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