Lung cancer incidence statistics

Lung cancer is the second most common cancer in the UK (2009), accounting for around 13% of all new cases. Lung cancer is the second most common cancer among men in the UK (2009), accounting for around 14% of all new cases of cancer in males. It is the third most common cancer among women (2009), responsible for more than 11% of all new cases of cancer in females.1-4

In 2009, there were 41,428 new cases of lung cancer in the UK (Table 1.1); 23,041 (56%) in men and 18,387 (44%) in women, giving a male:female ratio of more than 12:10. In 1975, the male:female ratio for lung cancer cases was around 39:10, but has fallen sharply since then due to the decline in lung cancer incidence among men reflecting the reduction in prevalence of cigarette smoking among men in Britain after World War II. Until the late 1990s, lung cancer was the most frequently occurring cancer in the UK; in 1997 it was overtaken by breast cancer.1-4

Table 1.1: Lung Cancer (C33-C34), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK, 2009

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A north-south divide in lung cancer incidence has existed in Britain since at least the 1990s.5 Among males, the European age-standardised incidence rates (AS rates) are significantly lower in England than the UK average, and in Scotland the rates are significantly higher. The geographical variation in the UK for females is similar to that for males (Table 1.1).

Lung cancer incidence rates in Scotland are among the highest in the world,6 reflecting the country’s history of high smoking prevalence.7 Scotland is the only nation in the UK where lung cancer remains the most common cancer when males and females are combined together.1-4  

Rates are particularly high in Greater Glasgow & Clyde NHS Board, where rates are almost a third higher than the average for Scotland.8 Although lower than Greater Glasgow & Clyde, the lung cancer incidence rate in Lothian is also higher than the Scotland average.8 These areas are the densely populated belt from Glasgow in the west to Edinburgh in the east, reflecting the higher rates in urban rather than rural areas, mainly as a result of higher smoking prevalence in urban areas.9 For example, smoking prevalence in Greater Glasgow & Clyde in 2003-2004 was 30%, which is the highest of all the Scottish NHS boards.10 The substantial proportions of the male workforce along the River Clyde employed in the shipbuilding industry, where asbestos was widely used in the 1930s-1960s, may also have contributed to the higher lung cancer incidence in Glasgow.11

The most recent data for England shows that incidence is still higher in the north of England and lower in the East, South East and South West,12 reflecting the regional variation in smoking prevalence in England.13

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Lung cancer is strongly related to age. In the UK between 2007 and 2009, an average of three-quarters of cases were diagnosed in persons aged 65 and over (Figure 1.1).1-4 Age-specific incidence rates rise steeply from age 40, peaking in the 80-84 year olds. Incidence rates are similar for men and women in their 40s, but, thereafter, male rates are higher than female rates, and this gap widens with increasing age. At age 50-54, the male:female ratio of the age-specific incidence rates (to account for the different proportions of males to females in each age group) is around 12:10. By age 85+, it is around 23:10 (Figure 1.1).1-4

Figure 1.1: Lung Cancer (C33-C34), Average Number of New Cases Per Year and Age-Specific Incidence Rates, UK , 2007-2009

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Male lung cancer incidence rates have decreased by 46% overall in Britain since the mid-1970s. Rates were stable between 1975-1977 and 1981-1983, then fell almost continuously between 1981-1983 and 2002-2004, falling by 42%. Since then the rates have declined more gradually with rates in 2007-2009 being just over 6% lower than those 2002-2004. In contrast, the rate for women increased by 67%  from the mid 1970s until 2007-2009, although the increase has been less sharp in the past decade (Figure 1.2).1-3

Figure 1.2: Lung Cancer (C33-C34), European Age-Standardised Incidence Rates, Great Britain, 1975-2009

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Lung cancer incidence trends are shown for the UK in Figure 1.3.1-4 Over the last decade (between 1998-2000 and 2007-2009), the European AS rate for men in the UK fell by 16%, while the rate for women increased by more than 9% (Figure 1.3).1-4

Figure 1.3: Lung Cancer (C33-C34), European Age-Standardised Incidence Rates, UK, 1993-2009

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For males in Britain aged 80 and over a strange pattern in lung cancer incidence rates is observed. Initially, the rate increased by 46% between 1975-1977 and 1985-1987 but since then the rate has declined to the point that the figure in 2007-2009 is not statistically significantly different from the rate for those diagnosed in 1975-1977. For males aged 70-79, the rate rose slightly between 1975-1977 and 1979-1981 (around 3% increase), but has since declined. 

