Patterns of Absolute Risk of Lung Cancer Mortality in Former Smokers

Halpern, Michael T.; Gillespie, Brenda W.; Warner, Kenneth E.

doi:10.1093/jnci/85.6.457

Cited by 290 publications

(183 citation statements)

References 8 publications

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“…The relative risk of lung cancer decreases following smoking cessation, 15 and the impact of the decline in cigarette smoking on lung-cancer mortality would be expected to show up first in the younger groups as a cohort effect. The downturn in cigarette consumption since the 1960s combined with lower tar content of cigarettes was a clear precursor to the decline in lung-cancer mortality rates in the United States and the United Kingdom.…”

Section: Resultsmentioning

confidence: 99%

Changes in lung‐cancer mortality trends in Spain

Franco

Pérez‐Hoyos²,

Plaza

2001

Intl Journal of Cancer

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Several changes in smoking patterns over the past decades in Spain can be expected to result in a shift in lung-cancer mortality rates. We examined time trends in lung-cancer mortality from 1973-1997 using a log-linear Poisson ageperiod-cohort model. The standardized lung-cancer mortality rate for men almost doubled, from 31.4 per 100,000 in 1973 to 58.6 in 1997, with an average annual increase of 2.7%. Mortality increased for male generations born until 1952 as a consequence of the increasing cigarette smoking in successive birth cohorts. However, the slight downward trend observed for the 2 youngest generations suggests a more favorable outcome of the lung-cancer epidemic among Spanish males in the coming years, if this trend continues. For women, mortality rates were 5 to 9 times lower than those for men, 6.3 per 100,000 in 1973 and 6.4 in 1997. However, the increasing mortality among younger generations born since 1942 reflects the rise in the prevalence of smoking women during the last decades and can be expected to spread to older age groups as a cohort effect, indicating the early phase of the smoking-related lung-cancer epidemic among Spanish females. The decreasing mortality trend observed in women until the late 1980s could be attributed to a lower exposure to environmental tobacco smoke at home as a result of a significant reduction in the prevalence of smoking men. In Mediterranean countries and in Spain since 1990, malignant tumors are the leading cause of death, whereas heart diseases are placed second. 1 Lung cancer is the most frequent fatal cancer among men in Spain 2 as well as in many other developed countries.Because of the poor survival from lung cancer, there is a close correlation between incidence and mortality. The overall 5-year survival rate of 10 -13% has not changed over the past 2 decades, though the implementation of multimodality therapy in locally advanced disease has begun to modestly improve survival in patients with more advanced stages of disease. 3 Cigarette smoking plays a dominant role in lung-cancer causation, being responsible for up to 90% of the lung-cancer epidemic, not only directly but indirectly (passive smoking) and in association with other substances such as asbestos and radon. 4 Smoking patterns have changed markedly and in different directions in several countries over the past decades; therefore, time trends in lung-cancer mortality differ between countries, cohorts and sexes. 5 Several changes in smoking habits in Spain, such as a decline in the prevalence of smoking among men and a rise among women, can be expected to result in a shift in lung-cancer mortality trends.Because tobacco smoking habits are generally established at an early age and are characteristic for a given birth cohort, 5 the development of the lung-cancer epidemic can be analyzed most accurately by studying age-specific rates by birth cohort. 6 We analyzed trends in lung-cancer mortality in Spain from 1973-1997, using a Poisson log-linear age-period-cohort model. MATERIAL AND METHODSPopula...

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Section: Resultsmentioning

confidence: 99%

Changes in lung‐cancer mortality trends in Spain

Franco

Pérez‐Hoyos²,

Plaza

2001

Intl Journal of Cancer

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“…Assuming an exponential increase in lung cancer mortality with a factor of 2.5 in 10 years, the mean risk is reached after 5.5 years. 21,22 Thus, in theory, NELSON subjects with age at entry of 44.5 through 74.5 have a mean lung cancer mortality rate of CPS II subjects with attained ages 50-79. In NELSON no subjects aged less than 50 were included, and so NELSON subjects with age at entry of 50 through 74.5 have a mean lung cancer mortality rate of CPS II subjects with attained ages 55.5 through 79.…”

Section: Calculation Of Expected Lung Cancer Mortalitymentioning

confidence: 98%

Risk‐based selection from the general population in a screening trial: Selection criteria, recruitment and power for the Dutch‐Belgian randomised lung cancer multi‐slice CT screening trial (NELSON)

