Decline in lung cancer mortality is almost exclusive to men

Age-standardised lung cancer mortality rate decreased constantly from 2000 to 2017. Whilst mortality in men dropped annually by an average of -2.3%, mortality in women only decreased by an average of -0.3%, and this slight decline was driven exclusively by the United States.

Treatment options for patients with lung cancer have increased tremendously in the last decades and the efficacy of existing treatment options has improved. To see what consequences this has for lung cancer mortality in the real world, German investigators explored the changes in lung cancer mortality in Northern America and Europe between 2000 and 2017. They analysed data from the WHO Mortality Database covering Northern America and Eastern/Northern/Southern/Western Europe and calculated the average annual percentage change (AAPC) as a summary measure of overall and country-specific trends in lung cancer mortality. Dr Philip Baum (Thoraxklinik Heidelberg, Germany) presented the results [1].

In the total investigated population of 872.5 million people, the average annual, age-standardised mortality between 2015 and 2017 was 54.6 deaths per 100,000 with a strong inter-country variability both for men and women (see Figure). Age-standardised lung cancer mortality rate decreased constantly (AAPC -1.5%) from 2000 to 2017. However, whereas mortality in men dropped annually by an average of -2.3%, mortality in women only decreased by an average of -0.3%. Moreover, this slight decline was driven exclusively by a mortality drop in the United States, as 21 out of 31 countries in the database registered a significant increase in lung cancer mortality in women between 2000 and 2017, with Spain (AAPC +4.1%) and France (AAPC +3.6%) leading the list.

Figure: Average annual, age-standardised lung cancer mortality in Northern America and Europe between 2015 and 2017 [1]



The sex difference in the decrease in lung cancer mortality between 2000 and 2017 may be (partially) explained by 2 observations, said Dr Baum. First, the peak in smoking incidence in men is about 2 decades ahead of the peak in smoking incidence in women [2]. In addition, young women appear to have a higher lung cancer incidence not attributable to smoking compared with young men [3].

In conclusion, despite the overall decreasing lung cancer mortality trends in Europe and Northern America, in all countries except the USA, mortality in women remained either unchanged or even increased. National mortality outcomes are very heterogeneous and influenced by variabilities in tobacco control, screening, and access to effective treatment.

1. Baum P, et al. Trends in age and sex specific lung cancer mortality in Europe and Northern America: Analysis of vital registration data from the WHO mortality database between 2000 and 2017. Abstract 131MO. ELCC 2022 Virtual Meeting, 30 March–02 April.
2. Wensink M, et al. BMC Public Health. 2020;20:39.
3. Jemal A, et al. N Engl J Med 2018;378:1999–2009.

 

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Posted on 25 May, 2022