again to a high of 4,148 in 1973. Since then in association with the growth of the nonsmoker movement and anti-smoking legislation restricting smokingin publicplaces, there has been a steady decIine to 2,936 in 1989, the lowest level since 1942.4 This decline is related to the leveling off of lung cancer mortality ra...

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