Creation of an Epidemic: The Tobacco Industry and the Rise of Smoking-Related Adenocarcinoma of the Lung: Surveillance-Epidemiology and End Results (SEER) Analysis, 1973-2011

Abstract

SESSION TITLE: Lung Cancer Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: When epidemiologic research first established a definitive association between cigarette smoking and lung cancer in the early 1950s, adenocarcinoma comprised about 5% of lung cancers and appeared to be unrelated to smoking. In the 1960s and 1970s, adenocarcinoma increased sharply, and became strongly related to cigarette smoking. METHODS: We analyzed time trends in lung cancer histology with changes in cigarette design and Tobacco Industry actions over six decades. We utilized SEER data on 419,941 lung cancers diagnosed between 1973 and 2011 to analyze time trends of age-standardized incidence rates of five histologic subtypes: adenocarcinoma, squamous cell, small cell, large cell, and adenosquamous carcinoma RESULTS: As time progressed, the percentage of lung cancers that were adenocarcinomas dramatically increased from 29% (in 1973-1974) to 55% (in 2010-2011). During this 38-year period, the percentage of lung cancers that were squamous cell carcinomas decreased from 41% to 26%. Among all patients, adenocarcinoma incidence surpassed squamous cell carcinoma by 1985-1989 to become the most common histologic subtype. Adenocarcinoma surpassed squamous cell carcinoma in 1990-1994 in men, while it was already most common in women by 1973-1974. Adenocarcinoma rose 77% in men from 1973-1974 to 1990-1994, while it rose 197% in women between 1973-1974 and 2005-2006. Among whites, adenocarcinoma surpassed squamous cell carcinoma by 1985-1989, while this occurred among blacks by 1990-1994. It was already most common among other race individuals in 1973-1974. Adenocarcinoma was already most common among patients < 50 yrs of age by 1973-1974, while adenocarcinoma rapidly increased and surpassed squamous carcinoma in all other age groups by 1990-1994. CONCLUSIONS: The frequency of adenocarcinoma of the lung has dramatically increased over the last six decades from that of an uncommon lung cancer subtype comprising about 5% of lung cancers to its current status as the most common form of lung cancer. Since inception of the SEER database in 1973, adenocarcinoma rose from 29% to 55% of lung cancers in the US. Adenocarcinoma incidence is higher that that of all other lung cancer subtypes combined. It is the most common histology in men and women, in whites, blacks, and other-races, and in all age groups. CLINICAL IMPLICATIONS: The role of Big Tobacco in leading to creation of the current epidemic of smoking-related adencarcinoma of the lung will be addressed in a companion presentation submitted to this meeting. DISCLOSURE: The following authors have nothing to disclose: Gary Strauss, Alejandro Moreno-Koehler, Matthew Finkelman No Product/Research Disclosure Information