Increase In Lung Cancer Mortality Research Articles

Is the apparent rise in cancer mortality in the elderly real? analysis of changes in certification and coding of cause of death in England and Wales, 1970–1990

The effect of changes in recording and coding of cause of death on trends in cancer mortality in England and Wales in persons aged 45 and over during 1970-1990 is reviewed. During this period, all-cancer mortality rates increased only at ages over 75 in males and over 55 in females. Rises in cancer mortality were largely due to increases in cancer of lung, prostate and unspecified site in men, and of lung, breast and unspecified site in women. Death coding and certification artefacts were much larger in older persons. In those aged 75-84, a change in the position of recording cancer on the death certificate could potentially account for 46% of the recorded increase in prostate-cancer mortality and 28% of the increase in breast-cancer mortality. The decrease in recorded mortality from ill-defined terminal events was far greater than the increase in cancer mortality in this age group. The rise in all-cancer mortality in the elderly was partly due to an increase in lung-cancer mortality, and data artefacts explained a large proportion of the increase in the other common specified cancers in those aged 75-84. The use of routine mortality statistics to chart progress against cancer lacks validity at older ages because of imprecision in certification of cause of death.

Recent Cancer Trends in the United States

Background Cancer incidence rates have been reported to be increasing in the United States, although trends vary according to form of cancer. Purpose We identify the cancers accounting for the rising incidence, quantify the changes that have occurred from the mid-1970s to the early 1990s, and contrast incidence and mortality trends to provide clues to the determinants of the temporal patterns. Methods Sex-, race-, and age-specific and age-adjusted incidence rates for the 5-year periods 1987-1991 versus 1975-1979 were calculated for 28 cancers among men and 30 cancers among women using data from the Surveillance, Epidemiology, and End Results (SEER) Program of cancer registration covering about 10% of the U.S. population. Similar rates were computed using national mortality data. Cancers were ranked according to the change in incidence rates over the two periods. Results Age-adjusted incidence rates for all cancers combined increased by 18.6% among males and 12.4% among females from 1975-1979 to 1987-1991, due largely to rising rates for prostate cancer among men and for breast and lung cancers among women. National mortality rates for all cancers combined rose less steeply, 3% and 6% among men and women, respectively, driven mostly by continuing increases in lung cancer mortality, while death rates for the majority of the cancers were steady or declining. Total cancer incidence rose at all ages, but with different tumors responsible for the increases at different ages: leukemia and brain/nervous system cancer among children; testicular cancer, nonmelanoma skin cancer (largely Kaposi's sarcoma), non-Hodgkin's lymphoma, and melanoma among young and middle-aged adults; and prostate, breast, and lung cancers among older individuals. In contrast, mortality rates for all cancers combined declined among both males and females under age 55 years, increasing only among older persons. Conclusions Trends in cancer incidence and mortality differ. For most cancers, incidence rates are rising, while mortality rates are generally stable or declining. Implications Much of the recent increase in cancer incidence can be explained by known factors. Improved detection appears to account for most of the increases in breast cancer among women and prostate cancer among men. On the other hand, cigarette smoking is the major determinant of the rise in lung cancer among women, acquired immunodeficiency syndrome has led to increases in non-Hodgkin's lymphoma and Kaposi's sarcoma among young and middle-aged men, and sunlight exposure patterns have affected the trends in melanoma. Some trends remain unexplained, however, and may reflect changing exposures to carcinogens yet to be identified and clarified.

Recent cancer trends in the United States.