Iersel

Koning

Draisma

et al. 2006

Intl Journal of Cancer

442

357

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A method to obtain the optimal selection criteria, taking into account available resources and capacity and the impact on power, is presented for the Dutch-Belgian randomised lung cancer screening trial (NELSON). NELSON investigates whether 16-detector multi-slice computed tomography screening will decrease lung cancer mortality compared to no screening. A questionnaire was sent to 335,441 (mainly) men, aged 50-75. Smoking exposure (years smoked, cigarettes/day, years quit) was determined, and expected lung cancer mortality was estimated for different selection scenarios for the 106,931 respondents, using lung cancer mortality data by level of smoking exposure (US Cancer Prevention Study I and II). Selection criteria were chosen so that the required response among eligible subjects to reach sufficient sample size was minimised and the required sample size was within our capacity. Inviting current and former smokers (quit 10 years ago) who smoked >15 cigarettes/day during >25 years or >10 cigarettes/day during >30 years was most optimal. With a power of 80%, 17,300-27,900 participants are needed to show a 20-25% lung cancer mortality reduction 10 years after randomisation. Until October 18, 2005 11,103 (first recruitment round) and 4,325 (second recruitment round) (total 5 15,428) participants have been randomised. Selecting participants for lung cancer screening trials based on risk estimates is feasible and helpful to minimize sample size and costs. When pooling with Danish trial data (n 5 64,000) NELSON is the only trial without screening in controls that is expected to have 80% power to show a lung cancer mortality reduction of at least 25% 10 years after randomisation. ' 2006 Wiley-Liss, Inc.Key words: lung cancer; screening; computed tomography; power; risk estimation Lung cancer is the most common cause of cancer-related death in men and the second most common cause of cancer-related death in women in Europe. 1 Because lung cancer is often in an advanced stage at the time of diagnosis, 5-year-survival is only 15% or less. 2 Japanese studies and the US Early Lung Cancer Action Project (ELCAP) showed that in a high-risk population more lung cancers can be detected by spiral computed tomography (CT) screening than by chest X-ray screening. 3,4 These and other observational studies with spiral CT screening showed that 55-85% of CTdetected lung cancers at baseline screening in a high-risk population of current and former smokers are at a surgically removable stage (stage I). 5 Although these results seem promising, observational studies are prone to lead-time, length-time and overdiagnosis bias. Only in a randomised design, disease-specific mortality between the screened and the unscreened population, instead of survival, can be compared. Lead-time, length-time and overdiagnosis do not bias the analysis in such comparisons. 6 Therefore, in the United States the National Lung Screening Trial (NLST) was launched in 2002 7 and in the Netherlands and Belgium, the NEL-SON trial, a Dutch acronym for ÔDutch-Belgian lu...

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“…[57,58] Since the risk for LC only declines many years after smoking cessation, it is also important to recognise that a significant percentage of LCs occur in former smokers. [59][60][61] Since cigarette smoking plays a central role in LC development, promotion of smoking cessation and reduction in population smoking rates are imperative for reducing the long-term burden of disease and cannot be replaced by LC screening. The decline in LC incidence and mortality among men in the US between 1975 and 2010, which was observed in tandem with a reduction in the smoking rate among adults in the US between 1965 and 2011, lends support to smoking cessation as an effective means of lowering LC mortality.…”

Section: Importance Of Smoking Cessationmentioning

confidence: 99%

Lung Cancer Screening

Schar¹

2015

S Afr Res J

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Lung cancer (LC) is the leading cause of cancer-related death worldwide. Its overall poor prognosis is attributable to the fact that most patients remain asymptomatic until the disease is advanced and, therefore, present with late-stage incurable disease. e rationale for LC screening is that early detection of asymptomatic disease oers the opportunity for earlier intervention, at a stage when denitive cure is still feasible, which has the potential to reduce LC-related mortality and morbidity. e ndings of the National Lung Screening Trial provided the rst strong evidence in support of this rationale. Since its publication, several professional organisations and societies have developed guidelines recommending the implementation of LC screening with low-dose computed tomography in asymptomatic, high-risk individuals. Although the benets of such screening programmes may be signicant, they must be carefully weighed against the potential harms to the relatively large number of healthy individuals who would undergo screening. is review examines the available evidence and current recommendations for LC screening, including benets, potentials harms and requirements for implementation of a high-quality, safe and eective programme. In addition, the costs and availability of LC screening programmes in both the global and local settings are considered.

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Patterns of Absolute Risk of Lung Cancer Mortality in Former Smokers

Abstract: Smokers of all ages should be encouraged to quit because cessation at any age decreases lung cancer risk relative to that of current smokers.

Cited by 290 publications

References 8 publications

Changes in lung‐cancer mortality trends in Spain

Changes in lung‐cancer mortality trends in Spain

Risk‐based selection from the general population in a screening trial: Selection criteria, recruitment and power for the Dutch‐Belgian randomised lung cancer multi‐slice CT screening trial (NELSON)

Lung Cancer Screening

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