Lung Cancer Mortality In Men Research Articles

Cancer mortality in chrysotile miners and millers, Russian Federation: main results (Asbest Chrysotile Cohort-Study)

Background. We investigated mortality in workers of the world’s largest chrysotile mine and enrichment factories located in the town of Asbest, Russian Federation.
 Methods. This historical cohort study included all workers employed for at least 1 year between 1975 and 2010 and follow-up until the end of 2015. Cumulative exposure to dust was estimated based on workers’ complete occupational history linked to dust measurements systematically collected from the 1950s. Exposure to chrysotile fibers was estimated using dust-to-fiber conversion factors. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated as mortality rate ratios in Poisson regression models.
 Results. A total of 30 445 (32% women) workers accumulated 721 312 person-years at risk and 11 110 (36%) died. Of the workers, 54% had more than 30 years since their first exposure. We found an exposure-response between cumulative dust and lung cancer mortality in men. No clear association with dust exposure but a modest increase in the highest category of fiber exposure was seen for lung cancer in women. Mesothelioma mortality was increased (RR=7.64, 95% CI=1.18 to 49.5, to at least 80 fibers per cm3 years and RR=4.56, 95% CI=0.94 to 22.1, to at least 150 mg/m3 years [dust]), based on 13 deaths. For colorectal and stomach cancer, there were inconsistent associations. No associations were seen for laryngeal or ovarian cancer.
 Conclusion. In this large-scale epidemiological study in the world’s largest active asbestos mine, we confirmed an increased risk of mesothelioma with high fiber exposure and an increasing mortality for lung cancer in men with increasing dust exposure. Less clear-cut increased lung cancer mortality was seen in the women. Continued mortality follow-up is warranted.

Cancer mortality in chrysotile miners and millers, Russian Federation: main results (Asbest Chrysotile Cohort-Study).

We investigated mortality in workers of the world's largest chrysotile mine and enrichment factories located in the town of Asbest, Russian Federation. This historical cohort study included all workers employed for at least 1 year between 1975 and 2010 and follow-up until the end of 2015. Cumulative exposure to dust was estimated based on workers' complete occupational history linked to dust measurements systematically collected from the 1950s. Exposure to chrysotile fibers was estimated using dust-to-fiber conversion factors. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated as mortality rate ratios in Poisson regression models. A total of 30 445 (32% women) workers accumulated 721 312 person-years at risk and 11 110 (36%) died. Of the workers, 54% had more than 30 years since their first exposure. We found an exposure-response between cumulative dust and lung cancer mortality in men. No clear association with dust exposure but a modest increase in the highest category of fiber exposure was seen for lung cancer in women. Mesothelioma mortality was increased (RR = 7.64, 95% CI = 1.18 to 49.5, to at least 80 fibers per cm3 years and RR = 4.56, 95% CI = 0.94 to 22.1, to at least 150 mg/m3 years [dust]), based on 13 deaths. For colorectal and stomach cancer, there were inconsistent associations. No associations were seen for laryngeal or ovarian cancer. In this large-scale epidemiological study in the world's largest active asbestos mine, we confirmed an increased risk of mesothelioma with high fiber exposure and an increasing mortality for lung cancer in men with increasing dust exposure. Less clear-cut increased lung cancer mortality was seen in the women. Continued mortality follow-up is warranted.

The lag effect of 24-year tobacco consumption on lung cancer mortality in Henan Province, China, 1992 to 2016.

Tobacco exposure is the major risk factor for lung cancer. Previous studies have shown that there is a correlation between tobacco consumption and lung cancer mortality, but they do not show a specific trend. This study established the polynomial distributed lags (PDLs) model to explore the distributional lag effect between tobacco consumption and lung cancer mortality by using the lung cancer mortality rate of residents in Henan Province and the annual per capita tobacco consumption data from 1992 to 2016 and adopted dynamic simulation prediction method to predict lung cancer mortality for the next 20years. We found that per capita tobacco consumption had a 10-year lag effect on lung cancer mortality. The harm of tobacco consumption did not show in the first 4years, but after a lag of 4years or more, the lung cancer mortality in men was higher than that in women, with a peak effect occurring 10years later. The prediction showed that if per capita tobacco consumption was controlled, lung cancer mortality would show a steady decline trend after 10years. These results suggested that tobacco consumption and lung cancer mortality were asynchronous, with a lag effect of tobacco use on the occurrence of lung cancer.

