Trends in incidence and prognosis of the histological subtypes of lung cancer in North America, Australia, New Zealand and Europe

doi:10.1016/S0169-5002(00)00197-5

Lung Cancer

Volume 31, Issues 2–3, March 2001, Pages 123-137

https://doi.org/10.1016/S0169-5002(00)00197-5 Get rights and content

Abstract

Background: Since the incidence of the histological subtypes of lung cancer in industrialised countries has changed dramatically over the last two decades, we reviewed trends in the incidence and prognosis in North America, Australia, New Zealand and Europe, according to period of diagnosis and birth cohort and summarized explanations for changes in mortality. Methods: Review of the literature based on a computerised search (Medline database 1966–2000). Results: Although the incidence of lung cancer has been decreasing since the 1970s/1980s among men in North America, Australia, New Zealand and north-western Europe, the age-adjusted rate continues to increase among women in these countries, and among both men and women in southern and eastern Europe. These trends followed changes in smoking behaviour. The proportion of adenocarcinoma has been increasing over time; the most likely explanation is the shift to low-tar filter cigarettes during the 1960s and 1970s. Despite improvement in both the diagnosis and treatment, the overall prognosis for patients with non-small-cell lung cancer hardly improved over time. In contrast, the introduction and improvement of chemotherapy since the 1970s gave rise to an improvement in — only short-term (<2 years) — survival for patients with small-cell lung cancer. Conclusions: The epidemic of lung cancer is not over yet, especially in southern and eastern Europe. Except for short-term survival of small cell tumours, the prognosis for patients with lung cancer has not improved significantly.

Introduction

At the beginning of this century lung cancer was a very rare disease, but rates in North America, Australia, New Zealand and Europe have increased so dramatically that lung cancer can be considered a major epidemic of the 20th century. Currently lung cancer is the first or second most frequent tumour type among men in industrialised countries and ranks second or third for women [1], [2], [3], [4], [5].

Trends in mortality are influenced by trends in incidence and survival. Since the incidence of the histological subtypes of lung cancer in industrialised countries has changed dramatically over the last two decades, we now review time and birth cohort trends in the incidence and prognosis of lung cancer in North America, Australia, New Zealand and Europe according to geography and histological subtype, and summarise explanations for the changes in mortality. Trends in incidence are described in the first part of this review, while the second part focuses on trends in prognosis, which so far have received little attention. We focused on industrialised countries, because the epidemic of smoking and the subsequent temporarily very high incidence of lung cancer in these countries are illustrative for other parts of the world where smoking is on the rise.

Section snippets

Methodological considerations

This review was based on a computerised search (Medline database 1966–2000). Included were English-written, peer-reviewed articles on trends in incidence, mortality, risk factors, prognostic factors and survival for the histological subtypes of lung cancer. We also used volumes IV to VII of ‘Cancer Incidence in Five Continents’, in which incidence of cancer in different geographical locations and distinct ethnic sub-populations between 1973 and 1992 are described.

Geographical variations

Worldwide male lung cancer incidence rates between 1988 and 1992 were highest (>50 per 100 000 person-years) in the USA, Canada, New Zealand (Maori) and most European countries, moderate (35–50 per 100 000) in China, Ireland, Malta, Spain, Australia and New Zealand (non-Maori), and low (<35 per 100 000) in Utah (USA), Latin America, most Asian countries, Iceland, Norway and Sweden [2]. For women lung cancer incidence rates were exceptionally high (>50 per 100 000) in New Zealand (Maori), high

Geographical variations

Worldwide, the prognosis for patients with lung cancer is very poor, because metastases are often present at the time of diagnosis. Survival is associated with age and tumour stage: 1-year relative survival rates decreased from 40% for patients younger than 45 years old to 20% for patients of 75 and older [88], [89], and was better for patients with localised disease (40–65%) than for those with metastasised disease (15–30%) [80], [90], [91], [92].

In North America the 1- and 5-year survival

Summary and conclusions

Since the beginning of this century the incidence of lung cancer has been increasing dramatically in most Western countries; it is now the most frequent or second most frequent tumour in men and the second or third in women. The peak of the epidemic among men was reached in the 1970s or 1980s in North America, Australia, New Zealand and north-western Europe, first in the younger age groups. The peak among men in southern and Eastern Europe and for women has not yet been reached. The trends were

References (162)

M. McCredie et al.
Cancer incidence in New South Wales, Australia
Eur. J. Cancer
(1991)
C. La Vecchia et al.
Trends of cancer mortality in Europe, 1955–1989: II, respiratory tract, bone, connective and soft tissue sarcomas, and skin
Eur. J. Cancer
(1992)
R.C. Daly et al.
Bronchoalveolar carcinoma: factors affecting survival
Ann. Thorac. Surg.
(1991)
J.W. Horm et al.
Falling rates of lung cancer in men in the United States
Lancet
(1986)
H. Skuladottir et al.
Incidence of lung cancer in Denmark: historical and actual status
Lung Cancer
(2000)
M.L.G. Janssen-Heijnen et al.
Striking changes in smoking behaviour and lung cancer incidence by histological type in the south-east Netherlands, 1960–1991
Eur. J. Cancer
(1995)
A. Russo et al.
Changes in lung cancer histological types in Varese Cancer Registry, Italy 1976–1992
Eur. J. Cancer
(1997)
J.R. McLaughlin et al.
Cancer incidence registration and trends in Ontario
Eur. J. Cancer
(1991)
H.H. McDuffie et al.
Determinants of cell type in patients with cancer of the lungs
Chest
(1990)
I.T.T. Higgins et al.
Lung cancer among cigar and pipe smokers
Prev. Med.
(1988)

S.D. Stellman et al.