Cancer incidence rates have been reported to be increasing in the United States, although trends vary according to form of cancer. We identify the cancers accounting for the rising incidence, quantify the changes that have occurred from the mid-1970s to the early 1990s, and contrast incidence and mortality trends to provide clues to the determinants of the temporal patterns. Sex-, race-, and age-specific and age-adjusted incidence rates for the 5-year periods 1987-1991 versus 1975-1979 were calculated for 28 cancers among men and 30 cancers among women using data from the Surveillance, Epidemiology, and End Results (SEER) Program of cancer registration covering about 10% of the U.S. population. Similar rates were computed using national mortality data. Cancers were ranked according to the change in incidence rates over the two periods. Age-adjusted incidence rates for all cancers combined increased by 18.6% among males and 12.4% among females from 1975-1979 to 1987-1991, due largely to rising rates for prostate cancer among men and for breast and lung cancers among women. National mortality rates for all cancers combined rose less steeply, 3% and 6% among men and women, respectively, driven mostly by continuing increases in lung cancer mortality, while death rates for the majority of the cancers were steady or declining. Total cancer incidence rose at all ages, but with different tumors responsible for the increases at different ages: leukemia and brain/nervous system cancer among children; testicular cancer, nonmelanoma skin cancer (largely Kaposi's sarcoma), non-Hodgkin's lymphoma, and melanoma among young and middle-aged adults; and prostate, breast, and lung cancers among older individuals. In contrast, mortality rates for all cancers combined declined among both males and females under age 55 years, increasing only among older persons. Trends in cancer incidence and mortality differ. For most cancers, incidence rates are rising, while mortality rates are generally stable or declining. Much of the recent increase in cancer incidence can be explained by known factors. Improved detection appears to account for most of the increases in breast cancer among women and prostate cancer among men. On the other hand, cigarette smoking is the major determinant of the rise in lung cancer among women, acquired immunodeficiency syndrome has led to increases in non-Hodgkin's lymphoma and Kaposi's sarcoma among young and middle-aged men, and sunlight exposure patterns have affected the trends in melanoma. Some trends remain unexplained, however, and may reflect changing exposures to carcinogens yet to be identified and clarified.

A mortality study of lung cancer among swiss professional drivers: accounting for the smoking related fraction by a multivariate approach.

The mortality due to lung cancer among 'chauffeurs', who have a presumably long-term exposure to diesel exhaust fumes, was analysed. As controls, men in industrial occupations of similar socio-economic status were selected. Cases were drawn from the Swiss mortality register for the years 1979-1983. Person-years were obtained using data from the 1980 census records. These two data files were combined by occupation, age class and socio-economic status. Age adjusted incidence rates were calculated applying Poisson regression. To control for tobacco related lung cancer mortality an indirect adjustment was undertaken. Using information about the smoking habits of the people in the occupations under study, smoking-attributable lung cancer mortality was accounted for by incorporating Axelson's technique into multivariate regression modeling. The mortality ratio for lung cancer for chauffeurs with respect to the controls was 2.27, which is significantly in excess of 1:95% CI (1.99, 2.58). Other tobacco related diagnoses such as bladder cancer, esophageal cancer and ischemic heart diseases showed excess risks as well. After accounting for smoking, a slight but significant increase in lung cancer mortality remained among chauffeurs (mortality ratio 1.48, 95% CI: 1.30, 1.68). In summary, the present results do support the hypothesis that diesel exhaust is a significant cause of lung cancer.

MORTALITY AND CANCER INCIDENCE OF WORKERS EXPOSED TO CHRYSOTILE ASBESTOS IN THE FRICTION-PRODUCTS INDUSTRY

Three studies provide data on this topic. The largest was at the Ferodo factory in the U.K. There was no evidence of an overall excess in mortality from all causes, and in particular no increase in mortality due to lung cancer. Also, there was no evidence of any dose-response effect for lung cancer. There were 13 mesotheliomas but for 10 of these there had been exposure to crocidolite whilst working on a special contract that only a small minority of the workforce were involved in. Another one had worked in an asbestos-cement factory for 20 years. This left two mesotheliomas, one unconfirmed, for which the only known exposure was to chrysotile asbestos. The second study was of a plant in Connecticut. There was a significant increase in mortality due to respiratory cancer, but this excess was greatest in those with less than 1 year's exposure and was unrelated to cumulative exposure. No mesotheliomas occurred. The third study was of two factories in Ontario manufacturing automotive components. There was a non-significant increase in lung cancer mortality but the majority of these had not worked in the departments where asbestos was used. There were two unconfirmed mesotheliomas, one of whom had worked with friction materials. In conclusion, the three studies show that, if there are any effects on mortality due to working in the manufacture of friction materials, these effects must be small.