Explaining spatial patterns of lung cancer mortality in Russia

ABSTRACT Socialization theory assumes that socialization agents, such as family, school, and church, inculcate human values and behaviors. The current study proposes that socialization has affected social acceptability of tobacco use. The analysis identifies socio-demographic risk factors, as measured in two postwar Soviet censuses, for age-adjusted lung cancer mortality in Russia in 2014−2018, using findings from the micro-level. Based on the 1959 and 1970 National Census results, three pairs of principal components were extracted corresponding to three socialization agents. A general-to-specific strategy was used to specify a spatial model and resulted in a spatial autoregressive model with autoregressive disturbances. Four spatial models show consistently that the strength of informal institutions in the postwar societies (i.e. at the socialization stage) was spatially related to a lower age-adjusted lung cancer mortality in men and women. Also, urban style of living and low education in the postwar societies were spatially related to an elevated age-adjusted lung cancer mortality in men. It is concluded that socialization theory can explain spatial variation in age-adjusted lung cancer mortality. The observed latitudinal spatial clustering of age-adjusted lung cancer mortality in the European part of the country remains consistent with the previous research on the spatial variation in violent mortality and suicide mortality.

Radon R222 flux associations with standardized mortality rates of lung cancer in men and women in Spain

Background/Aim: López-Abente et al. (2017) found a linear significant relationship between residential concentration of radon and mortality for lung, stomach and brain cancer in women in Galicia (Spain). Karsten et al. (2015) presented a method applied for developing a high-resolution 222Rn flux map for Europe, based on a parameterization of gas production depending on soil properties, uranium content, moisture and transport in the soil. Aim of our exploratory study was to check association between 222Rn flux values and standartised mortality rates (SMR) of lung cancer in men and women in 48 regions of Spain. Methods: 222Rn flux data were calculated as per Karsten et al. (2015) methods. The epidemiological data on lung cancer mortality in men and women by region were taken from free available source (Carlos III Institute). Paired t-differences were used to observe the statistically significant differences in seasonal variations of 222Rn flux. Regression analysis was performed to observe the relationship of epidemiological data with 222Rn flux. Results: Statistically significant differences were found between seasonal variations: winter / spring vs. summer / autumn (but not between winter and spring or summer and autumn) in 222Rn flux parameters. The higher values were related to summer and autumn period (by a factor 1.4 in average). Regression analyses reveled statistically significant associations between SMR of lung cancer in men and Rn flux in summer/autumn: R2=0.15, p=0.007), winter/spring: R2=0.10, p=0.002). No any significant relationship was found for women in this study. Conclusions: In spite of study limitations (not availability of epidemiological data for the periods posteriors to measurements to perform time series analyses with associations related on time lags); 222Rn flux data could be used as proxies comparable to 222Rn concentrations. Further comparative studies with similar data on indoor concentration vs. flux are to be performed and analyses with corresponding epidemiological data.

