Epidemiology of Lung Cancer

Despite increased awareness and advances in diagnosis and treatment, lung cancer is still a common, lethal disease in both the United States and around the world. The American Cancer Society (ACS) estimates that over 210,000 new cancers of the lung and bronchus are diagnosed in the U.S. every year. Fifteen percent of all diagnosed cancers are lung cancer. The ACS also reports that over 150,000 Americans will die from lung cancer every year. This represents 28% of all cancer deaths. Lung cancer is responsible for more cancer-related deaths than any other type of cancer, by a wide margin.

Men and women are affected by lung cancer in roughly equal numbers though this has not always been the case. It is estimated that approximately 116,000 men were diagnosed with lung cancer in 2009 and 103,000 women. The disease is slightly more lethal for American men than it is for women. While men make up 53% of the total number of lung cancer diagnoses, they make up close to 56% of all deaths from the disease (89,000 men). This nearly equal distribution between men and women reflects the steady decrease in incidence in men over the past 20 years. In women, the rates have leveled off and stayed constant for some time. While the factors that lead to these rates are varied and complex, for the most part the changes reflect different relative rates of tobacco smoking between men and women over the past half century.

If one were to look at the US cancer death rates over the past 80 years, there was a rapid increase in lung cancer related deaths in men from 1940 to 1990. In women, a rapid increase occurred between 1970 and 1990. Since about 1990, the mortality rate from cancers of the lung and bronchus among men has dropped nearly as sharply as it rose. This is not the case for American women—the mortality rate has stayed constant since 1990 with no indication of making a significant decline.

Of the states for which there is data (45 states), the highest incidence of lung cancer is in Kentucky. The rates are high in both men (136.2 diagnoses per 100,000 men) and women (76.2 diagnoses per 100,000 women) in that state. The national average was 87.3 and 55.4 per 100,000 men and women, respectively. On the other hand, Utah has the fewest new cases of lung cancer with 39.6 and 22.4 per 100,000 men and women, respectively. The reasons for this difference are not clear but it probably reflects different proportions of smokers in the respective states.

Periodically, the ACS estimates cancer incidence grouped by race, specifically cancer rates among African Americans and Hispanics/Latinos. In African Americans, the rate of lung and bronchus cancers mirror what is seen in the US population as a whole. In 2007, lung cancer accounted for approximately 15% of all cancers diagnosed in African Americans (12,490 cases in men and 9,060 cases in women). In African Americans, new cancers of the lung and bronchus are second only to prostate and breast cancers in men and women, respectively, just as it occurs in the general population. When compared to whites, the incidence of lung cancer is 1.4 times as great in African Americans.

In Hispanics/Latinos, lung cancer is the third most frequent new cancer diagnosis. Prostate and breast cancers top all new diagnoses regardless of race, but Hispanics/Latinos have high rates of colon and rectal cancer. As a result, lung cancer incidence is third most common in this racial group. Lung cancer accounts for eight and six percent of cancer diagnoses in Hispanic/Latino men and women, respectively. Regardless of race, lung cancer is the deadliest form of cancer. Even in Hispanics/Latinos where the number of diagnoses is lower relative to other cancers, it is still the leading cause of cancer related death. This high mortality rate is true across all races followed by the ACS.

While the numbers of new diagnoses and deaths from lung cancer among African American men has been similar to white men, there has been a particularly disturbing trend among African American women. The mortality rate among African American women has risen sharply over the past 20 to 30 years—out of proportion to the new diagnoses. This mortality rate is leveling off over the past few years, but the deadliness of lung cancer in African American women has identified a need for increased efforts in this patient population.

In contrast, the rates of lung cancer diagnoses and deaths have either remained constant or have declined among Hispanics/Latinos over the past two decades. Among subgroups of Hispanics/Latinos in the US, deaths from lung cancer are higher in Cuban men than they are in Puerto Rican and Mexican men. More on recent trends. The reasons for this difference are not completely clear.

The lifetime probability of developing cancer of the lung and bronchus is 1 in 13 in men and 1 in 16 for women across all races. In African Americans, this rate is 1 in 12 for men and 1 in 19 for women. In Hispanics/Latinos, the lifetime probability is 1 in 19 for men and 1 in 30 for women. Of note, rates are dramatically different between people who smoke and those who do not.

What is not apparent from this data is that in both Hispanics/Latinos and African Americans, the disease is usually more advanced at the time of diagnosis than when it is diagnosed in whites. This likely reflects differences in access to healthcare. In fact, when lung cancer incidence rates are compared in a military setting where healthcare is universal, these rates are not different among races. Since the disease is more advanced at diagnosis in non-white Americans, the five-year survival rate tends to be lower. Therefore efforts to make earlier diagnoses of lung and bronchus cancer in non-white races are a priority for health care groups.

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