Abstract
BackgroundDifferent methods exist to estimate smoking attributable cancer mortality rates (Peto and Ezzati methods, as examples). However, the smoking attributable estimates using these methods cannot be generalized to all population sub-groups. A simpler method has recently been developed that can be adapted and applied to different population sub-groups. This study assessed cumulative tobacco smoke damage (smoke load)/non-lung cancer mortality associations across time from 1979 to 2003 among all Massachusetts males and ages 30–74 years, using this novel methodology.MethodsAnnual lung cancer death rates were used as smoke load bio-indices, and age-adjusted lung/all other (non-lung) cancer death rates were analyzed with linear regression approach. Non-lung cancer death rates include all cancer deaths excluding lung. Smoking-attributable-fractions (SAFs) for the latest period (year 2003) were estimated as: 1-(estimated unexposed cancer death rate/observed rate).ResultsMale lung and non-lung cancer death rates have declined steadily since 1992. Lung and non-lung cancer death rates were tightly and steeply associated across years. The slopes of the associations analyzed were 1.69 (95% confidence interval (CI) 1.35–2.04, r = 0.90), and 1.36 (CI 1.14–1.58, r = 0.94) without detected autocorrelation (Durbin-Watson statistic = 1.8). The lung/non-lung cancer death rate associations suggest that all-sites cancer death rate SAFs in year 2003 were 73% (Sensitivity Range [SR] 61–82%) for all ages and 74% (SR 61–82%) for ages 30–74 years.ConclusionThe strong lung/non-lung cancer death rate associations suggest that tobacco smoke load may be responsible for most prematurely fatal cancers at both lung and non-lung sites. The present method estimates are greater than the earlier estimates. Therefore, tobacco control may reduce cancer death rates more than previously noted.
Highlights
Different methods exist to estimate smoking attributable cancer mortality rates (Peto and Ezzati methods, as examples)
Massachusetts male cancer death rates peaked in the early 1990s, including the rates for all sites, and non-lung cancer death rates for all age groups and for the 30–74 years age group (Figure 1)
The lung/non-lung cancer death rate associations suggest that year 2003 all-sites male cancer death rate Smoking attributable fractions (SAF) are 73% (SR 61–82%) across all ages and 74% (SR 61–82%) for males aged 30–74 years, or 196 deaths per 100,000
Summary
Different methods exist to estimate smoking attributable cancer mortality rates (Peto and Ezzati methods, as examples). Recent estimates of smoking-attributable cancer mortality utilize lung cancer mortality data as an indicator of the accumulated hazards of tobacco smoking and tightly link several temporal, ethnic, and geographic cancer mortality disparities to smoking [1,2]. In the authors' words, the Peto estimates are based on a "simple halving of the excess risk [linked to smoke exposure which] is obviously not a satisfactory procedure, for it is crude and arbitrary and may seriously underestimate some of the true hazards of tobacco" [3] Both estimates are based in part on the Cancer Prevention Study (CPS) – II, which has considerable selection, exposure misclassification, and other biases [3,4,5]; and they may seriously underestimate the actual smoking attributable mortality. The absolute death rates among the non-smokers and the smokers (and the smoker/nonsmoker death rate ratios) in the CPSII study cannot be generalized over the US population [3,6]
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