Lung Cancer Mortality in China: Spatial and Temporal Trends Among Subpopulations

Background: Little is known regarding spatial and temporal trends of lung cancer mortality (LCM) among subpopulations in China. The study identified the changing spatial and temporal patterns of LCM across China as a whole and in different subpopulations (ie., region, age, and sex). Methods: The data on LCM for the period of 2006 to 2015 by region, age, and sex were extracted from the Chinese National Death Surveillance. Joinpoint regression and seasonal decomposition were used to assess the temporal trends of LCM. Geographic information system and spatial kriging interpolation were used to examine the spatial distributions of LCM. Findings: LCM was highest in men aged 70+ (annual average mortality rate 397·2 (95%CI (394·6-399·8)) per 100,000 person-years). LCM rate in men aged 30 to 49 significantly declined from 2009 to 2015 (annual percentage change: -2·7%, P<0·05). However, LCM continued to rise in men aged 70+ and women aged 50+ in the east, men and women aged 50 to 69 in the south, and most groups in the southwest. Among provincial capital cities, Shenyang, Changsha, and Hohhot had the highest ten-year average LCM rates for men aged 30 to 49, 50 to 69, and 70+, respectively, while among all ages of women, Harbin had the highest ten-year average LCM rates. When dividing the period by 5 years, the odds of the increases in LCM in men and women aged 30 to 49 and 50 to 69 decreased by 3% to 7% with the longitudes increasing by 1° (OR ranged from 0·93 (95%CI 0·90-0·95) to 0·97 (95%CI 0·95-0·99)), and decreased by 5% to 6% with the latitudes increasing by 1° (OR ranged from 0·94 (95%CI 0·91-0·97) to 0·95 (95%CI 0·92-0·98)). Interpretation: Disparities in the spatial and temporal patterns of LCM among different subpopulations support the need for long-term LC surveillance covering larger geographical areas in China and the need for exploration of possible socio-environmental drivers in a spatiotemporal context. Further investigation into the potential risk factors for rising LCM are urgently required in the east, south, and southwest of China. Funding Statement: For continuous support and assistance, we thank Peng Yin, Jiangmei Liu, and Yunning Liu (National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention). We thank all research staff from local Center for Disease Control and Prevention for collection of data. N Wang was supported by the Queensland University of Technology Postgraduate Research Award and Queensland University of Technology Higher Degree Research International Tuition Fee Sponsorship. K Mengersen is supported by the ARC Center of Excellence in Mathematics and Statistical Frontiers. M Kimlin is supported through a Cancer Council Queensland Professorial Chair. W Hu is supported by ARC future fellowship (FT140101216). Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The study has been approved by the Human Research Ethics Committee of Queensland University of Technology (Reference No. 1700001107).

Neutrophil‐to‐lymphocyte ratio and risk of lung cancer mortality in a low‐risk population: A cohort study

Neutrophil-to-lymphocyte ratio (NLR) is associated with poor prognosis in patients with lung cancer, but the predictive role of NLR on the risk of developing lung cancer is unknown. We investigated the association between NLR and lung cancer mortality in lung cancer-free adults. A cohort study was performed with 527,124 Korean adults who were free of lung cancer and were followed for up to 16 years. Vital status and lung cancer-related deaths were ascertained through national death records. Hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer mortality were estimated using a Cox proportional hazards model. During 4,567,495.8 person-years of follow-up, 574 lung cancer deaths were identified. A higher NLR was positively associated with lung cancer mortality. The multivariable-adjusted HR (95% CI) for lung cancer mortality comparing quintiles 2, 3, 4 and 5 of NLR to the lowest quintile were 1.26 (0.96-1.67), 1.23 (0.93-1.63), 1.33 (1.01-1.75) and 1.47 (1.13-1.92), respectively. The highest risk of lung cancer mortality was also observed in the highest NLR quintile among never-smokers and low-risk individuals after adjusting for lung function and other possible confounders. Platelet-to-lymphocyte ratio showed an inverse J-shaped association with lung cancer mortality in men but the trends in women, low-risk individuals or never-smokers were neither linear nor U-shaped. In this large cohort of young and middle-aged individuals, NLR was independently associated with increased risk of lung cancer mortality in low-risk individuals, indicating a role of systemic inflammation in lung cancer mortality in our study population.

Associations of Circulating Cytokines and Chemokines With Cancer Mortality in Men With Rheumatoid Arthritis.

