Cancer mortality after multiple fluoroscopic examinations of the chest

Total cancer deaths were not increased among 2,074 women and 1,277 men who were fluoroscopically examined an average of 73 and 91 times, respectively, during lung-collapse therapy for tuberculosis (TB). Patients who did not receive this form of therapy (2,141 women and 1,418 men) and general population rates were used for comparison. All subjects were discharged alive from eight TB sanatoria in Massachusetts between 1930 and 1954; the average follow-up was 23 years. Deaths due to breast cancer were not increased among exposed females [standardized mortality ratio (SMR) = 1.0, n = 24], and SMRs greater than 2.1 could be excluded with 95% confidence. In contrast to other series, our inability to detect a breast cancer excess was likely due to lower breast doses (66 rad) and higher average ages at exposure (28 yr) and thus lower sensitivity. A deficit of lung cancer among exposed males and females was observed (SMR = 0.8, n = 26), even though increased risks have been observed among other populations exposed to similar dose levels. The estimated average lung dose was 91 rad, and SMRs greater than 1.2 for lung cancer could be excluded with 95% confidence. Overall, this study indicates that the radiation hazard of multiple low-dose exposures experienced over many years is not greater than currently accepted estimates for breast and lung cancer. For lung cancer the radiogenic risk may be less than predicted from high-dose, single-exposure studies.     

Racial and ethnic differences in lung cancer incidence: how much is explained by differences in smoking patterns? (United States)

Objectives Lung cancer rates vary considerably among U.S. racial/ethnic groups. We quantitatively analyzed the extent to which these differences can be attributed to differential patterns of smoking. Methods We utilized survey data from the U.S. Census to estimate smoking patterns in the following racial/ethnic groups: non-Hispanic whites, non-Hispanic blacks, Hispanics, Asian/Pacific Islanders and American Indians. We used several dose-response models of smoking and lung cancer to predict relative lung cancer rates in these groups based on reported smoking patterns, specifically, on smoking status (current, former, never), cigarettes per day, age started, and age quit (for former smokers). Predicted rates were compared to observed population rates for these groups. Results Black men had slightly lower predicted lung cancer rates than white men, but had 35–47% higher observed rates. Hispanic men had predicted rates about 25% lower than whites but observed rates 50% lower than whites; predicted rates for Hispanic women were 50% lower than whites compared to observed rates that were 60–70% lower. For Asian/Pacific Islanders, predicted and observed rates relative to whites were comparable. Predicted rates for American Indians were slightly higher than whites while observed rates were about 40% lower. Conclusion Differences in smoking largely explain lower lung cancer rates in Asian/Pacific Islanders relative to whites and partially explain lower rates in Hispanics compared to whites. Increased rates in black men and decreased rates in American Indians are not explained by differences in smoking.     

Changing area socioeconomic patterns in U.S. cancer mortality, 1950-1998: Part II--Lung and colorectal cancers

BACKGROUND: Lung cancer and colorectal cancer are leading causes of U.S. cancer mortality. Because mortality rates for many cancers vary by socioeconomic characteristics, we used area socioeconomic indices to examine patterns in U.S. lung and colorectal cancer mortality between 1950 and 1998. METHODS: A factor-based area socioeconomic index was linked to 1950-1998 county mortality data to generate annual lung and colorectal cancer mortality rates for each area socioeconomic group. Joinpoint regression analysis was used to model and identify statistically significant changes in the mortality trends. RESULTS: Area socioeconomic patterns in U.S. lung cancer mortality changed dramatically between 1950 and 1998. Men aged 25-64 years and those aged 65 years or older in higher socioeconomic areas generally had higher lung cancer mortality than did those in lower socioeconomic areas during 1950-1964 and 1950-1980, respectively. Area socioeconomic differences in lung cancer mortality began to reverse and widen by the early 1970s for younger men and by the mid-1980s for older men. In 1998, lung cancer mortality was 56% (95% confidence interval [CI] = 49% to 64%) higher for younger men and 38% higher (95% CI = 34% to 43%) for older men in the lowest area socioeconomic group than for the same age groups in the highest area socioeconomic group. Lung cancer mortality among older women in all socioeconomic groups increased sevenfold to eightfold between 1950 and 1998, with higher mortality in higher area socioeconomic groups. The positive socioeconomic gradient in colorectal cancer mortality diminished substantially over time. Although colorectal cancer mortality among women in all area socioeconomic groups showed a consistent downward trend, colorectal cancer mortality among men in low area socioeconomic groups, but not in high area socioeconomic groups, showed an upward trend. CONCLUSIONS: Socioeconomic gradients in male lung cancer mortality reversed between 1950 and 1998, and those in colorectal cancer mortality narrowed over that time. Area measures may be useful for monitoring socioeconomic disparities in cancer mortality and for identifying areas for potential cancer control interventions.     

Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival

BACKGROUND: The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information regarding cancer occurrence and trends in the U.S. This year's report features a special section on cancer survival. METHODS: Information concerning cancer cases was obtained from the NCI, CDC, and NAACCR and information concerning recorded cancer deaths was obtained from the CDC. The authors evaluated trends in age-adjusted cancer incidence and death rates by regression models and described and compared survival rates over time and across racial/ethnic populations. RESULTS: Incidence rates for all cancers combined decreased from 1991 through 2001, but stabilized from 1995 through 2001 when adjusted for delay in reporting. The incidence rates for female lung cancer decreased (although not statistically significant for delay adjusted) and mortality leveled off for the first time after increasing for many decades. Colorectal cancer incidence rates also decreased. Death rates decreased for all cancers combined (1.1% per year since 1993) and for many of the top 15 cancers occurring in men and women. The 5-year relative survival rates improved for all cancers combined and for most, but not all, cancers over 2 diagnostic periods (1975-1979 and 1995-2000). However, cancer-specific survival rates were lower and the risk of dying from cancer, once diagnosed, was higher in most minority populations compared with the white population. The relative risk of death from all cancers combined in each racial and ethnic population compared with non-Hispanic white men and women ranged from 1.16 in Hispanic white men to 1.69 in American Indian/Alaska Native men, with the exception of Asian/Pacific Islander women, whose risk of 1.01 was similar to that of non-Hispanic white women. CONCLUSIONS: The continued measurable declines for overall cancer death rates and for many of the top 15 cancers, along with improved survival rates, reflect progress in the prevention, early detection, and treatment of cancer. However, racial and ethnic disparities in survival and the risk of death from cancer, and geographic variation in stage distributions suggest that not all segments of the U.S. population have benefited equally from such advances.     

Prospective study of fruit and vegetable consumption and risk of lung cancer among men and women

BACKGROUND: Diets high in fruits and vegetables have been shown to be associated with a lower risk of lung cancer. beta-Carotene was hypothesized to be largely responsible for the apparent protective effect, but this hypothesis was not supported by clinical trials. METHODS: We examined the association between lung cancer risk and fruit and vegetable consumption in 77 283 women in the Nurses' Health Study and 47 778 men in the Health Professionals' Follow-up Study. Diet was assessed with the use of a food-frequency questionnaire that included 15 fruits and 23 vegetables. We used logistic regression models to estimate relative risks (RRs) of lung cancer within each cohort. All statistical tests were two-sided. RESULTS: We documented 519 lung cancer cases among the women and 274 among the men. Total fruit and vegetable consumption was associated with a modestly lower risk of lung cancer among the women but not among the men. The RR for the highest versus lowest quintile of intake was 0.79 (95% confidence interval [CI] = 0.59-1.06) among the women and 1.12 (95% CI = 0.74-1.69) among the men after adjustment for smoking status, quantity of cigarettes smoked per day, time since quitting smoking, and age at initiation of smoking. However, total fruit and vegetable consumption was associated with a lower risk of lung cancer among never smokers in the combined cohorts, although the reduction was not statistically significant (RR = 0.63; 95% CI = 0.35-1.12 in the highest tertile). CONCLUSION: Higher fruit and vegetable intakes were associated with lower risks of lung cancer in women but not in men. It is possible that the inverse association among the women remained confounded by unmeasured smoking characteristics, although fruits and vegetables were protective in both men and women who never smoked.     