Unusually high indoor radon concentrations from a giant rock slide

In a village in western Tyrol, Austria (Umhausen, ∼ 2600 inhabitants) unusually high indoor radon concentrations were measured. The medians were found to be 3750 Bq/m 3 (basements) and 1160 Bq/m 3 (ground floors) in winter, and 361 Bq/m 3 (basements) and 210 Bq/m 3 (ground floors) in summer. Maximum radon concentrations of up to 274 000 Bq/m 3 were registered. The unusually high radon concentrations are due to the geology of the locality. The part of Umhausen with the highest radon concentrations is built on an alluvial fan of a giant rock slide (granitic gneiss). Measurements of the radon exhalation rate from soil showed a median of 0.4 Bq/m 2/s, measurements of the radium content of rock samples yielded a median of 125 Bq/kg. The material of the rock slide is heavily fractured so that an elevated emanating power and an increased diffusion coefficient for radon in soil must be assumed. Given a diffusion coefficient of 8 × 10 −6 m 2/s and a emanating power of 0.3, the median exhalation rate of 0.4 Bq/m 2/s is obtained at a radium concentration of 125 Bq/kg. The rock slide is therefore considered to be the main source of radon. The abnormally high radon concentrations in Umhausen coincide with a statistically significant increase in lung cancer mortality (age and sex standardized mortality rate = 3.9, 95% C.I.: 2.9–5.1); the control population of the entire Tyrol (630 000 inhabitants).

La Contribucién del Tabaco y de Otros Hábitos de Vida a la Mortalidad por Cáncer de Pulmón en España de 1940 a 1988

Because the causal relationship between tobacco smoking and lung cancer has been clearly established, we have set out to measure its magnitude among the Spanish population in the time period 1940-1988 using observational methods. To do so, we have carried a time series study of ecological data. Information on lung cancer mortality, tobacco smoking and other potential predictors of lung cancer has been elaborated from official statistics. Data analysis has been performed by graphical methods and multiple linear regression techniques. Lung cancer mortality, tobacco smoking, total lipid intake and the Spanish wealth, as measured by national per caput income and gross domestic product, have increased very importantly over the study period. After controlling for the effect of lipids and alcohol intake, for every gram/per caput/day of increase in tobacco smoking in the period 1940-1988, there has been a 19% increase in lung cancer mortality with a 15 year lag. We conclude that tobacco smoking has fueled the lung cancer epidemic in Spain during the study period. This finding provides additional arguments for the implementation of tobacco control programmes in our country.

Unusually high indoor radon concentrations

Abstract Measurements of indoor radon concentrations in the village Umhausen (2600 inhabitants, Otztal valley, Tyrol, Austria) revealed unusually high indoor radon concentrations up to 274,000 Bq m −3 . The medians measured on the basements were 3750 Bq m −3 in winter and 361 Bq m −3 in summer, those on the ground floors were 1180 Bq m −3 and 210 Bq m −3 , respectively. Seventy-one per cent of the houses showed basement radon concentrations above the Austrian action level of 400 Bq m −3 in winter, 33% in summer. There are indications that the high radon concentrations are due to a giant rock slide about 8700 years ago. The unusually high radon concentrations in Umhausen coincide with a statistically significant increase in lung cancer mortality. For the period 1970–1991 the age and sex standardized mortality rate is 3.85 (95% confidence interval: 2.9 to 5.1). The control population is the total population of Tyrol (630,000 inhabitants).

Adult mortality from leading sites of cancer in Italy and a note on European data.

An overview is given of recent patterns of trends in cancer mortality in various age groups in Italy and, for comparative purposes, in other European countries. Important changes in mortality for several major cancer sites have been observed over the last two decades, such as the declines in gastric cancer or the increases in lung cancer mortality. These are difficult to understand and justify from an epidemiological and public health viewpoint, since the main cause of lung cancer (cigarette smoking) has long been known, while the determinants of stomach cancer are still largely undefined. Changes were minor, and inconsistent across countries, for other major cancers, such as intestines or breast. Furthermore, trends were systematically more favourable in young adults (and, to a less extent middle age), as compared to the elderly. The decline in young adults reflects more favourable exposure to risk factors (eg declined smoking prevalence, better diet), but also improvements in diagnostic and therapeutic procedures for some cancers. Due caution is required in any extrapolation, particularly since the distribution of the most common types of cancer changes in subsequent age groups. These favourable trends in young adults offer, none the less, important (and positive) indications as to the likely future trends when the same generations will reach middle and older age.

