Chest
Volume 132, Issue 3, Supplement, September 2007, Pages 29S-55S
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DIAGNOSIS AND MANAGEMENT OF LUNG CANCER: ACCP GUIDELINES (2ND EDITION)
Epidemiology of Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition)

https://doi.org/10.1378/chest.07-1347Get rights and content

Background

The objective of this study was to summarize the published literature concerning the epidemiology of lung cancer.

Methods

A narrative review of published evidence was conducted, identifying and summarizing key reports that describe the occurrence of lung cancer in populations and factors that affect lung cancer risk.

Results

In the United States, lung cancer remains the leading cause of cancer death in both men and women, even though an extensive list of modifiable risk factors has long been identified. The predominant cause of lung cancer is exposure to tobacco smoke, with active smoking causing most cases but passive smoking also contributing to the lung cancer burden.

Conclusions

The reductions in smoking prevalence in men that occurred in the late 1960s through the 1980s will continue to drive lung cancer mortality rates downward in men during the first portion of this century, but rates in women have not yet begun to decrease. Fortunately, exposures to major occupational respiratory carcinogens have largely been controlled, but the population is still exposed to environmental causes of lung cancer, including radon, the second leading cause of lung cancer death.

Section snippets

Materials and Methods

A narrative review of published evidence on the epidemiology of lung cancer was conducted. Key reports that described the occurrence of lung cancer in populations and factors that affect lung cancer risk were identified. This was accomplished using a combination of approaches that included cataloguing reports from the authors' files and augmented with MEDLINE searches. The MEDLINE searches included a term for “lung cancer” along with additional terms for various exposures that have been studied

Survival

The 5-year relative survival rate for lung cancer for the period of 1995 to 2001 was 15.7%, reflecting a steady but slow improvement from 12.5% from 1974 to 1976.20 The 5-year relative survival rate varies markedly depending on the stage at diagnosis, from 49 to 16 to 2% for local, regional, and distant stage disease, respectively.20 Stage at diagnosis accounts for the most marked variation in prognosis, but patient characteristics associated with poorer survival also include being older, male,

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 exposure to these agents, then this would be expected to reduce the risk for lung cancer. Preventive strategies can be pursued in the public policy arena or in public health interventions directed at individual behavior. Cigarette smoking provides a useful example to illustrate the multiple levels that can form

Acknowledgment

We thank Elisa Mundis and Charlotte Gerczak for assistance in the preparation of this article.

REFERENCES (288)

  • WingoPA 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)
  • RosenG
    (1993)
  • Reducing the health consequences of smoking: 25 years of progress; a report of the Surgeon General

    (1989)
  • ProctorR
    (1999)
  • DollR et al.

    Smoking and carcinoma of the lung; preliminary report

    BMJ

    (1950)
  • LevinML et al.

    Cancer and tobacco smoking; a preliminary report

    J Am Med Assoc

    (1950)
  • WynderEL et al.

    Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma; a study of 684 proved cases

    J Am Med Assoc

    (1950)
  • Smoking and health: report of the Advisory Committee to the Surgeon General

    (1964)
  • (1962)
  • The health consequences of involuntary smoking: a report of the Surgeon General

    (1986)
  • Respiratory health effects of passive smoking: lung cancer and other disorders

    (1992)
  • SametJM

    Radon and lung cancer

    J Natl Cancer Inst

    (1989)
  • Health effects of exposure to radon (BEIR VI)

    (1999)
  • Tobacco smoke and involuntary smoking

    IARC Monogr Eval Carcinog Risks Hum

    (2004)
  • The health effects of active smoking: a report of the Surgeon General

    (2004)
  • RiesL et al.

    Cancer statistics review, 1975–2002

    (2005)
  • Cancer facts and figures

    (2006)
  • JemalA et al.

    Lung cancer rates convergence in young men and women in the United States: analysis by birth cohort and histologic type

    Int J Cancer

    (2003)
  • ThunMJ et al.

    Lung cancer death rates in lifelong nonsmokers

    J Natl Cancer Inst

    (2006)
  • HaimanCA et al.

    Ethnic and racial differences in the smoking-related risk of lung cancer

    N Engl J Med

    (2006)
  • EdwardsBK et al.

    Annual report to the nation on the status of cancer, 1975–2002, featuring population-based trends in cancer treatment

    J Natl Cancer Inst

    (2005)
  • MaoY et al.

    Socioeconomic status and lung cancer risk in Canada

    Int J Epidemiol

    (2001)
  • LiK et al.

    Economic status, smoking, occupational exposure to rubber, and lung cancer: a case-cohort study

    J Environ Sci Health C Environ Carcinog Ecotoxicol Rev

    (2002)
  • van LoonAJ et al.

    Socioeconomic status and lung cancer incidence in men in the Netherlands: is there a role for occupational exposure?

    J Epidemiol Community Health

    (1997)
  • SchwartzKL et al.

    Race, socioeconomic status and stage at diagnosis for five common malignancies

    Cancer Causes Control

    (2003)
  • World cancer report 2003 IARC Press, World Health Organization, International Agency for Research on Cancer. Lyon,...
  • International Agency for Research on Cancer: GLOBOCAN 2002 2002 International Agency for Research on Cancer. Lyon,...
  • GordonT et al.

    End results and mortality trends in cancer: II. Cancer mortality trends in the United States, 1930–1955

    Natl Cancer Inst Monogr

    (1961)
  • StocksP et al.

    Lung cancer death rates among non-smokers and pipe and cigarette smokers; an evaluation in relation to air pollution by benzpyrene and other substances

    BMJ

    (1955)
  • BlotWJ et al.

    Geographic patterns of lung cancer: industrial correlations

    Am J Epidemiol

    (1976)
  • MasonT et al.

    Cancer mortality by county: 1950–1969. USDHEW 74–615

    (1973)
  • BlotW et al.

    Cancer among shipyard workers

    Banbury report 9. Quantification of occupational cancer

    (1981)
  • BlotWJ et al.

    Changing patterns of lung cancer in the United States

    Am J Epidemiol

    (1982)
  • SaracciR et al.

    Interactions of tobacco smoking and other causes of lung cancer

    (1994)
  • WillettWC

    Diet, nutrition, and avoidable cancer

    Environ Health Perspect

    (1995)
  • PetoR et al.
    (1994)
  • SametJM

    Lung cancer

    (1995)
  • ZaridzeD et al.

    Tobacco: a major international health hazard

    (1986)
  • PetoR et al.

    Tobacco: the growing epidemic

    Nat Med

    (1999)
  • LiuBQ et al.

    Emerging tobacco hazards in China: 1. Retrospective proportional mortality study of one million deaths

    BMJ

    (1998)
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    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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