Overall, rates in 2007-2009 are 41% lower than those for 1975-1977. For all other age groups the rates for males have fallen almost continuously since the mind-1970s, with falls of 68%, 62% and 53% in the 40-49, 50-59 and 60-69 age groups, respectively, between 1975-1977 and 2007-2009. (Figure 1.4).1-3

Figure 1.4: Lung Cancer (C33-C34), European Age-standardised Incidence Rates, Males, By Age, Great Britain, 1975-2009

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The rates for females in the 60-69 age group increased by 56%, overall, since the mid-1970s. Between 1975-1977 and 1988-1990, the rate increased by 60%, it then declined by 16% between 1988-1990 and 2001-2003, but has since then increased by 16%. The rate for females in the 70-79 age group shows a different pattern, with incidence rates more than doubling between 1975-1977 and 1999-2001, an increase of almost 150%. Since then, the rate has remained stable. 

Even larger increases have been seen for women aged 80 and over, with rates tripling since the mid-1970s; these rates have not yet stabilised. In contrast, rates for females in Britain aged 40-49 have decreased by 17% between 1975-1977 and 2007-2009, while the rate for women aged 50-59 have been stable over the same period (Figure 1.5).1-3

Figure 1.5: Lung Cancer (C33-C34), European Age-standardised Incidence Rates, Females, By Age, Great Britain, 1975-2009

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It has been estimated that the lifetime risk of developing lung cancer in 2008 is 1 in 14 for men and 1 in 19 for women in the UK. This was done using the AMP method.14

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There are two main types of lung cancers. In England and Wales, around 18% are small cell lung cancers (SCLC) and around 78% are non-small cell lung cancers (NSCLC).18

The main types of NSCLC are squamous cell carcinoma, adenocarcinoma, which account for approximately 32% and 26% of all NSCLC cases, respectively, in England and Wales. However, the largest proportion of NSCLC cases in England and Wales (35%) are non-specified as to their histology subtype (non-small cell not otherwise specified).18

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Although cancer registration has a long history in many countries of the world, particularly in the more affluent regions such as the UK, nearly 80% of the world’s populations live in regions that are not covered by such systems.15 Nonetheless, with a view to characterising the global burden of the disease, the International Agency for Research on Cancer routinely uses the available data to estimate worldwide cancer incidence.16

Lung cancer is the most common cancer worldwide, with an estimated 1.61 million new cases diagnosed in 2008 (around 13% of the total). Lung cancer incidence rates are highest in Europe and Northern America and lowest in parts of Africa, with a 20-fold variation in male and a 40-fold variation in female World AS incidence rates between the regions of the world (Figure 1.6).16

Figure 1.6: Lung Cancer (C33-C34), World Age-Standardised Incidence Rates, World Regions, 2008 Estimates

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Within the 27 countries of the European Union, the highest European AS incidence rates for 2008 are estimated to be in Hungary for men (around 115 cases per 100,000) and Denmark for women (around 51 cases per 100,000), while the lowest rates are in Sweden for males (around 27 cases per 100,000) and Cyprus for females (around 7 cases per 100,000, Figure 1.7).17

UK lung cancer incidence rates are estimated to be the 20th (males) and 3rd (females) highest in Europe (EU-27).17

Figure 1.7: Lung Cancer (C33-C34), European Age-Standardised Incidence Rates, EU-27 Countries, 2008 Estimates

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Lung cancer incidence is strongly related to deprivation. In an analysis of patients diagnosed with lung cancer incidence in 1993 in England & Wales broken down by the Carstairs deprivation index, incidence was almost 2.5 times higher in the most deprived male groups compared with the least deprived; the difference for women was even greater at 3 times (Figure 1.8).19

Figure 1.8: Lung Cancer (C33-C34), Age-Standardised Incidence Rates By Deprivation Category, England and Wales, 1993

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The most recent England-wide data for 2000-2004 shows European AS incidence rates are more than twice as high for men and women living in the most deprived areas compared with the least deprived, and this gap has remained fairly stable since the mid 1990s.20 A deprivation gap of a similar magnitude has been shown for Northern Ireland,21 and a study in Scotland for 2005-2009 shows that incidence is around three times higher for the most deprived compared with the most affluent.8 There is also a clear association with deprivation in Wales.22 This association is related to the higher smoking prevalence in more deprived groups.13

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Prevalence refers to the number of people who have previously received a diagnosis of cancer and who are still alive at a given time point. Some patients will have been cured of their disease and others will not. The latest estimates for the UK (Table 1.2) show that around 38,100 people were still alive at the end of 2006, up to ten years after being diagnosed with lung cancer.23 Worldwide, it is estimated that there were 1.68 million lung cancer patients still alive in 2008, up to five years after their diagnosis.16

Table 1.2: Lung Cancer (C33-C34), One, Five and Ten Year Cancer Prevalence, UK, 31st December 2006

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General information about cancer prevalence in the UK can be found in the Prevalence section of the CancerStats website.

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