Smoking and Lung Cancer Mortality in the United States From 2015 to 2065: A Comparative Modeling Approach

Ann Intern Med. 2018 Nov 20;169(10):684-693. doi: 10.7326/M18-1250. Epub 2018 Oct 9.


Background: Tobacco control efforts implemented in the United States since the 1960s have led to considerable reductions in smoking and smoking-related diseases, including lung cancer.

Objective: To project reductions in tobacco use and lung cancer mortality from 2015 to 2065 due to existing tobacco control efforts.

Design: Comparative modeling approach using 4 simulation models of the natural history of lung cancer that explicitly relate temporal smoking patterns to lung cancer rates.

Setting: U.S. population, 1964 to 2065.

Participants: Adults aged 30 to 84 years.

Measurements: Models were developed using U.S. data on smoking (1964 to 2015) and lung cancer mortality (1969 to 2010). Each model projected lung cancer mortality by smoking status under the assumption that current decreases in smoking would continue into the future (status quo trends). Sensitivity analyses examined optimistic and pessimistic scenarios.

Results: Under the assumption of continued decreases in smoking, age-adjusted lung cancer mortality was projected to decrease by 79% between 2015 and 2065. Concomitantly, and despite the expected growth, aging, and longer life expectancy of the U.S. population, the annual number of lung cancer deaths was projected to decrease from 135 000 to 50 000 (63% reduction). However, 4.4 million deaths from lung cancer are still projected to occur in the United States from 2015 to 2065, with about 20 million adults aged 30 to 84 years continuing to smoke in 2065.

Limitation: Projections assumed no changes to tobacco control efforts in the future and did not explicitly consider the potential effect of lung cancer screening.

Conclusion: Tobacco control efforts implemented since the 1960s will continue to reduce lung cancer rates well into the next half-century. Additional prevention and cessation efforts will be required to sustain and expand these gains to further reduce the lung cancer burden in the United States.

Primary funding source: National Cancer Institute.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Computer Simulation
  • Female
  • Humans
  • Life Expectancy
  • Lung Neoplasms / epidemiology
  • Lung Neoplasms / mortality*
  • Lung Neoplasms / prevention & control
  • Male
  • Middle Aged
  • Prevalence
  • Smoking / adverse effects*
  • Smoking / epidemiology
  • Smoking / trends
  • Smoking Cessation
  • United States / epidemiology