Lung cancer risk is proportional to cigarette tar yield: evidence from a prospective study

Prev. Med.

(1989)

P. Wilkinson et al.

Is lung cancer associated with asbestos exposure when there are no small opacities on the chest radiograph?

Lancet

(1995)

E.L. Wynder et al.

Epidemiologic patterns in lung cancer by histologic type

Eur. J. Cancer Clin. Oncol.

(1987)

M.L.G. Janssen-Heijnen et al.

Variation in survival of patients with lung cancer in Europe, 1985–1989

Eur. J. Cancer

(1998)

E. Vrdoljak et al.

Survival analysis of untreated patients with non-small-cell lung cancer

Chest

(1994)

E.W. Humphrey et al.

National survey of the pattern of care for carcinoma of the lung

J. Thorac. Cardiovasc. Surg.

(1990)

F. Levi et al.

Trends in cancer survival in Vaud, Switzerland

Eur. J. Cancer

(1992)

P.A. Wingo et al.

Annual report to the nation on the status of cancer, 1973–1996, with a special section on lung cancer and tobacco smoking

J. Natl. Cancer Inst.

(1999)

Parkin DM, Whelan SL, Ferlay J et al., editors. Cancer incidence in five continents, vol VII, No. 143. Lyon: IARC...

S.S. Devesa et al.

Cancer incidence and mortality trends among whites in the United States, 1947–84

J. Natl. Cancer Inst.

(1987)

The World Health Organization histological typing of lung tumours

Am. J. Clin. Pathol.

(1982)

S.H. Barsky et al.

Rising incidence of bronchioloalveolar lung carcinoma and its unique clinicopathologic features

Cancer

(1994)

R.T. Falk et al.

Epidemiology of bronchioloalveolar carcinoma

Cancer Epidemiol. Biomarkers. Prev.

(1992)

A.R. Feinstein et al.

The Will Rogers’ phenomenon: stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer

New Engl. J. Med.

(1985)

M. McCredie et al.

The changing incidence of cancer in adults in New South Wales

Int. J. Cancer

(1988)

G.E. Dinse et al.

Exploring time trends in cancer incidence

Cancer Causes Control

(1992)

L. Vecchia et al.

Trends in cancer mortality, 1955–1989: Asia, Africa and Oceania

Eur. J. Cancer ;29A

(1993)

T. Zheng et al.

Time trend and the age-period-cohort effect on the incidence of histologic types of lung cancer in Connecticut, 1960–1989

Cancer

(1994)

W.D. Travis et al.

United States lung carcinoma incidence trends: declining for most histologic types among males, increasing among females

Cancer

(1996)

F. Levi et al.

Lung carcinoma trends by histologic type in Vaud and Neuchâtel, Switzerland, 1974–1994

Cancer

(1997)

M.J. Thun et al.

Cigarette smoking and changes in the histopathology of lung cancer

J. Natl. Cancer Inst.

(1997)

Waterhouse J, Muir CS, Powell J, Shanmugaratnam K, editors. Cancer Incidence in Five Continents, vol. IV, No. 42. Lyon:...

Muir CS, Waterhouse J, Mack T, Powell J, Whelan S. Cancer incidence in five continents, vol. V, No. 88. Lyon: IARC...

(1996)

W. Jedrychowski et al.

Effect of tobacco smoking on various histological types of lung cancer

J. Cancer Res. Clin. Oncol.

(1992)

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Trends in incidence and prognosis of the histological subtypes of lung cancer in North America, Australia, New Zealand and Europe

Abstract

Introduction

Section snippets

Methodological considerations

Geographical variations

Geographical variations

Summary and conclusions

Eur. J. Cancer

Eur. J. Cancer

Ann. Thorac. Surg.

Lancet

Lung Cancer

Eur. J. Cancer

Eur. J. Cancer

Eur. J. Cancer

Chest

Prev. Med.

Prev. Med.

Lancet

Eur. J. Cancer Clin. Oncol.

Eur. J. Cancer

Chest

J. Thorac. Cardiovasc. Surg.

Eur. J. Cancer

Annual report to the nation on the status of cancer, 1973–1996, with a special section on lung cancer and tobacco smoking

J. Natl. Cancer Inst.

Cancer incidence and mortality trends among whites in the United States, 1947–84

J. Natl. Cancer Inst.

The World Health Organization histological typing of lung tumours

Am. J. Clin. Pathol.

Rising incidence of bronchioloalveolar lung carcinoma and its unique clinicopathologic features

Cancer

Epidemiology of bronchioloalveolar carcinoma

Cancer Epidemiol. Biomarkers. Prev.

The Will Rogers’ phenomenon: stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer

New Engl. J. Med.

The changing incidence of cancer in adults in New South Wales

Int. J. Cancer

Exploring time trends in cancer incidence

Cancer Causes Control

Trends in cancer mortality, 1955–1989: Asia, Africa and Oceania

Eur. J. Cancer ;29A

Time trend and the age-period-cohort effect on the incidence of histologic types of lung cancer in Connecticut, 1960–1989

Cancer

United States lung carcinoma incidence trends: declining for most histologic types among males, increasing among females

Cancer

Lung carcinoma trends by histologic type in Vaud and Neuchâtel, Switzerland, 1974–1994

Cancer

Cigarette smoking and changes in the histopathology of lung cancer

J. Natl. Cancer Inst.

Declining lung cancer rates among young men and women in the United States: a cohort analysis

J. Natl. Cancer Inst.

The changing histopathology of lung cancer: a review of 1682 cases

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A population-based study of lung cancer incidence trends by histologic type, 1974–81

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Secular trends in histologic types of lung cancer

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