Objective: The aims of the study were to review long-term trends in lung cancer incidence, survival and mortality and, in light of these, to consider prospects for prevention.
Design: Descriptive epidemiological study.
Subjects: Incident cases of lung cancer, diagnosed 1959-1993, and registered with the Scottish Cancer Registry, and recorded deaths from lung cancer during 1919 to 1993.
Results: Scottish men and women continue to experience rates of lung cancer which are amongst the highest in the world. In men, incidence rose from 1959 to a peak in the late 1970s and is now decreasing steadily. In women, although starting from a lower baseline, incidence has risen steadily since 1959 (at an annual rate of increase of 5.0 per cent) and shows no evidence of a sustained decline. It is estimated that, between 1986 and 2000, the annual number of registrations in those aged under 85 years could fall by 20 per cent in men and rise by 8 per cent in women. Incidence in the most deprived areas of Scotland is twice that in the least deprived areas. Survival prospects have changed little over the last 25 years. In both sexes, trends in mortality mirror trends in incidence.
Conclusion: Although lung cancer incidence in men is falling, it is likely that we have not yet reached the peak of the lung cancer epidemic amongst women. As up to 90 per cent of these tumours are attributable to tobacco, measures to control this drug should be the main focus of prevention activities. Emphasis should be placed on efforts to cut smoking prevalence among women and the most deprived groups of society and to reduce the uptake of smoking amongst the young. The fact that some other countries report more favourable survival figures suggests that there may be scope for improvements in diagnosis and therapy. The formulation of guidelines for best current practice in the management of lung cancer should aid progress in this respect.