Chronic Disease Reports: Deaths from Lung Cancer -- United States, 1986

In 1986, 126,000 persons in the United States died from cancer of the trachea, bronchus, or lung (i.e., "lung cancer," ICD-9-CM code 162). Lung cancer mortality increased by 15% overall from 1979 to 1986 (1)--by 7% among males and 44% among females (2,3). Lung cancer mortality rates increase with age; 62% of lung cancer deaths in 1986 occurred in persons greater than or equal to 65 years of age (3).

Although age-adjusted lung cancer mortality rates are higher in southern and lower midwestern states, high rates occur elsewhere (Table 1, Figure 1). Age-adjusted lung cancer mortality rates are highest in Alaska (70.5 per 100,000 population) and lowest in Utah (24.3 per 100,000).

Evidence for a causal relationship between cigarette smoking and lung cancer incidence and mortality has been documented extensively (Table 2) (4). Risk for mortality varies by smoking status, sex, and daily cigarette consumption. Passive smoking has also been associated with increased risk for lung cancer; an estimated 3800 lung cancer deaths are attributable to passive smoking each year (5). Moderately high levels of dietary vitamin A have been associated with lower rates of lung cancer (6); however, this effect may be reduced in smokers (7).

Numerous agents have been associated with lung cancer in occupational (8) and other settings; for example, exposures to radon emission and asbestos fibers are known risk factors for lung cancer mortality (9,10). The risk associated with radon is an estimated 6-11 times higher in smokers than in nonsmokers (11). Risk is also higher in asbestos workers who smoke than in those who do not smoke (12). Although information on the population prevalence of exposure to radon and asbestos (and to each in combination with cigarette smoking) is preliminary, mortality attributable to these causes can be estimated. Exposure to radon in homes is associated with 5000-20,000 lung cancer deaths annually (13); an estimated 85% of these deaths are due to the combined exposure of radon and cigarette smoke (4). Approximately 5500 lung cancer deaths in the United States in 1987 were expected among persons with occupational exposure to asbestos (10). Reduction of cigarette smoking remains the single most important means of controlling lung cancer in the United States (4). More than 80% of lung cancer deaths are estimated to be caused by cigarette smoking. Reduction of cigarette smoking would decrease lung cancer mortality both directly, by moderation of an independent risk factor, and indirectly, by mitigation of the effects of other risk factors such as radon and asbestos exposures. While the prevalence of smoking has declined in recent decades, this decline has been slow in women and negligible among persons with less than high school education; rates remain especially high among certain groups (e.g., blue-collar workers and less educated persons) (4). To reduce lung cancer mortality, physicians and public health practitioners must emphasize noninitiation of smoking among youths and quitting among current smokers. Reported by: Div of Surveillance and Epidemiologic Studies, Epidemiology Program Office; Office on Smoking and Health, Center for Chronic Disease Prevention and Health Promotion, CDC.

References

1. CDC. Chronic disease reports: mortality trends--United States,

1979-1986. MMWR 1989;38: 189-91.

2. NCHS. Vital statistics of the United States, 1979. Vol II--Mortality, pt A. Hyattsville, Mary land: US Department of Health and Human Services, Public Health Service, 1984:103; DHHS publication no. (PHS)84-1101.

3. NCHS. Vital statistics of the United States, 1986. Vol II--Mortality, pt A. Hyattsville, Mary land: US Department of Health and Human Services, Public Health Service, 1988:105; DHHS publication no. (PHS)88-1122.

4. CDC. Reducing the health consequences of smoking: 25 years of progress--a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

5. National Research Council. Environmental tobacco smoke: measuring exposures and assessing health effects. Washington, DC: National Academy Press, 1986.

6. Public Health Service. The Surgeon General's report on nutrition and health. Washington, DC: US Department of Health and Human Services, Public Health Service, 1988; DHHS publication no. (PHS)88-50210.

7. Byers TE, Graham S, Haughey BP, Marshall JR, Swanson MK. Diet and lung cancer risk: findings from the Western New York Diet Study. Am J Epidemiol 1987;125:351-63.

8. CDC. Leading work-related diseases and injuries--United States. MMWR 1983;32:24-6,32.

9. Council on Scientific Affairs, American Medical Association. Radon in homes. JAMA 1987;258:668-72. 10. Nicholson WJ, Perkel G, Selikoff IJ. Occupational exposure to asbestos: population at risk and projected mortality--1980-2030. Am J Industrial Med 1982;3:259-311. 11. National Research Council. Health risks of radon and other internally deposited alpha-emitters. Washington, DC: National Academy Press, 1988. 12. CDC. The health consequences of smoking: cancer and chronic lung disease in the workplace--a report to the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1985. 13. Office of Air and Radiation/CDC. A citizen's guide to radon: what it is and what to do about it. Washington, DC: US Environmental Protection Agency, Office of Air and Radiation; US Department of Health and Human Services, Public Health Service, 1986.

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