Use of a multistage model to predict time trends in smoking induced lung cancer.

The aims were to use a mathematical model to predict the time course of smoking induced lung cancer, and to investigate to what extent the most recent increases in lung cancer mortality are due to cigarette smoking. A mathematical model was developed and solved by simulation to construct detailed smoking histories of the US white male population given available prevalence data by age and cohort. A multistage carcinogenesis model was used to predict the time course of smoking induced lung cancer given the detailed smoking histories. SOURCE OF DATA AND MODEL PARAMETERS: The smoking prevalence figures were taken from work by Harris who calculated them using data collected in the Health Interview Survey. The parameters of the multistage model were taken from Whittemore who fitted the model to several sets of smoking and lung cancer data. The smoking model was used to construct detailed smoking histories of the US white male population from 1900 to 1985. In turn the multistage model was used to predict age and cohort specific smoking induced lung cancer mortality rates over this period. These results were compiled to predict the overall age adjusted trend in smoking induced lung cancer from 1970 to 1985. The model predicts a 12% decline in smoking induced lung cancer for this group over the 15 year period. The model calculations predict a 12% decline in smoking induced lung cancer for this group, during a period when the actual total rate of lung cancer increased by 26%. Taken together with the decline in average tar content in cigarettes over this period, and the relatively constant dose rate among smokers, these results strongly suggest that the recent increase in lung cancer among white males in the USA is due entirely or in large part to factors other than cigarette smoking.

Trends in cancer mortality, France 1950-1985

Trends in mortality for main cancer sites in France between 1950 and 1985 are presented by sex. In the population aged 35-65, where long term trends can most reliably be assessed, an overall 1.1% mean annual increase is observed for males and a 0.6% mean annual decrease is observed for females. For males, this increase in total cancer mortality is mostly due to the sites associated with tobacco and alcohol. The important increase for lung cancer, and lesser increases for bladder, pancreas and kidney cancers are related to the increase in tobacco consumption from 4.7 g per adult per day in 1950 to 6.3 g in 1976. For cancer sites associated with alcohol and tobacco, namely oesophagus, pharynx, larynx, tongue and mouth, mortality is increasing similarly for males and for females, although these cancers are much less frequent among females. For females, the overall moderate decrease is mostly due to the decrease in cervix and stomach cancer mortality, uncompensated by the observed increase in breast cancer; there is no marked increase in lung cancer mortality for women, contrary to what is observed in other Western countries.

Changing Mortality Patterns for Major Cancers in Spain, 1951–1985

Mortality trends for main cancer sites in Spain from 1951-1985 are presented. Age-standardized mortality rates per 100,000 were computed using the direct method. The Spanish population of 1970 was used as the standard. Age-standardized mortality rates for total cancer showed a marked increase among men throughout the period of study. This can be attributed mainly to the increase in lung cancer mortality (from 8.63 person-years to 44.74 between 1951 and 1985), which was only partially balanced by a reduction in the stomach cancer mortality (from 36.18 to 18.31). Among women the increase in total cancer is lower overall. It occurred mainly during the 1950s and thereafter the trend has remained stable and even declined in recent years. Lung cancer mortality rates among women have remained fairly stable and stomach cancer followed the same pattern as for men. Breast cancer mortality increased constantly during the period (from 7.21 to 19.38) but it was not until 1978 that it became the leading cause of cancer mortality among women.

Patterns of cigarette smoking and trends in lung cancer mortality in Italy.

Cigarette consumption has increased steadily throughout this century in Italy. There were marked increases in three periods: in the 1920s, in the 1950s possibly due to the spread of smoking among young men, and in the 1970s in part due to smoking among women. The average number of cigarettes per adult per day sold legally in 1980 was 6.9 but, taking smuggling into account, the actual average number of cigarettes smoked per day is likely to range between eight and nine. Data from a national sample-based survey conducted in 1980 showed that smoking prevalence in men was broadly similar within age groups, geographical area, education, and socioeconomic groups. Smoking in women, on the other hand, was concentrated in younger and more educated women living in larger towns and in richer areas of the country. This pattern is typical of a recent rapid spread of smoking among women. The average tar yield of Italian cigarettes in 1983-4 was about 17 mg. Tar yield was strongly and negatively correlated with price (r = -0.55). This abnormality should be urgently reversed by government intervention. No material increase in lung cancer mortality in young women was evident up to the lat 1970s. Lung cancer death rates in men correlated closely with the observed changes in cigarette consumption. The highest mortality rates (about 7, 20, and 50/100 000 respectively in the age groups 35-39, 40-44, and 45-49) were reached by the generation born around 1927-30, and the rates have remained fairly constant around these maximum levels for those born up to 1940. As a consequence, Italian lung cancer death rates in middle-aged men (45 to 54) are currently the highest registered in developed countries, and large upward trends are currently detectable in older men.