To examine the potential of circulating cytokines and chemokines as biomarkers of cancer mortality risk in patients with rheumatoid arthritis (RA). Male participants in the Veterans Affairs RA registry were followed up from the time of enrollment until death or December 2013. Cytokines and chemokines were measured in banked serum obtained at the time of enrollment, using a bead-based multiplex assay, and a previously developed cytokine score was calculated. Vital status and cause of death were determined through the National Death Index. Associations of cytokines with cancer mortality were examined using multivariable competing-risks regression. Among 1,190 men with RA, 60 cancer deaths (30 of which were attributable to lung cancer) occurred over 5,307 patient-years of follow-up. The patients had a mean age of 64.5 years, had established disease (median duration 8.7 years), were seropositive for rheumatoid factor (81%) or anti-cyclic citrullinated peptide antibody (77%), and frequently had a history of smoking (82% current or former). Seven of 17 analytes examined were individually associated with cancer mortality. The cytokine score was associated with overall cancer (subhazard ratio [SHR] 1.42, 95% confidence interval [95% CI] 1.08-1.85) and lung cancer (SHR 1.86, 95% CI 1.57-2.19) mortality in multivariable analyses. Those in the highest quartile of cytokine scores had a >2-fold increased risk of overall cancer mortality (P = 0.039) and a 6-fold increased risk of lung cancer mortality (P = 0.028) relative to the lowest quartile. A synergistic interaction between current smoking and high cytokine score was observed. Serum cytokines and chemokines are associated with cancer and lung cancer mortality in men with RA, independent of multiple factors including age, smoking status, and prevalent cancer.

Abstract 1750: Sleepduration across the adult lifecourse and risk of lung cancer mortality in Xuanwei, China

Abstract Previous studies have implicated sleep duration as a risk factor for cancer incidence and all-cause mortality. However, to our knowledge, no study has addressed its relationship to lung cancer mortality among Chinese populations. Our objective was to evaluate the association between average sleep hours during various age periods, and risk of lung cancer mortality in rural Xuanwei, China. Men and women who were born in 1917-1951 and lived in Xuanwei as of Jan 1 1976 were recruited for this cohort study. A total of 42,421 participants interviewed in 1992 contributed data to this analysis. The exposure was average sleep hours in the age periods of: 21-30, 31-40, 41-50, and 51-60 years, categorized as ≤ 7, 8 (reference), 9, and ≥10 hrs/day. The outcome was time to lung cancer mortality in 1992-2009. Cases diagnosed in the first two years of follow-up were excluded to avoid reporting bias due to early, undiagnosed disease. Fine and Gray models with age as the time scale were used to estimate the hazard ratios (HR) and 95% confidence intervals (CI). Separate models were performed for each age period, and were adjusted for hours of indoor activities, respondent, secondary job, education, ethnicity, number of people and rooms in residence, fuel type and tons used, ventilation, smoking status and duration in men, mining work in men, and cooking age in women. Analyses were further stratified by sex and median age at baseline (≥ 61 and &amp;lt; 61 years). Non-linear relationships were found between sleep duration and lung cancer mortality. In men ≥61 years of age at baseline, ≥10 sleep hrs/day across adulthood was associated with substantially increased risks of lung cancer mortality compared to the recommended 8 sleep hrs/day [21-30 years: HR = 1.44 (95%CI: 1.00-2.07), 31-40 years: HR = 1.73 (95%CI: 1.15-2.59), 41-50 years: HR = 3.97 (95%CI: 2.64-5.97), and 51-60 years: HR = 3.55 (95%CI: 2.41-5.22). Furthermore, ≤ 7 sleep hrs/day in middle and later age was associated with significantly increased risks [41-50 years: HR = 1.56 (95%CI: 1.17-2.07) and 51-60 years: HR = 1.48 (95%CI: 1.15-1.92)]. Trends were similar in men &amp;lt;61 years of age at baseline for the later age period. In women ≥61 years of age at baseline, ≥10 sleep hrs/day in ages 41-50 and 51-60 years was associated with substantially increased risks [HR = 2.45 (95%CI: 1.37-4.37) and HR = 2.59 (95%CI: 1.61-4.17)]. However, no statistically significant associations with ≤ 7 sleep hrs/day were found. Similar trends were observed for women &amp;lt;61 years of age at baseline. These findings suggest that both excessive and insufficient sleep may be risk factors for lung cancer mortality. Sleep deficit was associated with increased risks of lung cancer mortality in men, but less apparent in women. However, overabundance of sleep was found to be detrimental in both men and women, particularly during later ages. This study enriches the body of evidence implicating sleep duration in risk of lung cancer. Citation Format: Jason Y. Wong, Robert S. Chapman, Wei Hu, Wei Jie Seow, Bu-Tian Ji, Bryan Bassig, Nathaniel Rothman, Qing Lan. Sleepduration across the adult lifecourse and risk of lung cancer mortality in Xuanwei, China. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1750.