Lung cancer patients with chronic obstructive pulmonary disease

The aim of this study is to evaluate characteristics in lung cancer patients with chronic obstructive pulmonary disease (COPD). Among 966 lung cancer patients admitted to our division over a period of 24 years, 73 patients were diagnosed as having COPD. There were 68 (93.2%) men and 5 women; of the tumors 43 (58.9%) were squamous cell carcinomas. Although 41 (56.2%) patients had stage IA-IIIA, only 11 (15.1%) had surgery. Coexistence of COPD was proved to be a prognostic factor (p=0.0451). Adequate palliative care to provide quality survival would be the primary goal of therapy for lung cancer patients with COPD.     

Incidence of esophageal and gastric cancers among Hispanics,non-Hispanic whites and non-Hispanic blacks in the United States: subsite and histology differences

Objective We examined subsite- and histology-specific esophageal and gastric cancer incidence patterns among Hispanics/Latinos and compared them with non-Hispanic whites and non-Hispanic blacks. Methods Data on newly diagnosed esophageal and gastric cancers for 1998–2002 were obtained from 37 population-based central cancer registries, representing 66% of the Hispanic population in the United States. Age-adjusted incidence rates (2000 US) were computed by race/ethnicity, sex, anatomic subsite, and histology. The differences in incidence rates between Hispanics and non-Hispanics were examined using the two-tailed z-statistic. Results Squamous cell carcinoma accounted for 50% and 57% of esophageal cancers among Hispanic men and women, respectively, while adenocarcinoma accounted for 43% among Hispanic men and 35% among Hispanic women. The incidence rate of squamous cell carcinoma was 48% higher among Hispanic men (2.94 per 100,000) than non-Hispanic white men (1.99 per 100,000) but about 70% lower among Hispanics than non-Hispanic blacks, for both men and women. In contrast, the incidence rates of esophageal adenocarcinoma were lower among Hispanics than non-Hispanic whites (58% lower for men and 33% for women) but higher than non-Hispanic blacks (70% higher for men and 64% for women). Cardia adenocarcinoma accounted for 10–15% of gastric cancers among Hispanics, and the incidence rate among Hispanic men (2.42 per 100,000) was 33% lower than the rate of non-Hispanic white men (3.62 per 100,000) but 37% higher than that of non-Hispanic black men. The rate among Hispanic women (0.86 per 100,000), however, was 20% higher than that of non-Hispanic white women (0.72 per 100,000) and 51% higher than for non-Hispanic black women. Gastric non-cardia cancer accounted for approximately 50% of gastric cancers among Hispanics (8.32 per 100,000 for men and 4.90 per 100,000 for women), and the rates were almost two times higher than for non-Hispanic whites (2.95 per 100,000 for men and 1.72 per 100,000 for women) but about the same as the non-Hispanic blacks. Conclusion Subsite- and histology-specific incidence rates of esophageal and gastric cancers among Hispanics/Latinos differ from non-Hispanics. The incidence rates of gastric non-cardia cancer are almost two times higher among Hispanics than non-Hispanic whites, both men and women. The rates of gastric cardia cancer are lower among Hispanics than non-Hispanic whites for men but higher for women. The rates of esophageal and gastric cardia adenocarcinomas are higher among Hispanics than non-Hispanic blacks.     

European cancer mortality predictions for the year 2015: does lung cancer have the highest death rate in EU women?

Total cancer mortality rates in the EU are predicted to fall 7.5% in men and 6% in women between 2009 and 2015. However, due to population aging, total number of cancer deaths will rise to 1 359 100. Cancer mortality outlook for 2015 remains favourable, except for pancreas in both sexes and female lung that is predicted to overtake breast becoming the female cancer with the highest rate (14.24/100 000).BackgroundCancer mortality statistics for 2015 were projected from the most recent available data for the European Union (EU) and its six more populous countries. Prostate cancer was analysed in detail.Patients and methodsPopulation and death certification data from stomach, colorectum, pancreas, lung, breast, uterus, prostate, leukaemias and total cancers were obtained from the World Health Organisation database and Eurostat. Figures were derived for the EU, France, Germany, Italy, Poland, Spain and the UK. Projected 2015 numbers of deaths by age group were obtained by linear regression on estimated numbers of deaths over the most recent time period identified by a joinpoint regression model.ResultsA total of 1 359 100 cancer deaths are predicted in the EU in 2015 (766 200 men and 592 900 women), corresponding to standardised death rates of 138.4/100 000 men and 83.9/100 000 women, falling 7.5% and 6%, respectively, since 2009. In men, predicted rates for the three major cancers (lung, colorectum and prostate) are lower than in 2009, falling 9%, 5% and 12%. Prostate cancer showed predicted falls of 14%, 17% and 9% in the 35–64, 65–74 and 75+ age groups. In women, breast and colorectal cancers had favourable trends (-10% and -8%), but predicted lung cancer rates rise 9% to 14.24/100 000 becoming the cancer with the highest rate, reaching and possibly overtaking breast cancer rates—though the total number of deaths remain higher for breast (90 800) than lung (87 500). Pancreatic cancer has a negative outlook in both sexes, rising 4% in men and 5% in women between 2009 and 2015.ConclusionsCancer mortality predictions for 2015 confirm the overall favourable cancer mortality trend in the EU, translating to an overall 26% fall in men since its peak in 1988, and 21% in women, and the avoidance of over 325 000 deaths in 2015 compared with the peak rate.     

