Epidemiology and Treatment of Lung Cancer in Seattle

Abstract

The epidemiology of lung cancer in Seattle-King County, Washington, during the last 70 years was ascertained by a thorough review and analysis of death certificates, plus the study of hospital and coroners’ records for lung cancer patients dying in 1930 to 1935 and in 1955. The first death ascribed to lung cancer in this community was that of a 70-yearold man in 1900. Since 1930, total mortality ascribed to lung cancer in this community has increased rapidly, due to the increasing mortality of older men from this disease. During the last five years, the rate of increase of total lung cancer mortality has slackened. The changes in total and age-specific mortality trends suggest that the 20th century lung cancer epidemic may be nearing its crest in this community, or at least approaching a plateau. A detailed analysis showed that the use and accuracy of diagnostic procedures was much increased in 1955 as compared with the 1930 to 1935 period. Only 18 (64 per cent) of the 28 cases studied in 1930 to 1935 were diagnosed as having lung cancer prior to death and in only two (7 per cent) of the 28 cases was a tissue diagnosis made ante-mortem; whereas 132 (87 per cent) of the 152 lung cancer patients studied who died in 1955 were diagnosed as having lung cancer prior to death and 70 (46 per cent) of the 152 had a tissue diagnosis ante-mortem. The average lung cancer patient dying in 1955 lived 10.1 months after the onset of symptoms, slightly longer than the 9.2 months lived after onset of symptoms by the average patient dying in the early 1930's. Addition of the survival time of those few cases treated in 1955 and known to be alive without apparent recurrence in 1960 would increase the average survival time, from onset of symptoms, of all 1955 cases to roughly 12 months, and of all treated cases to roughly 18 months. However, despite the contributions of surgery and of all modern treatment, only about 3 per cent of all lung cancer patients in Seattle survived five years after onset of symptoms; and social measures aimed at abatement of this problem must clearly be directed toward prevention—which can largely be accomplished by avoidance of smoking.