Lung cancer mortality in European men: Trends and predictions

Lung cancer mortality in men from the European Union (EU) peaked in the late 1980s at an age-standardised (world standard population) rate over 53/100,000 and declined subsequently to reach 44/100,000 in the early 2000s. To provide a comprehensive picture of recent trends in male lung cancer mortality in Europe, we analyzed available data from the World Health Organization up to 2009 and predicted future rates to 2015. Lung cancer mortality rates in EU men continued to fall over recent years, to reach a value of 41.1/100,000 in 2005–2009. The fall was similar at all-ages and in middle-aged men (less than 2% per year over most recent years), but was appreciably larger in young men (aged 20–44years, over 5% per year). A favourable trend is thus likely to be maintained in the foreseeable future, although the predicted overall EU rate in 2015 is still over 35/100,000, i.e., higher than the US rate in 2007 (33.7/100,000). Over most recent calendar years, overall male lung cancer rates were around 35–40/100,000 in western Europe, as compared to over 50/100,000 in central and eastern Europe. Within western Europe, lung cancer rates were lower in northern countries such as Sweden, but also Finland and the UK (below 30/100,000), where the tobacco-related epidemic started earlier and rates have long been declining, whereas mortality was high in Belgium (51.6), France (42.3), the Netherlands and Spain (around 43.0), where the epidemic started later but is persisting. Widespread measures for smoking control and cessation in middle-aged European men, i.e., in the generations where smoking prevalence used to be high, would lead to appreciable reductions in male lung cancer mortality in the near future. This is particularly urgent in central and eastern European countries.

Trends in lung cancer mortality in South Africa 1995–2008

ObjectivesCancers remains a major cause of morbidity and mortality in the world today. The global burden of cancer is expected to continue to increase with much of the burden being...

Trends in lung cancer mortality in South Africa: 1995-2006.

BackgroundCancer remains a major cause of morbidity and mortality worldwide. In developing countries, data on lung cancer mortality are scarce.MethodsUsing South Africa's annual mortality and population estimates data, we calculated lung cancer age-standardised mortality rates for the period 1995 to 2006. The WHO world standard population was used as the reference population. Scatter plots and regression models were used to assess linear trends in mortality rates. To better characterise emerging trends, regression models were also partitioned for defined periods.ResultsLung cancer caused 52,217 deaths during the study period. There were 4,525 deaths for the most recent year (2006), with men accounting for 67% of deaths. For the entire South African population, the age-standardised mortality rate of 24.3 per 100,000 persons in 1995 was similar to the rate of 23.8 per 100,000 persons in 2006. Overall, there was no significant decline in lung cancer mortality in South Africa from 1995 to 2006 (slope = -0.15, p = 0.923). In men, there was a statistically non-significant annual decline of 0.21 deaths per 100,000 persons (p = 0.433) for the study period. However, from 2001 to 2006, the annual decline of 1.29 deaths per 100,000 persons was statistically significant (p = 0.009). In women, the mortality rate increased significantly at an annual rate of 0.19 per 100,000 persons (p = 0.043) for the study period, and at a higher rate of 0.34 per 100,000 persons (p = 0.007) from 1999 to 2006.ConclusionThe more recent declining lung cancer mortality rate in men is welcome but the increasing rate in women is a public health concern that warrants intervention. Smoking intervention policies and programmes need to be strengthened to further reduce lung cancer mortality in men and to address the increasing rates in women.