原发性肺癌521例临床特点分析

目的：分析原发性肺癌的临床特点.方法：回顾性分析521例确诊为原发性肺癌且有完整资料患者的临床特点.结果：男377例,女144例,年龄15-80岁,中位年龄58岁.鳞癌、腺癌、小细胞癌和其他病理类型肺癌分别占32.44％、35.12％、25.14％和7.29％.女性患者腺癌发生率高于男性,鳞癌发生率较男性低.吸烟主要与鳞癌的发生有关.男性患者的平均发病年龄高于女性患者.最常见的转移部位从高到低依次为骨、脑、对侧肺及肝脏,其中腺癌的骨、脑、肺转移发生率均高于其他病理类型.结论：腺癌仍是目前肺癌的主要病理类型,吸烟、性别均是肺癌病理类型的影响因素,骨、脑是肺癌最常见的转移部位.     

Epidemiological Patterns of Cancer Incidence in Southern China: Based on 6 Population-based Cancer Registries

Background: The epidemiological patterns of cancer incidence have been investigated widely in westerncountries. Nevertheless, information is quite limited in Jiangxi province, southern China. Materials and Methods:All data were reported by 6 population-based cancer registries in Jiangxi Province. The results were presentedas incidence rates of cases by site (ICD-10), sex, crude rate (CR), age-standardized rates (ASRs) and truncatedincidence rate (TR) per 100,000 person-years, using the direct method of standardization to the world population.Results: 8,765 new cancer cases were registered in our study during the period 2009-2011. Diagnosis of cancerwas based on histopathology in 61.0%, clinical or radiology findings in 4.87% and death certificate only (DCO)in 3.0% of the cases. The median age at diagnosis was 62.0 years (mean, 61; standard deviation, 15). The ASRswere 170.8 per 100,000 for men and 111.2 for women. The ASRs for all invasive cancers from the urban areas(145.7 per 100,000) was higher than that of rural areas (137.1). Incidence rates for lung cancer were higher inrural (35.8) than in urban areas (27.0). Similarly, relatively high rates were observed for stomach cancer in rural(20.1) relative to urban areas (15.5). Conclusions: Our results reveal that the most common cancers were breastand lung in women and lung and liver in men. Interestingly, this study suggested a higher incidence rates forlung and stomach cancer in rural males than in urban population, which may suggest other potential causes,such as over-consumption of smoked meats and high prevalence of Helicobacter pylori infection, respectively.Public education and the promotion of healthy lifestyles should be actively carried out.     

Assessing a decade of progress in cancer control

The age-adjusted death rate from cancer peaked in the U.S. in 1990, and has declined steadily since then. We assess reasons for this progress by examining trends in cancer mortality by age, gender, and cause, using underlying cause mortality data from the Centers for Disease Control. Mortality rates for 2000 were estimated using models based on 1979 through 1997 mortality data. Indirect standardization was used to calculate the expected number of cancer deaths in 2000, by age, gender, and cause, assuming that the rates in 1990 had not changed. In the U.S. in 2000, there were an estimated 500,000 deaths from cancer; 64,000 (12.7%) fewer than expected, with 51,900 fewer cancer deaths among men and 12,200 fewer deaths among women. The decline in deaths among men resulted from fewer deaths from lung cancer (20,800), colon cancer (6,700), and prostate cancer (12,900). The decline in deaths among women resulted from fewer deaths from breast cancer (11,100) and colon cancer (4,200), but there were more deaths from lung cancer (6,500). Among women over the age of 75, 5,000 more died of cancer than expected. Declines in lung, prostate, and colon cancer deaths among men and breast and colon cancer among women account for 86% of the recent decline in cancer deaths over the past decade.     

