Lung cancer

The link between tobacco and lung cancer was established more than sixty years ago,7 and incidence rates closely reflect past smoking prevalence with a time lag of approximately 20-30 years.1,8,9 Manufactured cigarettes were first introduced at the end of the nineteenth century and since then the global consumption of tobacco has been rising steadily.9,10

There is estimated to be more than one billion smokers in the world, which is about a quarter of all adults. Smoking prevalence is higher in men than in women in most countries worldwide; the overall world estimates for 2006 were 41% of men and 9% of women smoking, though this varied considerably by country and age. In many developing countries the consumption of cigarettes is increasing rapidly in both sexes, due to both population growth and the increased targeting of tobacco marketing in these areas (especially to young people).9,10

Throughout most of Europe, smoking prevalence has now peaked among men but is increasing in women (particularly in the younger age groups, where teenage girls can be as likely to smoke as teenage boys). Worldwide, the number of smokers is continuing to rise, and without intervention this will lead to large increases in the incidence of lung cancer in the coming decades.9,10

section reviewed 19/09/11
section updated 19/09/11

Lung cancer has been estimated as the most common cancer in the world for several decades (Figure 1.3).1-6 An estimated 1.61 million people across the world were diagnosed with lung cancer in 2008, accounting for 13% of the total.1  More than half (55%) of the cases occurred in the developing world.1

Lung cancer incidence is more than double in men than in women worldwide (rate ratio 2.5 : 1.0).1 Male lung cancer incidence rates vary twenty-fold across the regions of the world. In 2008, the highest incidence rates were seen in Central and Eastern Europe at 57 per 100,000 (Figure 2.1).1 The proportion of men smoking is also high in this region, with Russia, Ukraine and Belarus having some of the highest age-standardised smoking prevalence estimates in the world (with 70%, 64% and 64% of men currently smoking any form of tobacco, respectively).10

Figure 2.1: Lung Cancer (C33-C34), World Age-Standardised Incidence and Mortality Rates, Males, Regions of the World, 2008 Estimates

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Male lung cancer incidence rates were very low in Middle, Western and Eastern Africa (3-4 per 100,000) in 2008. However, these regions are experiencing an increasing rate of tobacco use, with many countries reporting age-standardised smoking prevalence estimates in excess of 25% (the highest being Mauritius with 36% of men currently smoking a tobacco product).10 The UK male lung cancer incidence rate was 44th highest out of 184 countries worldwide.1

There is wider variation (forty-fold) in female lung cancer incidence across the regions of the world. In 2008, the highest incidence rates were seen in Northern America at 36 per 100,000 (Figure 2.2).1 Though the proportion of smokers is moderate in US women (with an age-standardised prevalence estimate of 22% of women smoking a tobacco product), the current lung cancer incidence rates will have been driven by earlier, higher smoking prevalence (around 30% of women were reported to smoke cigarettes in the 1970s).10,11

Figure 2.2: Lung Cancer (C33-C34), World Age-Standardised Incidence and Mortality Rates, Females, Regions of the World, 2008 Estimates

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Female lung cancer incidence rates were lowest in four of the five African regions (1-2 per 100,000). Smoking prevalence is also currently very low in these regions (age-standardised smoking prevalence estimates are less than 5% for most countries) - but, as with men, this is expected to rise in the future.10 The UK female lung cancer incidence rate was relatively high for females at joint 7th highest out of 184 countries worldwide.1

section reviewed 19/09/11
section updated 19/09/11

Lung cancer is the most common cause of death from cancer worldwide, estimated to be responsible for nearly one in five (18%), or 1.38 million, cancer deaths in 2008.1 Survival from lung cancer is poor in both developing and developed regions of the world (the mortality to incidence ratio, that is the number of deaths divided by the number of cases, was 0.86 in 2008),1 and as such geographical patterns in mortality closely follow those in incidence (Figures 2.1 and 2.2).

section reviewed 19/09/11
section updated 19/09/11