Acute and Long-term Excess Mortality After Polychlorinated Biphenyls and Polychlorinated Dibenzofurans Mixed Exposure From Contaminated Rice Oil: Yusho

PP-29-073 Background/Aims: In Japan in 1968, rice-oil contaminated by polychlorinated biphenyls and polychlorinated dibenzofurans (PCDFs) caused severe food poisoning, termed “Yusho” (oil disease). Several previous studies of Yusho attempted to evaluate the effects of exposure using standard mortality ratios (SMRs), and showed the relationship with total, liver, and lung cancer mortality in men. The findings, however, may have been compromised by disease misclassification or an inappropriate reference population. Therefore, we conducted an area-based SMR study to overcome several limitations of the previous studies. Methods: We adopted the population of a severely affected area (Tamanoura area) as the exposed group, with a reference population from Nagasaki prefecture in Kyushu, which included the Tamanoura area. A large number of residents in Tamanoura were exposed to the rice oil. We estimated SMRs of cancer and noncancer diseases and their confidence intervals (CIs) for the years 1968–2002. Results: In the first 10 years, SMRs of all causes, diabetes mellitus, heart diseases, hypertensive disease, pneumonia/bronchitis, stomach cancer, and bronchus/lung cancer were elevated. SMRs of heart diseases were 2.0 (95% CI: = 1.1–3.6) in 1968, 2.0 (95% CI: = 1.2–3.6) in 1969, and 1.9 (95% CI: = 1.1–3.6) in 1975. SMRs of bronchus/lung cancer were 3.8 (95% CI: = 1.2–11.8) in 1971 and 3.4 (95% CI: = 1.1–11) in 1974. SMRs of several cancers and intentional self-harm were elevated for decades after exposure. Conclusion: In this study, we present further evidence about health effects due to severe exposure to polychlorinated biphenyls and polychlorinated dibenzofurans in Yusho.

Lung Cancer Mortality Trend by Birth Cohort in Men, Tuscany, 1971–2006

In Tuscany, lung cancer mortality in men has shown a decreasing geographical trend over the last 3 decades from the most industrialized north-western coastal areas (Massa-Carrara, Viareggio) to the south-eastern areas (Arezzo, Siena), following the path of the development of industrial activities. The aim of the study was to evaluate lung cancer mortality in males by birth cohort in order to verify whether there was also a decreasing birth cohort trend in male lung cancer mortality rates between north-western and south-eastern Tuscan areas. Lung cancer deaths that occurred in men resident in Tuscany, 1971-2006, were analyzed by birth cohort, age group and local health authority area. Rates in men >65 years were significantly higher in Viareggio and Massa-Carrara than in the south-eastern areas for all generations, in particular for men born in 1896-1926. Rates for men aged 55-64 years were higher in Massa-Carrara and Viareggio than in south-eastern areas for men born before 1926, whereas for younger generations the rates leveled off. For men aged 45-54 years, rates were similar in all areas only for younger generations (men born around 1951 and 1956), whereas for men aged 35-44 years, rates were similar in all areas for all generations considered. The higher lung cancer mortality rates in men aged >65 years and born in 1896-1926 in the north-western areas than in those born in the south-eastern areas may indicate that the tobacco epidemic spread earlier in the north-western areas of Tuscany, following the path of industrialization. However, the higher mortality rates in north-western than in south-eastern areas are at least in part attributable to the high occupational risks for lung cancer experienced by workers in these areas during the first half of 20th century.

Increased Risk of Lung Cancer Mortality among Residents near an Asbestos Product Manufacturing Plant

We investigated whether individuals exposed to asbestos by living near an asbestos-manufacturing facility experienced increased lung cancer mortality. We studied a neighborhood around such a plant in the central Japanese city of Hashima. From 1943 to 1991 this plant produced insulation and packing material using amosite- and chrysotile-type asbestos fibers. The study group was comprised of 577 households. We obtained demographic information by a questionnaire and determined the underlying cause of death for deceased household members from death certificates. Using hourly meteorological data from local observatories, we estimated relative asbestos concentrations in the plant's vicinity, determined the quartile boundaries, and designated each study subject's quartile of ambient exposure. Finally, we calculated standardized mortality ratios to evaluate the association of residential asbestos with lung cancer risk. Our findings strongly suggest that neighborhood asbestos exposure can increase the risk of lung cancer mortality in men and probably in women.