Patho-epidemiology of Lung Cancer in Karachi (1995-2002)

The objective of the study was to provide an overview of the demographics of lung cancer, the number one cancer ‍killer of men in Karachi South (1995-2002). Lung cancer cases recorded at Karachi Cancer Registry during 1st ‍January 1995 to 31st December 2004 were analyzed. To allow for maximum data completion, cases recorded from ‍1st January 1995 to 31st December 2002 were included for final analysis. Trends were studied by analyzing the age ‍standardized incidence rates (ASR)s in 2 time periods, 1995-1997 and 1998-2002. Odds ratio for sex, age-groups, ‍ethnicity, religion, and residence by socio-economic categories were calculated by considering all malignancies (except ‍tobacco-associated malignancies) for each group, registered at KCR for the same period as controls. Cancer of the ‍lung ranked the most frequent malignancy in men in Karachi in the entire 1995-2002 period, though it did not ‍feature amongst the first 10 malignancies in the females. In the 1995-1997 period, the ASR per 100,000 population ‍for cancer of the lung was 21.4 and 2.9 in males (M) and females (F) respectively. The mean age of the patients was ‍60.4 years (95% CI, 59.1-61.7) M and 53.7 years (95% CI 48.9-58.5) F. In the 1998-2002 period the incidence rate ‍increased to 25.5 per 100,000 (M) and 4.2 per 100,000 (F). Thus between 1995 and 2002, the incidence of lung cancer ‍registered a 19% increase in men and almost 100% in women. The component of adenocarcinoma in females remained ‍stable during 8 years, but increased 55% in males. Histologic confirmation was 80%; majority of cancer cases ‍presented as grade 3 and grade 4 lesions (62.3%), and were discovered at advanced stages (stage III 35.7%; stage IV ‍55.8%).The odds ratio (OR) in men was 4.5 (95% CI 3.7; 5.4). The risk of developing lung cancer increased with age, ‍the highest risk being observed in the 65+ age group. A marginally higher risk was observed in the higher socioeconomic ‍categories for men and in the lower socio-economic categories for women. A higher risk was also observed ‍for men who were residing along the coastal belt, and for ethnicities belonging to Southern Pakistan (Sindhi and ‍Mohajir) residing in Karachi South. In conclusion, Pakistan at present falls into a low risk lung cancer region in ‍females and a moderate risk region for males and the highest registered increase between 1995 and 2002 was observed ‍in the older age groups (65+). It is however a cause of concern that the overall lung cancer incidence rates continue ‍to rise. The age specific rates though stable in the younger age groups (35-49 years), are at present equivalent to ‍contemporary rates in high- risk countries. These rates correspond with the trends of smoking prevalence in the ‍younger age groups in the last 2 decades. Published studies have given alerts to increase in the smoking habits of the ‍present day youngsters and with an expanding population the country can expect a substantial increase in lung ‍cancer. This threat can only be averted by implementation of stringent anti-tobacco rules and health education; ‍prohibition of smoking in educational institutions at all levels and a ban on the sale of cigarettes to minors.     

Lower lung cancer rates in Jewish smokers in Israel and the USA

Lung cancer rates in Israeli Jews have remained stable over the last five decades and are much lower than in most developed countries despite high historical smoking rates. We compared lung cancer risk in Jews and non‐Jews in Israel and in the United States. Data were derived from a population‐based, case–control study in Israel (638 cases, 496 controls) to estimate lung cancer risk associated with smoking. Data were also acquired from a case–control study in the United States with information on religious affiliation (5,093 cases, 4,735 controls). Smoking was associated with lung cancer risk in all religion/gender groups in both studies. However, major differences in risk magnitude were noted between Jews and non‐Jews; ever smoking was associated with a moderately elevated risk of lung cancer in Jewish men and women in Israel (OR = 4.61, 2.90–7.31 and OR = 2.10, 1.36–3.24, respectively), and in Jewish men and women in the United States (OR = 7.63, 5.34–10.90 and OR = 8.50, 5.94–12.17) but were significantly higher in Israeli non‐Jewish men (OR = 12.96, 4.83–34.76) and US non‐Jewish men and women (OR = 11.33, 9.09–14.12 and OR = 12.78, 10.45–15.63). A significant interaction between smoking and religion was evident in light, moderate and heavy male and female smokers. The differences in risk level between Israeli Jews and non‐Jews could not be explained by lung cancer genetic risk variants which were identified in GWAS (genes in the CHRNA5, TERT and CLPTM1L regions). Data from the two studies support the notion of a reduced risk of lung cancer in Jewish compared to non‐Jewish smokers in different areas of the world.     

