Histologic Lung Cancer Incidence Rates and Trends Vary by Race/Ethnicity and Residential County

J Thorac Oncol. 2018 Apr;13(4):497-509. doi: 10.1016/j.jtho.2017.12.010. Epub 2018 Jan 31.


Introduction: Lung cancer incidence is higher among non-Hispanic (NH) blacks than among the NH white and Hispanic populations in the United States. However, national cancer estimates may not always reflect the cancer burden in terms of disparities and incidence in small geographic areas, especially urban-rural disparities. Moreover, there is a gap in the literature regarding rural-urban disparities in terms of cancer histologic type.

Methods: Using population-based cancer registry data-Surveillance, Epidemiology and End Results and National Program of Cancer Registries data-we present age-adjusted histologic rates and trends by race/ethnicity and residential county location at the time of first cancer diagnosis. Rate ratios were calculated to examine racial/ethnic differences in rates. Annual percent change was calculated to measure changes in rates over time.

Results: We found that declines in squamous cell carcinoma are occurring fastest in metropolitan counties, whereas rates of adenocarcinoma increased fastest in counties nonadjacent to metropolitan areas. Further, although NH black men have increased lung cancer incidence compared with NH white and Hispanic men in all geographic locations, we found that the degree of the disparity increases with increasing rurality of residence. Finally, we discovered that among women whose lung cancer was diagnosed when they were younger than 55 years, the incidence of squamous cell carcinoma and adenocarcinoma was higher for NH blacks than for NH whites.

Conclusions: Our results highlight disparities among NH blacks in nonadjacent rural areas. These findings may have significant impact for the implementation of smoking cessation and lung cancer screening programs.

Keywords: Health disparities; Histology; Incidence; Lung cancer; Registry; Surveillance.

MeSH terms

  • Early Detection of Cancer
  • Ethnic Groups
  • Female
  • Humans
  • Incidence
  • Lung Neoplasms / epidemiology*
  • Lung Neoplasms / pathology
  • Male
  • Middle Aged