Influence of cardiorespiratory fitness on lung cancer mortality.

Previous studies have suggested that higher levels of physical activity may lower lung cancer risk; however, few prospective studies have evaluated lung cancer mortality in relation to cardiorespiratory fitness (CRF), an objective marker of recent physical activity habits. Thirty-eight thousand men, aged 20-84 yr, without history of cancer, received a preventive medical examination at the Cooper Clinic in Dallas, Texas, between 1974 and 2002. CRF was quantified as maximal treadmill exercise test duration and was grouped for analysis as low (lowest 20% of exercise duration), moderate (middle 40%), and high (upper 40%). A total of 232 lung cancer deaths occurred during follow-up (mean = 17 yr). After adjustment for age, examination year, body mass index, smoking, drinking, physical activity, and family history of cancer, hazard ratios (95% confidence intervals) for lung cancer deaths across low, moderate, and high CRF categories were 1.0, 0.48 (0.35-0.67), and 0.43 (0.28-0.65), respectively. There was an inverse association between CRF and lung cancer mortality in former (P for trend = 0.005) and current smokers (P for trend < 0.001) but not in never smokers (trend P = 0.14). Joint analysis of smoking and fitness status revealed a significant 12-fold higher risk of death in current smokers (hazard ratio = 11.9, 95% confidence interval = 6.0-23.6) with low CRF as compared with never smokers who had high CRF. Although the potential for some residual confounding by smoking could not be eliminated, these data suggest that CRF is inversely associated with lung cancer mortality in men. Continued study of CRF in relation to lung cancer, particularly among smokers, may further our understanding of disease etiology and reveal additional strategies for reducing its burden.

Lung cancer mortality trends in 36 European countries: secular trends and birth cohort patterns by sex and region 1970–2007

Smoking is a major contributor to all-cause mortality in Europe and accounts for one-fifth of the cancer-related deaths. Monitoring the tobacco epidemic via an analysis of lung cancer trends is essential in helping countries arrest the effects of tobacco epidemic in the region. The study aims to provide a comprehensive and up-to-date overview of the temporal patterns of lung cancer mortality in Europe, emphasizing country- and sex-specific differences. National lung cancer mortality data were extracted from the WHO mortality databank by age, sex, year of death (1970-2007) for 36 countries in Europe. Trends in lung cancer mortality in men have tended to decrease in many European countries during the last two decades, particularly in North and Western Europe. Among women, mortality rates are still increasing in many countries, although in a few populations, rates are beginning to stabilize, notably in the high-risk countries within Eastern Europe (Hungary, Poland and the Czech Republic), and in Northern Europe (Denmark, Iceland and the United Kingdom). Men and women are clearly in very different phases of the smoking epidemic, and, as reflected in the mortality rates by birth cohort, the stage varies widely by country within each European region. That lung cancer mortality trends in men are on a downwards path in most European countries while female rates continue to rise, points to an urgent need for national and European prevention strategies that target tobacco cessation and prevention among European women.

Cancer Mortality in Italy, 2003

This report provides data and statistics for cancer mortality in Italy in 2003, updating previous work on the issue. Cancer death certification numbers by cause and estimates of the resident population in 2003, stratified by sex and quinquennium of age, were obtained from the World Health Organization database. In 2003, cause of death encoding was changed from the 9th to the 10th Revision of the International Classification of Diseases (ICD). All cancers and groups of cancers, classified according to the 10th revision of the ICD, were grouped into 30 categories, besides other and unspecified sites. Mortality rates were age-standardized on the world standard population in five-year age groups up to 80-84 years and 85+. The total number of cancer deaths in Italy was 167,144 in 2003 (96,127 men and 71,017 women), with age-standardized death rates of 160.63 and 89.32 per 100,000 inhabitants, respectively. Lung cancer mortality in men confirmed the favorable trend, with rates of 43.72/100,000 and 51.68/100,000 in the all ages and truncated groups, respectively. Most other tobacco-related cancers were also declining in men but not in women. Cancers of the female breast and uterus (cervix and corpus) continue to decrease, with overall rates of 17.11/100,000 and 3.71/100,000. Declines were also observed in stomach and testis cancers. A few cancer sites such as prostate and multiple myeloma appeared to rise, but these trends were mainly due to the ICD change and the stricter age-standardization categories (80-84 and 85+ instead of 80+). Trends in cancer mortality remained favorable for most major cancer sites, mainly in men for tobacco-related cancers. Due to the classification changes brought about by the change of ICD and the stricter age standardization, the present mortality rates should only be compared to previous ones with due caution.