Changing trends in incidence of lung cancer by histologic type in Scotland

Lung cancer is a major public health concern worldwide. Our study aims to examine trends in incidence of lung cancer in Scotland during 1959-97 and by histologic type for 1975-97. In Scotland, lung cancer is the most commonly diagnosed cancer in men and is the second most commonly diagnosed cancer in women. Due to poor survival rates, trends in incidence and mortality display similar patterns. Within the United States and many parts of Europe, falls in the incidence of squamous cell carcinoma have occurred whilst the incidence of adenocarcinoma has increased. Data were extracted from the Scottish Cancer Registry. Trends in incidence were examined by standardising rates to the World Standard Population. Age-specific rates were examined by year of diagnosis and mid year of birth. In Scotland the incidence of lung cancer in men has fallen since the late 1970s, whereas incidence in women has continued to increase. Incidence rates of adenocarcinoma have increased over time but squamous cell carcinoma remains the predominant type of lung cancer in Scotland. The quality of lung cancer registration data has improved over time, although a large proportion of lung cancers (>20%) are not microscopically verified. Changes in histologic types are unlikely to be solely due to diagnostic advances. Rates of adenocarcinoma have increased steadily over time, and this may be due to changes in cigarette design during the 1950s.     

The American Cancer Society challenge goal to reduce US cancer mortality by 50% between 1990 and 2015: Results and reflections

In 1996, the Board of Directors of the American Cancer Society (ACS) challenged the United States to reduce what looked to be possible peak cancer mortality in 1990 by 50% by the year 2015. This analysis examines the trends in cancer mortality across this 25‐year challenge period from 1990 to 2015. In 2015, cancer death rates were 26% lower than in 1990 (32% lower among men and 22% lower among women). The 50% reduction goal was more fully met for the cancer sites for which there was enactment of effective approaches for prevention, early detection, and/or treatment. Among men, mortality rates dropped for lung cancer by 45%, for colorectal cancer by 47%, and for prostate cancer by 53%. Among women, mortality rates dropped for lung cancer by 8%, for colorectal cancer by 44%, and for breast cancer by 39%. Declines in the death rates of all other cancer sites were substantially smaller (13% among men and 17% among women). The major factors that accounted for these favorable trends were progress in tobacco control and improvements in early detection and treatment. As we embark on new national cancer goals, this recent past experience should teach us that curing the cancer problem will require 2 sets of actions: making new discoveries in cancer therapeutics and more completely applying those discoveries in cancer prevention we have already made. CA Cancer J Clin 2016;66:359–369. © 2016 American Cancer Society.     

Epidemiology Characteristics and Trends of Lung Cancer Incidence in Iran

Background: Lung cancer is one of the most common cancers in the world and a major cause of death from cancer. One of the important indicators to compare the prevalence and incidence of the disease is a change in the trend. The aim of this study was to investigate the changes in the incidence of lung cancer in Iran. Materials and Methods: This study was conducted based on existing data obtained from a national registry of cancer cases and the Disease Management Center of Ministry of Health in Iran. All cases registered in the country were included during 2003-2008. Incidence rates were reported based on the direct method and standard population of World Health Organization. The study also examined the morphology of common lung cancers. Trends in incidence underwent joinpoint regression analysis. Results: Based on the results of this study, 14,403 cases of lung cancer have been recorded of which 10,582 cases were in men and 3,821 in women. Highest incidence rates were observed in the 80-84 age group. Considerable variation across provinces was evident. In females squamous cell carcinoma (SCC) demonstrated a reduction from 24% to 16% of lesions over the period of study, while adenocarcinoma rose from 21% to 29%. In males a similar reduction in SCC was apparent (42% to 29%, again with increase in AC (13 % to 18%). Conclusions: The results show that the increase in the incidence of lung cancer the trend is that more men than women and in men and may be caused by changes in smoking pattern. The incidence of lung cancer in the North West and West provinces was higher than in other regions.     