Trends in cancer mortality in Italy, 1955-1978.

Trends in age-specific and age-standardized cancer death certification rates in Italy from 1955 to 1978 were analyzed. In males total cancer mortality rates increased in all age groups. However, when respiratory and other tobacco-related neoplasms were excluded, death certification rates were roughly stable up to age 64. Moderate decreases in overall cancer mortality have been apparent at younger ages (35-44) since the early 1970's. In females, all the age-specific and the age standardized, under-65 death certification rates decreased; the downward trends were more pronounced (-18.5%) in the younger age group considered (35-44 years). Respiratory cancer mortality increased sharply in males: lung cancer death rates reached a plateau in the early 1970's in the 35-44-year age group, but increased at all subsequent ages. In females, the increase in lung cancer mortality was about 50% in the 45-54 and 55-64-year age groups, but no upward trend was evident in younger women. Other tobacco-related cancers (mouth or pharynx, larynx, esophagus, pancreas, kidney and bladder) also rose considerably. In both sexes, gastric cancer mortality dropped about 50% below age 65, but mortality rates from cancer of the stomach were still considerably higher than in other Western countries. Likewise, mortality from cancer of the (cervix) uteri decreased markedly, mostly in younger age groups. Upward trends in death certification rates were evident for cancers of the bowel (colon and rectum, about 50% in males, and 35% in females below age 65), and of the breast in females. However, these trends have levelled off since the late 1960's, at least in the younger age groups. Certified death rates from cancer of the skin (melanoma) increased over all the periods considered in the young of both sexes. Cancer mortality rates showed marked increases in older (greater than or equal to 65) males, but this can be partially explained in terms of better case ascertainment and more accurate death certification.

Mortality Among a Cohort of U.S. Cadmium Production Workers—an Update

A previous retrospective mortality study of 292 U.S. cadmium production workers employed for a minimum of 2 years showed increased mortality from respiratory and prostate cancer and from nonmalignant lung disease. To examine further the mortality experience of these workers, investigators from the National Institute for Occupational Safety and Health extended the study to include 602 white males with at least 6 months of production work in the same plant between 1940 and 1969. Vital status was determined through 1978, which included the addition of 5 years to the original follow-up. Cause-specific mortality rates for seven causes of death potentially related to cadmium exposure were compared between the overall cohort and U.S. white males and between subgroups. Mortality from respiratory cancer and from nonmalignant gastrointestinal disease was significantly greater among the cadmium workers than would have been expected from U.S. rates. All deaths from lung cancer occurred among workers employed for 2 or more years. A statistically significant dose-response relationship was observed between lung cancer mortality and cumulative exposure to cadmium. A 50% increase in lung cancer mortality, which was not statistically significant, was observed even among workers whose cumulative exposure to cadmium was between 41 and 200 micrograms/m3 over 40 years. Since the previous investigation, no new deaths from prostate cancer and no excess of deaths from nonmalignant respiratory disease have been observed.

An analysis of lung cancer risk from exposure to hexavalent chromium.

