Lung cancer is the most common fatal malignant neoplasm in the United States. Based on current smoking patterns, the substantial public health burden of smoking-related lung cancer will continue during the next several decades. This report describes trends in lung cancer incidence from 1980 through 1986 and lung cancer mortality from 1980 through 1987.

Incident cases* for 1980-1986 were determined using data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute (NCI). Deaths** for 1980-1987 were identified using total mentions from the multiple cause-of-death data files compiled by CDC's National Center for Health Statistics. The denominators for both rates were derived from intercensal population estimates (1). Rates were standardized to the 1970 age distribution of the U.S. population. Race-specific rates are not reported for races other than white and black because appropriate denominators were not available.

From 1980 through 1986, the age-adjusted lung cancer incidence rate per 100,000 persons increased from 52.4 to 55.5 (Table 1).*** Although rates fluctuated for males, for females, they increased steadily from 28.4 to 36.3 per 100,000. Incidence in males was higher among blacks than whites; rates for females did not differ by race (Table 1).

Trends for lung cancer death rates paralleled those for incidence rates. From 1980 through 1987, the age-adjusted death rate per 100,000 persons increased from 46.2 to 52.1. Although death rates for males did not change substantially, rates were consistently higher for blacks than for whites. For females, the rates increased steadily but did not differ by race.

For males, lung cancer death rates were higher for older age groups but did not change substantially for any age group. For women aged greater than or equal to 55 years, death rates increased consistently for both blacks and whites (Figure 1). The greatest difference by race occurred for men aged 35-44 years; for this age group, the death rate was 2.3 times higher for blacks than for whites (Figure 2). Reported by: Chronic Disease Surveillance Br, Office of Surveillance and Analysis and Program Svcs Activity, Office on Smoking and Health, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Lung cancer is the second leading cause of death among black males (after coronary heart disease) (2). The excess morbidity and mortality from lung cancer among black men compared with white men is greatest for the 35- to 64-year age group (3).

Cigarette smoking accounts for approximately 85% of lung cancer cases (4). Since 1914, national surveys have consistently shown that the prevalence of smoking has been higher in black men than in white men (5); in addition, blacks tend to use brands with higher tar and nicotine content (6,7). However, black men and women initiate smoking at slightly older ages than white men and women (4) and smoke fewer cigarettes per day. The extent to which these differences in smoking patterns or other host or environmental factors contribute to the difference in lung cancer mortality is unknown.

The higher prevalence of smoking among black men and women reflects a decreased likelihood of quitting rather than a difference in initiation; this decreased likelihood is characteristic of all socioeconomic levels and ages (5,6). Smoking-cessation programs that recognize the smoking patterns of black men and women may be more effective and ultimately assist in lowering the lung cancer death rate.

For both black and white females, the similar increases in age-specific lung cancer incidence and death rates are consistent with historically increasing trends in smoking prevalence. Based on these trends, the increases in lung cancer incidence and mortality for females are not projected to plateau until after the year 2013 (8).

Epidemiologic and clinical studies have provided extensive information on the health benefits of smoking cessation (9). For example, after 10 years of smoking cessation, the risk for lung cancer is reduced to 30%-50% of the risk among continuing smokers (9). The national health objectives for the year 2000 include reducing the prevalence of cigarette smoking among adults to less than or equal to 15%, from a 1987 baseline of 29% (10). Recent declines in smoking prevalence, especially among black males, are encouraging. However, continued progress in both smoking-prevention and smoking-cessation efforts is essential to achieving this objective and protecting the population from the health hazards of tobacco use. These efforts must take into account the adverse effects of marketing strategies by the tobacco industry that target high-risk groups.

References

1. Irwin R. 1980-1988 Intercensal population estimates by race,

sex, and age (machine-readable data files). Washington, DC: US Department of Commerce, Bureau of the Census, nd.

2. National Center for Health Statistics. Health, United States, 1989. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1990; DHHS publication no. (PHS)90-1232.

3. Office of Minority Health. Report of the Secretary's Task Force on Black and Minority Health. Washington, DC: US Department of Health and Human Services, Public Health Service, 1986.

4. CDC. Reducing the health consequences of smoking: 25 years of progress--a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

5. Fiore MC, Novotny TE, Pierce JP, Hatziandreu EJ, Patel KM, Davis RM. Trends in cigarette smoking in the United States: the changing influence of gender and race. JAMA 1989;261:49-55.

6. Novotny TE, Warner KE, Kendrick JS, Remington PL. Smoking by blacks and whites: socioeconomic and demographic differences. Am J Public Health 1988;78:1187-9.

7. CDC. Cigarette brand use among adult smokers--United States, 1986. MMWR 1990;39:665,671-3.

8. Brown CB, Kessler LG. Projections of lung cancer mortality in the United States: 1985-2025. J Natl Cancer Inst 1988;80:43-51.

9. CDC. The health benefits of smoking cessation: a report of the Surgeon General, 1990. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1990; DHHS publication no. (CDC)90-8416. 10. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives. Washington, DC: US Department of Health and Human Services, Public Health Service, 1990; DHHS publication no. (PHS)90-50212.

• International Classification of Diseases for Oncology, rubric 162, which includes trachea, bronchus, and lung.

** International Classification of Diseases, Ninth Revision, rubric 162, which includes malignant neoplasm of the trachea, bronchus, and lung.

*** Rates reported here may not correspond to those published by NCI because of additional data recoding by NCI.

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