Lung cancer incidence in Australia: impact of filter-tip cigarettes with unchanged tar yields.

Filter-tip cigarettes became popular in Australia in the late 1950s, but "tar" yields remained high for another decade. Because of this, the effect of filters independently of tar reductions can be estimated by comparing the age-adjusted incidence of lung cancer for relevant birth cohorts of Australians. Separate analyses by histologic type may throw some light on the specific effects of filters. Age-adjusted incidence of squamous cell carcinoma (SCC), small cell lung carcinoma (SCLC) and adenocarcinoma (AC) was estimated by Poisson regression for 5-year birth cohorts of Australians using lung cancer registration data for 1982-95. To take account of changes in smoking prevalence, ever-smoker less never-smoker differences in age-adjusted incidence were estimated. Comparisons were made for smokers born during 1930-34 and 1940-44. Smokers born in 1940-44 commenced smoking at the time of introduction of filter-tips. Age-adjusted incidence of SCC (-23%) and SCLC (-21%) but not AC (+7%) was lower for female smokers born during 1940-44. For male smokers, rates of SCC (-42%), SCLC (-43%) and AC (-24%) were each lower. The high rates overall of 1940s-born women were due to disproportionately higher incidence of AC, the type that comprised 42% of diagnoses with histologic confirmation. In Australia, the switch to filter-tip cigarettes prior to any reduction in tar yields was associated with reduced incidence of SCC and SCLC, and of AC for men only. Rates of AC were not reduced for women, indicating that other factors were important for this type of lung cancer.     

Mortality Among Workers Employed in the Titanium Dioxide Production Industry in Europe

OBJECTIVES: To assess the risk of lung cancer mortality related to occupational exposure to titanium dioxide (TiO2). METHODS: A mortality follow-up study of 15,017 workers (14,331 men) employed in 11 factories producing TiO2 in Europe. Exposure to TiO2 dust was reconstructed for each occupational title; exposure estimates were linked with the occupational history. Observed mortality was compared with national rates, and internal comparisons were based on multivariate Cox regression analysis. RESULTS: The cohort contributed 371,067 person-years of observation (3.3% were lost to follow-up and 0.7% emigrated). 2652 cohort members died during the follow-up, yielding standardized mortality ratios (SMRs) of 0.87 (95% confidence interval [CI] 0.83-0.90) among men and 0.58 (95% CI 0.40-0.82) among women. Among men, the SMR of lung cancer was significantly increased (1.23, 95% CI 1.10-1.38); however, mortality from lung cancer did not increase with duration of employment or estimated cumulative exposure to TiO2 dust. Data on smoking were available for over one third of cohort members. In three countries, the prevalence of smokers was higher among cohort members compared to the national populations. CONCLUSIONS: The results of the study do not suggest a carcinogenic effect of TiO2 dust on the human lung.     

Cancer mortality in a higher-income black population in New York State. Comparison with rates in the United States as a whole

In the 1980 Census the median family income among blacks in Suffolk County, New York (i.e., $19,604) was much higher than that for American blacks as a whole (i.e., $12,618) and 94.1% of that for American whites (i.e., $20,840), but the proportion below the poverty level was still higher for Suffolk County blacks than for American whites. Observed numbers of deaths from 1979 to 1985 for total cancers and most cancer sites in Suffolk County black men and women were not lower than expected on the basis of age-specific and gender-specific death rates for blacks in the US. Although numbers of deaths from cervical cancer and prostate cancer were slightly lower than expected in Suffolk County blacks versus American blacks, these numbers were still significantly greater than expected on the basis of death rates among American whites. Age-specific death rates for age groups 25 to 44 years to 55 to 64 years tended to be lower in Suffolk County for lung cancers in black men but not for breast cancer in black women. Specific cancer sites, which differ in the direction of the association between incidence and socioeconomic status, age, and gender must be considered in comparisons of cancer mortality by race and socioeconomic level. Implications of the comparisons were discussed with regard to the goal of reducing racial differences in cancer death rates.