Lung cancer risk in relation to airborne levels of hexavalent chromium was analyzed for chromium chemical production workers studied by Hayes, Lilienfeld, and Snell. Hayes et al [18] had observed statistically significant increases in lung cancer mortality among chromium chemical production workers hired during 1945-1959 and followed to mid-1977. A dose-response was observed by Hayes et al. in that long-term workers had a higher lung cancer risk than short-term workers. Concurrent exposure data for the study plant were abstracted from the records of a local health department. The usual air concentration of hexavalent chromium was estimated as 413 micrograms per cubic meter (micrograms/m3) during 1945-1949. Cumulative exposure estimates for individual workers could not be developed with available information. Instead, cumulative exposures in terms of micrograms/m3-years were estimated for groups of short-term workers and long-term workers (cumulative exposure = usual exposure level in micrograms/m3 X average length of exposure). For workers hired during 1945-1949, cumulative exposures were estimated as 670 and 3,647 micrograms/m3-years for short-term and long-term workers, respectively. Like most estimates based on historical data, these exposure estimates are subject to uncertainty. Nevertheless, these results suggest a potential excess risk of death from lung cancer among U.S. workers exposed to the current permissible exposure limit (PEL) for hexavalent chromium of 52 micrograms/m3 because such workers could accumulate exposures (micrograms/m3-years) similar to those associated with excess risk in Hayes et al's cohort. Moreover, many current workers are estimated to be exposed to levels above the PEL. Further exploration of the dose-response relationship for chromium carcinogenesis is indicated.

Cardiovascular mortality trends in Minnesota, 1960–1978. The Minnesota heart survey

Age-adjusted mortality rates from coronary heart disease (CHD) and other causes were examined in Minnesota for the years 1960–1978. Regions differed in CHD mortality levels and time trends. The greatest decline in CHD mortality occurred in the Twin Cities. The Northeast region had the highest CHD mortality. Influenza and pneumonia death rates were unrelated to CHD trends. Stroke mortality, which also declined sharply, showed no regional differences. Cancer mortality was highest in the Twin Cities and Northeast regions and increased significantly over the period; most of this increase was due to a striking increase in lung cancer mortality. The authors conclude that: (1) the CHD mortality decline in Minnesota was similar to that in the United States; (2) regional differences within the state in CHD mortality levels and trends were statistically significant; (3) CHD trends were not explained by influenza epidemics; (4) regions differed in mortality rates for hypertension in the same way as they did in CHD mortality, but differed little in stroke mortality. This leaves unclear the role of hypertension in regional CHD differences. (5) Trends in cancer mortality indicate that a general decline in mortality, due to factors affecting a wide variety of diseases, does not explain the downward trends in CHD mortality.

Changing patterns of lung cancer in the United States.

Although mortality from lung cancer increased throughout the United States during 1950-1975, the rate of change varied according to sex, race, and geographic sector. A pronounced shift in the geographic pattern of lung cancer was seen in white males. The elevation in rates in urban counties of the north in the 1950s faded over time and was not observed in the 1970s. The highest rates during 1970-1975 were in the south, both in rural and urban areas, particularly at younger ages. The sharpest rise in US mortality rates was reported among nonwhite males. Cohort analysis revealed that for males born before 1885 age-specific rates among whites exceeded those among nonwhites by nearly 50%, but for those born after 1915 a 50% excess was seen among nonwhites. Among nonwhite males the highest mortality in the 1970s occurred in urban areas of the south. Among females the rate of increase in lung cancer mortality was higher in the 1970s, but racial and geographic differences tended to be minor. Cigarette smoking accounts for a substantial part of the shifting patterns of lung cancer, but it is likely that other factors are involved, including industrial exposure (e.g., exposure to asbestos in shipyards during World War II) and possibly nutritional deficiencies and other determinants yet to be identified.

Lung cancer and smoking in a group of iron ore miners.

Several studies have shown that miners, in both uranium and nonuranium mines, have an increased lung cancer mortality, probably caused by exposure to radon and its daughters. The excess mortality has been observed primarily among smoking miners but some recent studies have also indicated a considerably increased risk among nonsmoking miners. This study, among a group of iron ore miners, was undertaken to further elucidate the somewhat unclear and presumably complex relationship of mining, smoking, and lung cancer. The results show a 16-fold increase in lung cancer mortality among miners versus nonminers. Even nonsmoking miners seem to be at a rather high risk of developing lung cancer, but there was a tendency for the most heavy smoking miners to die earlier and to have a slightly shorter induction-latency period for development of lung cancer than was found among the nonsmoking miners.

Trends of lung cancer in northern Florida.

Although the entire state of Florida has experienced an increase in lung cancer mortality during the present decade, a differential rise among white men has been observed in Duval, a county in its northeastern region. This increase is not explained by population changes or migration of cases. It is hypothesized that an industrial exposure involving paper and pulp manufacturing, shipbuilding, or petroleum may account for these findings.