Figure 1. Time trends in lung cancer
80
1100
70
1000
60
900
50
800
40
700
30
600
20
500
10
400
0
cases per year
Cancer
Trends
1200
No.1; December 2009
age-standardised incidence rate
per 100,000
(EASR=age-standardised incidence rate, European standard population)
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
year of diagnosis
Recent trends in lung cancer
female cases
Cancer of the bronchus and lung is the third most
common cancer (excluding non-melanoma skin
cancer) in Ireland overall, and the second most
common in both men and women. It is the
commonest cause of death from cancer (1623
deaths in 2006). While the number of cases is
increasing for both sexes, by 5% annually for women
and by 1% for men, the age-standardised incidence
rates for men have been falling, while those for
women are rising (Figure 1).
female EASR
male EASR
Figure 2. Time trends in lung cancer, by cell type
females
ae-standardised incidence rate per 100,000
24
Incidence trends by cell type
20
16
12
8
4
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
year of diagnosis
squamous
adenocarcinoma
small cell
other
males
24
ae-standardised incidence rate per 100,000
The decrease in incidence for men has been largely
due to a fall in the numbers and incidence rate for
squamous carcinoma (SC) (Figure 2) which, in turn is
presumably due to a decrease in smoking
prevalence. The age-standardised incidence rate for
SC has been decreasing annually by 2.8% (95%
confidence interval (CI) 1.7%-3.9%) since 1994.
Almost all of this decrease was between 1994 and
2001, but since then the rate has changed very little.
The incidence rate of adenocarcinoma of the lung
has been increasing in men by 3.5% per annum (95%
CI 2.2%-4.7%) while there has been little change in
the incidence of small cell carcinoma. For women,
there have been increases in the incidence of
squamous carcinoma (by 1.3% annually, 95% CI
0.1%-2.5%) and of adenocarcinoma (6.5% annually,
95% CI 5.2%-7.8%), but no significant change in
small cell carcinoma incidence.
male cases
20
16
12
8
4
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Adenocarcinoma trends
year of diagnosis
An increase in the proportion of adenocarcinoma of
lung has been widely reported (1) and attributed to
changes from unfiltered to filtered cigarettes (1) or to
air pollution from motor vehicles (2).
squamous
small cell
other
5.0
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
year of incidence
In Ireland, the upward trend in adenocarcinoma has
been seen in both sparsely populated and densely
populated areas (Figure 3) suggesting that motor
vehicle pollution is not a major factor in the increase.
Lung cancer facts at a glance
Number of lung cancer cases 2007
Number of lung cancer deaths 2006
Age-standardised incidence rate 2007
Age-standardised mortality rate 2006
Risk of developing lung cancer before age 75
Risk of dying of lung cancer before age 75
adenocarcinoma
Figure 3. Time trends in adenocarcinoma of lung,
by population density (persons/hectare)
age-standardised incidence rate per
100,000
For both sexes there has been an increase in the
proportion
of
adenocarcinoma.
In
1994,
adenocarcinoma made up 12% of male lung cancers
and 16% of female; these percentages are now 21%
and 27% respectively. The ratio of male to female
incidence of adenocarcinoma has fallen from 1.9 in
1994 to 1.3 in 2007, and for squamous carcinoma
from 3.6 to 2.2.
<1 person/ha
1-19 p/ha
females
20+ p/ha
males
716
659
32.3
28.4
2.8%
2.2%
More information on cancer is available on our website www.ncri.ie
1001
964
51.8
50.6
4.1%
3.8%
Figure 4. Time trends in lung cancer, by age
annual percentage change in incidence
-8%
-6%
-4%
-2%
0%
2%
4%
6%
8%
35-39
40-44
45-49
50-54
age at diagnosis
Age-specific incidence trendsThere has been a
decrease in overall incidence rate for males in almost all
age groups (Figure 4), while there has been an increase
for almost all age groups of females. While the largest
increase is seen in the 45-49 year age group for both
sexes, this represents very few cases (2%-3% of the
total). The incidence rate for males 60 and over is falling
by 1.4% annually, and this seems to be accelerating. For
men under 60, the incidence rate is much lower, and
also falling by 1.4%. The incidence rate for women
under 60 is rising by 3.9% a year, and for those 60 and
over by 1.5% annually, although there is some evidence
that the latter has levelled off since 2003.
55-59
60-64
65-69
70-74
Mortality trends resemble those for incidence (Figure 5).
The risk of dying of lung cancer before age 75 has fallen
from 5.7% to 3.8% for men since 1980, while for women
it has risen slightly, from 2.0% to 2.2%.
75-79
80-84
85+
Person-years of life lost
6%
5%
4%
3%
2%
1%
2006
2004
2002
2000
1998
1996
year of death
males
females
Figure 6. Person-years of life lost due to lung cancer 1954-2006
Smoking prevalence in men and women in Ireland is
similar and has not changed substantially in the past
five years (Figure 7). Data from the UK show a striking
similarity in reported trends between the two countries
and the convergence of male and female smoking
prevalence in the early 1990s, despite the different
methods of measurement. This equalisation of smoking
behaviour is almost certain to result in a similar
convergence of cancer incidence and mortality in the
near future.
10000
person-years of life lost
12000
8000
6000
4000
2000
0
1954 1958 1962 1966 1970 1974 1978 1982 1986 1990 1994 1998 2002 2006
year of death
male
female
Figure 7. Prevalence of cigarette smoking in Ireland and the UK,
1970—2008
60
50
smoking prevalence (%)
2. Lung adenocarcinoma incidence rates and their
relation to motor vehicle density.
Chen F, Jackson H, Bina WF. Cancer Epidemiol
Biomarkers Prev. 18 :760-4 (2009)
1994
1992
1990
1988
1986
1984
1982
0%
Smoking prevalence
References
1. International lung cancer trends by histologic type:
male:female
differences
diminishing
and
adenocarcinoma rates rising.
Susan S. Devesa, Freddie Bray, A. Paloma Vizcaino and
D. Max Parkin. Int. J. Cancer: 117:294–9 (2005)
male
7%
1980
Figure 6 shows that the number of years of life lost to
men due to lung cancer has been constant, at around
10,000 PYLL per year, since the 1970s. This total is
now rising, due to improved life expectancy and the
increase in population size. The number of years of life
lost to women has increased steadily since the 1950s,
and has gone from 58% of the male total in 1991 to
80% in 2006. As with males, the number of years of life
lost has risen more rapidly in the last decade, and for
the same reasons.
female
Figure 5. Time trends in lung cancer mortality 1980-2006
risk of death from cancer before age 75
(%)
A useful measure of the overall impact of cancer
mortality is the number of person-years of life lost
(PYLL). Each person dying before their normal life
expectancy has suffered a loss of potential years of life
and this loss can be aggregated for the whole
population. Cancers causing death at an earlier age
have a greater impact on PYLL.
40
30
20
10
0
1970
1975
1980
1985
1990
1995
2000
2005
year
men (UK)
Sources:
women (UK)
men (Ire)
Ireland 1972-2002: OECD Health Data 2005
Ireland 2003-2008: Office of Tobacco Contro
UK: Cancer Research UK
More information on cancer is available on our website www.ncri.ie
women (Ire)