Lung cancer mortality in European women: recent trends and perspectives

Lung cancer mortality in men has been declining since the late 1980s in most European countries. In women, although rates are still appreciably lower than those for men, steady upward trends have been observed in most countries. To quantify the current and future lung cancer epidemic in European women, trends in lung cancer mortality in women over the last four decades were analyzed, with specific focus on the young. Age-standardized (world standard) lung cancer mortality rates per 100,000 women-at all ages, and truncated 35--64 and 20--44 years-were derived from the WHO for the European Union (EU) as a whole and for 33 separate European countries. Joinpoint regression analysis was used to identify points where a significant change in trends occurred. In the EU overall, female lung cancer mortality rates rose by 23.8% between 1980--1981 and 1990--1991 (from 7.8 to 9.6/100,000), and by 16.1% thereafter, to reach the value of 11.2/100,000 in 2000--2001. Increases were smaller in the last decade in several countries. Only in England and Wales, Latvia, Lithuania, Russia and Ukraine did female lung cancer mortality show a decrease over the last decade. In several European countries, a decline in lung cancer mortality in young women (20--44 years) was observed over the last decade. Although female lung cancer mortality is still increasing in most European countries, the more favorable trends in young women over recent calendar years suggest that if effective interventions to control tobacco smoking in women are implemented, the lung cancer epidemic in European women will not reach the levels observed in the USA.

Trends in mortality from major cancers in the European Union, including acceding countries, in 2004

In May 2004, 10 additional countries joined the European Union (EU), including a total of 75 million inhabitants. Most of these were from central and eastern European countries with comparably high cancer mortality rates and with relatively unfavorable trends. Therefore, it is important to provide updated mortality data regarding major cancers in various countries and to analyze trends for the current population of the EU. The authors considered mortality rates (directly standardized to the world standard population) for all cancers and for 8 major cancer sites in the year 2000 in the 25 countries of the EU and analyzed corresponding trends since 1980 using data derived from the World Health Organization data base. For men, overall cancer mortality in the year 2000 varied by a factor > 2 between the highest rate of 258.5 per 100,000 men in Hungary and the lowest rate of 122.0 per 100,000 men in Sweden. Central and Eastern European accession countries had the highest rates not only for lung and other tobacco-related cancers but also for gastrointestinal cancers and leukemias. The geographic pattern was different and the range of variation was smaller for women, i.e., between 136.7 per 100,000 women in Denmark and 76.4 per 100,000 women in Spain in the year 2000. In the EU as a whole, lung cancer mortality in men peaked at 55.4 per 100,000 men in 1988 and declined thereafter to 46.7 per 100,000 men in 2000. Gastric cancer steadily declined from 19.7 per 100,000 men in 1980 to 10.1 per 100,000 men in 2000. Other major sites showed moderately favorable trends over the last few years. In women, breast cancer peaked at 21.7 per 100,000 in 1989 and declined to 18.9 per 100,000 in 2000. Mortality from gastric, (cervix) uterus, and intestinal cancers demonstrated steady decreases, but lung cancer increased from 7.7 per 100,000 women in 1980 to 11.1 per 100,000 women in 2000. The increase in lung cancer mortality in women age < 55 years was 38% between 1990 and 2000 (from 2.16 per 100,000 women to 2.99 per 100,000 women), reflecting the spread of tobacco smoking among women in the EU over the last few decades. The priority for further reduction of cancer mortality in the EU remains tobacco control together with more widespread availability of modern diagnostic and treatment procedures for neoplasms that are amenable to treatment.