The smoking epidemic and lung cancer in the EU

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The smoking epidemic and lung cancer in the EU

• Carlo La Vecchia

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Lung cancer trends in the EU

• Male lung cancer mortality rates have peaked in
  1988 in the European Union (EU).

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Trends in mortality from major cancer sites in
the EU, men, 1980-2004.
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Male lung cancer in the EU

• Male lung cancer appreciable fall
• (over 20) from the peak rate
• (55.4/100,000) in 1988 to 43.1 in 2004.

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Male lung cancer in the EU
35-64
All ages
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Trends in mortality from major cancer sites in
the EU, women, 1980-2004.
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Female lung cancer in the EU
20-44
35-64
All ages
(Bosetti et al., 2005)
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Male/female lung cancer sex ratios in the EU
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Female lung cancer in the EU

• Lung 15 1990-2004
• Lung is now the second leading cause of cancer
  mortality in women after breast and before
  colorectum.
• Female lung cancer rates are however still 50
  lower than breast cancer ones, and 70 lower than
  US female lung cancer mortality.

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Female lung cancer in the EU

• In most EU countries, the lower extent of recent
  increases compared with those of the past, and
  the more favorable trends in young women, suggest
  that female lung cancer mortality rates will not
  reach the high levels observed in the USA.
• Effective interventions to control and reduce
  tobacco smoking in women should be implemented to
  avoid a major lung cancer epidemic in
• European women.

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Lung cancer in women 20-44 years
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LUNG CANCER IN YOUNG WOMEN

• Since recent trends in the young give relevant
  information to the likely future trends in middle
  age, the female lung cancer epidemic is likely to
  expand in southern Europe from the current rates
  of 5.0/100,000 in Spain and 7.7 in France to
  approach 20/100,000 within the next two to three
  decades. Urgent interventions for smoking
  cessation in women are therefore required.

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Smoking death in male British doctors 50-year
results50-year prospective study ask in
1951, periodically thereafter (1957,
1966,1971,1978, 1991,2001), what men
smoked.Monitor for 50 years (1951-2001) the
mortality of never-smokers of continuing
cigarette smokers (, after they quit,
ex-cigarette smokers).

• Doll, Peto et al
• British Med J. 2004 328 1519

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Cumulative risk at UK male 1990 rates BMJ
2000 321323-9
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Three main messages for the individual smoker

• Risk is BIG half are killed
• 1/6 die of lung cancer
• 1/4 are killed in MIDDLE age (35-69), losing many
  years
• STOPPING smoking works

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Effects of cessation at various ages

• On average, for men born 1900-1930, cigarette
  smokers lost about 10 years.
• But, cessation at ages 60, 50, 40 or 30 gained
  about 3, 6, 9 or the full 10 years

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Effects of cessation at various ages

• On average, for men born 1900-1930, cigarette
  smokers lost about 10 years.
• But, cessation at ages 60, 50, 40 or 30 gained
  about 3, 6, 9 or the full 10 years

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UK, 1950-2000 mortality trends in middle age
(35-69)
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UK cancer mortality trends in middle age
(35-69),from 1950 to 2000
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France, age 40-44 Concordance between trends in
cumulative cigarette consumption and in lung
cancer(source Catherine Hill, INSERM)
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DELAY of tobacco hazards

• Nationwide delay of several decades between main
  increase in cigarette smoking by young adults and
  main increase in tobacco deaths
• Main hazards are from cigarette smoking that
  starts in early adult life, and does not stop

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Example of long delay USA

• Main increase before 1950 in cigarette use by
  young adults (male, then female)
• Main increase after 1950 in tobacco deaths (male,
  then female)

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World tobacco deaths,if current smoking patterns
continue
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• Prevention of a substantial proportion of the 450
  million tobacco deaths before 2050 requires adult
  cessation
• Continuing to reduce the children starting
  smoking prevents many deaths,
• but its main effect will be on mortality in
  2050 later