© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 8, 659,
April 21, 1999
© 1999 Oxford University Press
MEMORANDUM FOR: Science Writers and Editors on the Journal Press List
April 15, 1999 (EMBARGOED FOR RELEASE 4 P.M. April 20)
Cancer Incidence and Mortality Decline 1990-1996
From 1990 through 1996, the cancer death rate in the United States was down for all types of cancer combined, and the incidence rates of a number of common cancers also fell.
These results, based on the latest national data available, are presented by Phyllis A. Wingo,
Ph.D., of the American Cancer Society, and colleagues from the National Cancer Institute (NCI)
and the Centers for Disease Control and Prevention (CDC), including the National Center for
Health Statistics (NCHS). They appear in the April 21 issue of the Journal of the National
Cancer Institute. Their work is based on cancer incidence data of newly diagnosed cases
from the NCI Surveillance, Epidemiology, and End Results (SEER)*
Program, cancer deaths from the national database maintained by the NCHS,
and prevalence of tobacco use from CDC Surveys.
Among the 10 most commonly diagnosed cancers, decreases in incidence were seen for leukemia and cancers of the lung (men only), colon/rectum, urinary bladder, oral cavity and pharynx, and prostate. Except for prostate cancer, all these trends reached statistical significance in men. In women, only the decrease in colorectal cancer was statistically significant. Exceptions to the decline were observed for non-Hodgkin's lymphoma and melanoma, which increased. Also, cancer of the female breast and cancer of the uterus remained approximately level.
For the 10 leading "mortality sites," statistically significant decreases were seen for cancers of the male lung, prostate, pancreas, and brain and the female breast and, for both genders, cancers of the colon/rectum and stomach. Exceptions were non-Hodgkin's lymphoma and cancer of the female lung. More than half of all cancer deaths involved cancers of the lung, prostate, colon/rectum, or female breast.
The authors conclude that the downward trends for incidence and death rates for leading cancer sites are encouraging but that more remains to be done. They say largest impact can be made in the area of lung cancer, which accounts for about 28% of cancer deaths each year and is caused almost exclusively (about 90%) by smoking. Forty-seven million American adults are regular smokers, and adult smoking has changed little from 1993 to 1997. The increasing trend in smoking among adolescents during the 1990s is cause for concern, say the authors; while some data collected in 1998 suggest that prevalence may have declined slightly, cigarette use by adolescents nonetheless remains unacceptably high. Cigar consumption increased by about 50% from 1993 to 1997, and cigars can cause lung, oral, esophageal, and laryngeal cancers. They thus conclude that a large impact can be made through programs that deter smoking initiation, promote quitting, and protect nonsmokers from environmental tobacco smoke.
In an editorial, Howard Koh, M.D., Commissioner of Public Health of Massachusetts, notes that future medical historians will undoubtedly recall the 1900s as the "tobacco and cancer" century. While the Wingo report shows that overall cancer incidence and mortality are generally declining, Koh says that a healthier 21st century will come only through a full commitment to eradicating tobacco addiction, with lung cancer once again relegated to the "rare" disease category where it belongs.
Contact: Joann Schellenbach, American Cancer Society, (212) 382-2169; fax (212) 719-0193. Editorial: Dr. Koh, Massachusetts Department of Public Health, (617) 624-5200; fax (617) 624-5206.
* SEER is a set of geographically defined, population-based central cancer registries in the United States, operated by local nonprofit organizations under contract to NCI.
Information on cause of death is reported by attending
physicians on death certificates filed in state vital statistics offices and is processed and
consolidated into a national database by NCHS.
CDC's Behavioral Risk Factor Surveillance
System monitors health risk behaviors among adults in a state-based surveillance system active
in all 50 states, CDC's Youth Risk Behavior Surveillance System monitors risk behaviors
among youth through national, state, and local school-based surveys, and NCHS's
National Health Interview Survey is a nationwide survey designed to monitor risk behavior
among adults.
Cigar and Pipe Smoking Associated With a High Risk of Lung Cancer
A case-control study in seven European areas concludes that smoking cigars, cigarillos, and pipe tobacco has a cancer-inducing effect on the lungs similar to cigarette smoking.
These results are presented by a team led by Paolo Boffetta, M.D., of the International Agency for Research on Cancer, Lyon, France, in the April 21 issue of the Journal of the National Cancer Institute.
The study involved 5621 men with lung cancer at seven centers in Germany, Italy, and Sweden and 7255 matched male control subjects. Women were excluded as so few smoke cigars or pipes. Detailed interviews were conducted with each participant, or a proxy if they had died, concerning lifetime smoking histories. Of the case patients, 117 were nonsmokers, 43 smoked cigars or cigarillos only, 61 smoked pipe tobacco only, 4204 smoked cigarettes only, and the rest smoked a combination of products.
Among the "exclusive" smokers, case patients who smoked cigars, cigarillos, or a combination of the two products had an odds ratio (OR) of developing lung cancer of 9.0, while the OR for case patients who smoked a pipe only was 7.9. Cigarette-only smokers had an OR of 14.9.
A dose-response relationship was seen for smoking duration and cumulative consumption for cigars and cigarillos and for pipe tobacco. The authors conclude that the somewhat lower risk of lung cancer seen among smokers of cigars and pipes as compared to cigarette smokers might be due to lower consumption in the former group, as the dose-response relationships they report are comparable for all types of tobacco use.
Despite some differences in cigars smoked in Europe and North America, these results, say the authors, show that control of cigar and pipe smoking may be as important for the prevention of lung cancer as control of cigarette smoking.
Editorial writer Howard Koh, M.D., Commissioner of Public Health of Massachusetts, notes that the elevated odds ratios relating cigar, cigarillo, and pipe smoking to lung cancer reported by Boffetta et al. are greater than previously reported. If confirmed, these European results have international ramifications, especially since cigar consumption in the United States has surged again.
Contact: Nicolas Gaudin, France, 33-47-273-8567; fax 33-47-273-8311. Editorial: Dr. Koh, Massachusetts Department of Public Health, (617) 624-5200; fax (617) 624-5206.
Note: This memo to reporters is from the Journal staff and is not an official release of the National Cancer Institute (NCI) or Oxford University Press (OUP) nor does it reflect NCI or OUP policy. In addition, unless otherwise stated, all articles and items published in the Journal reflect the individual views of the authors and not necessarily the official points of view held by NCI, any other component of the U.S. government, OUP, or the organizations with which the authors are affiliated. Neither NCI nor any other component of the U.S. government nor OUP assumes any responsibility for the completeness of the articles or other items or the accuracy of the conclusions reached therein.
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