Annual report to the nation on the status of cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control

Abstract

Background: The American Cancer Society, the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information on cancer occurrence and trends in the United States. This year's report includes trends in lung cancer incidence and death rates, tobacco use, and tobacco control by state of residence.

Methods: Information on invasive cancers was obtained from the NCI, CDC, and NAACCR and information on mortality from the CDC's National Center for Health Statistics. Annual percentage changes in the age-standardized incidence and death rates (2000 US population standard) for all cancers combined and for the top 15 cancers were estimated by joinpoint analysis of long-term (1975-2005) trends and by least squares linear regression of short-term (1996-2005) trends. All statistical tests were two-sided.

Results: Both incidence and death rates from all cancers combined decreased statistically significantly (P < .05) in men and women overall and in most racial and ethnic populations. These decreases were driven largely by declines in both incidence and death rates for the three most common cancers in men (lung, colorectum, and prostate) and for two of the three leading cancers in women (breast and colorectum), combined with a leveling off of lung cancer death rates in women. Although the national trend in female lung cancer death rates has stabilized since 2003, after increasing for several decades, there is prominent state and regional variation. Lung cancer incidence and/or death rates among women increased in 18 states, 16 of them in the South or Midwest, where, on average, the prevalence of smoking was higher and the annual percentage decrease in current smoking among adult women was lower than in the West and Northeast. California was the only state with decreasing lung cancer incidence and death rates in women.

Conclusions: Although the decrease in overall cancer incidence and death rates is encouraging, large state and regional differences in lung cancer trends among women underscore the need to maintain and strengthen many state tobacco control programs.

Figure 1

Trends in age-standardized lung cancer incidence and death rates by sex, United States, 1975–2005. Solid lines represent fitted values based on joinpoint analyses. Squares represent observed rates. SEER-9 incidence data for 1975–2005 are from the Surveillance, Epidemiology, and Ends Results (SEER)-9 areas and or cover 10% of the US population. US incidence data from 1996 to 2005 are from 29 SEER and or National Program of Cancer Registries areas reported by the North American Association of Central Cancer Registries as meeting high-quality data standards and cover about 65% of the US population. SEER-9 incidence data are adjusted for delays in reporting, but US incidence data are not. US and SEER-9 mortality data for 1975–2005 are from the National Center for Health Statistics, 2005 Mortality Special Research File.

Figure 2

Trends in age-specific lung cancer incidence rates by year of diagnosis and sex, United States, 1975–2005. Data are from Surveillance, Epidemiology, and Ends Results (SEER)-9 areas, and data points are based on 2-y average rates with the exception of the last point, which averages 3-y rates (1975–1976, 1977–1978, …, 2001–2002, 2003–2005). The SEER-9 areas cover about 10% of the US population.

Figure 3

Trends in age-specific lung cancer death rates by year of death and sex, United States, 1950–2005. Rates include cancers of the lung, bronchus, pleura, and trachea. Data are from the National Center for Health Statistics, 2005 Mortality Special Research File.

Figure 4

Trends in age-specific lung cancer death rates by year of birth and sex, United States, 1865–1970. Rates include cancers of the lung, bronchus, pleura, and trachea. The points vertically above each cohort year portray the cohort's age-specific mortality experience. Data are from the National Center for Health Statistics, 2005 Mortality Special Research File.

Figure 5

Trends in age-standardized lung cancer death rate for the US and selected states by sex, 1975–2005. Solid lines represent fitted values based on joinpoint analyses. Squares represent observed rates. Data are from the National Center for Health Statistics, 2005 Mortality Special Research File.

Figure 6

Initiation of smoking among 12- to 17-year-old adolescents in the United States by sex, 1940–2000. All calculations to determine the year in which respondents began smoking were based on the survey administration date in conjunction with responses given in the survey regarding initiation age of “regular” use and current age. Data are from the Tobacco Use Supplements to the Current Population Survey (25,26). Means and 95% confidence intervals (error bars) are shown.