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JNCI Journal of the National Cancer Institute 2001 93(4):277-283; doi:10.1093/jnci/93.4.277
© 2001 by Oxford University Press
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Journal of the National Cancer Institute, Vol. 93, No. 4, 277-283, February 21, 2001
© 2001 Oxford University Press

CANCER SURVEILLANCE SERIES

Recent Trends in Lung Cancer Mortality in the United States

Ahmedin Jemal, Kenneth C. Chu, Robert E. Tarone

Affiliations of authors: A. Jemal, R. E. Tarone (Division of Cancer Epidemiology and Genetics), K. C. Chu (Office of Special Populations Research), National Cancer Institute, Bethesda, MD.

Correspondence to: Ahmedin Jemal, Ph.D., D.V.M., National Institutes of Health, 6120 Executive Blvd., EPS 8049, Bethesda, MD 20892 (e-mail: Jemala{at}exchange.nih.gov).

Background: Previous age–period–cohort analyses of lung cancer incidence and mortality rates in the United States have demonstrated a decrease in risk by birth cohort through 1950, consistent with declining trends in smoking prevalence. This study was conducted to examine recent lung cancer trends, including trends among the cohorts born after 1950. Methods: Lung cancer mortality rates from 1970 through 1997 for whites aged 24–83 years and for blacks aged 30–83 years were investigated. Using age–period–cohort analyses with 2-year age and 2-year calendar-period intervals, we examined changes in the slope of the trends in birth-cohort and calendar-period effects. All statistical tests are two-sided. Results: There was an unexpected, statistically significant moderation in the rate of decrease of the birth-cohort trend in lung cancer mortality for whites born after 1950, with a corresponding smaller and statistically nonsignificant moderation for blacks. These data are consistent with smoking initiation rates: Rates of both cigarette and marijuana smoking initiation increased for children aged 12–17 years from 1965 through 1977. There was a statistically significant decrease in the slope of the calendar-period trend for lung cancer mortality in 1990 for both whites and blacks that was observed primarily in people 55 years of age and older. Conclusions and Implications: The birth-cohort pattern of lung cancer mortality after 1950 appears to reflect the early impact of teenage cigarette smoking on lung cancer risk in people under the age of 45 years, although a contribution from marijuana smoking cannot be ruled out. This result provides additional support for increasing smoking cessation and prevention programs for teenagers. The calendar-period decrease in lung cancer mortality after 1990 may reflect the long-term benefits of reductions in tobacco carcinogens in cigarettes and increases in smoking cessation beginning around 1960.


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