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Lung cancer is the deadliest of all cancers in the United States and the world. It kills more Americans than the next four most common cancers combined. Lung cancer is largely preventable; inroads in reducing cigarette smoking are having a positive influence, though other environmental exposures also put people at risk. Advances in understanding this disease are leading to new means of diagnosis and treatment. Whom does it affect? Epidemiology, prevalence, economic burden, vulnerable populations The World Health Organization’s Global Burden of Disease analysis projects 1,676,000 deaths from lung cancer worldwide in 2015. It predicts that this toll will continue to rise to reach a staggering 2,279,000 deaths in the year 2030 (1). In the United States, it has been estimated that 159,390 individuals (70,490 women and 88,900 men) died from lung cancer in 2009—more deaths than from cancers of the breast, colon, pancreas, and prostate combined (2). Lung cancer is a disease of modern times. At the turn of the 20th century, lung cancer was rare, accounting for less than 0.5 percent of all malignancies. Whitebook_breathing_Ch11.indd 109 6/26/10 12:13:17 AM Lung Cancer Chapter 11 110 In the early decades of the 1900s, a steeply rising incidence of lung cancer in men led to speculation implicating a variety of etiologies, including tuberculosis, influenza, industrial pollution, and chronic bronchitis, among others. In that period, tobacco tar liberated from burning tobacco was found to be carcinogenic, and clinical observations suggested a link between cigarette smoking and lung cancer. In 1950, landmark epidemiologic studies published in the United States and in the United Kingdom demonstrated that an association between cigarette smoking and lung cancer existed, that intensity of smoking was a factor in the development of lung cancer, and that a lag time of years between exposure to cigarette smoking and diagnosis of lung cancer was typical. In 1964, the United States Surgeon General issued a landmark report on the health consequences of smoking that acknowledged the causative role of cigarette smoking in the development of lung cancer. AL 3,140 AZ 2,820 AR 2,160 CA 12,750 CO 12,750 CT 1,810 DE 590 FL 12,210 GA 4,660 ID 630 IL 6,460 IN 4,000 IA 1,760 KS 1,620 KY 3,430 LA 2,700 ME 980 MD 2,880 MA 3,610 MN 2,380 MS 2,030 MO 4,100 MT 550 NE 890 NV 1,340 NH 750 NJ 4,190 NM 710 NY 8,780 NC 5,630 ND 370 OH 7,300 OK 2,390 OR 2,140 PA 8,090 RI 560 SC 2,880 SD 450 TN 4,520 TX 9,780 UT 480 VT 350 VA 4,250 WA 3,090 WV 1,500 WI 2,910 WY 260 DC 240 HI 570 AK 220 MI 5,840 PR N/A US 159,390 Lung cancer is the leading cause of cancer death in the United States. Its low survival rates are due in part to the lack of a method to detect it early. American Cancer Society. Cancer Facts and Figures 2009. Atlanta: American Cancer Society; 2009. Lung and bronchus deaths by state, 2009 Whitebook_breathing_Ch11.indd 110 6/25/10 12:51:18 PM Chapter 11 Lung Cancer 111 Before 1950, lung cancer in women was still an uncommon occurrence. However, over the latter half of the 20th century, an epidemic of lung cancer in women occurred, mirroring the rapid rise of lung cancer among men witnessed earlier. Since 1988, lung cancer has killed more women than breast cancer each year in the United States. Since 1991, lung cancer mortality rates have been declining in men, while in women they appear to be plateauing. Lung cancer is unfortunately likely to remain the leading cause of cancer death in both men and women in this country for the near future. The economic burden of lung cancer to the nation is immense, and can be gauged in a number of ways, including estimation of life-years lost,
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