Lung Cancer: Risk Factors

and Epidemiology

Gregory P. Kalemkerian, M.D.

Division of Hematology/Oncology
University of Michigan
 Objectives
• Review the risk factors that cause lung
cancer with a focus on tobacco smoking

• Review the epidemiology of lung cancer,

including the impact of race and gender
 Introduction
• Lung cancer is the most common cancer and cause
of cancer death in the world (>1.5 million cases/yr)
• Lung cancer is the leading cause of cancer death in
both men and women in the U.S.
• More Americans will die from lung cancer (154,050)
than from colon, pancreatic and breast cancer
combined (136,360)
CA Cancer J Clin 68:7, 2018
 Pre-Lecture Question
Which of the following is true regarding the incidence rate
of lung cancer in the United States?
a) It is highest in people between 50-60 years of age
b) It is higher in women than in men
c) It is highest in African-American men
d) It is higher in African-American women than in white
men
 Pre-Lecture Question
The lung cancer-specific mortality rate in the United States is
now declining.
What is the primary reason for this decline?
a) The development of filtered cigarettes
b) The decreasing prevalence of tobacco smoking
c) The increasing popularity of mentholated cigarettes
d) The introduction of “low-tar” cigarettes
e) The increasing use of lung cancer screening
Risk Factors
 Cause

Effect
Lung Cancer: High-Risk Populations
• Smokers and former smokers
– Dose-response relationship
• Inflammatory pulmonary disease
– COPD, interstitial fibrosis, autoimmune disorders
• Occupational exposures
– Asbestos, silica
– Radon (miners)
– Cadmium, chromium, nickel, arsenic
– Polycyclic aromatic hydrocarbons
• Prior lung or head & neck cancer
 Lung Cancer Mortality and Smoking

Scientific American; June 1997

 Lung Cancer Risk Factors
Lung cancer cases by smoking status
– 85-90% of lung cancers are due to smoking
Harvard M.D. Anderson

Current smokers 40% 34%

Former smokers 51% 50%

Never smokers 9% 16%

Khouri et al. Hem Onc Clin N Am 11:387, 1997

Epidemiology
Lung Cancer: Age Distribution
14000
12000
Number of Patients

10000
8000
6000
4000
2000
0
20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99
Age Range

Ramalingam, et al. J Clin Oncol 16:651,1998

Lung Cancer: Incidence by Gender

Incidence Rate Ratio (Male/Female)

90 4
80

Incidence (per 100,000)

70 3
60
50
2
40
30
20 1

10
0 0
1975 1980 1985 1990 1995
Year of Diagnosis

Male Female Ratio (M/F)

Fu, et al. Chest 127:768, 2005

 Lung Cancer: Survival by Gender
0.4 2-Year Male 2-Year Female
5-Year Male 5-Year Female
0.3
Survival Rate

0.2

0.1

0
1975 1980 1985 1990 1995 2000
Year of Diagnosis

Fu, et al. Chest 127:768, 2005

Lung Cancer: Incidence by Race

Gadgeel, et al. Chest 120:55, 2001

Lung Cancer: Survival by Race

Gadgeel, et al. Chest 120:55, 2001

 Pre-Lecture Question
Which of the following is true regarding the incidence rate
of lung cancer in the United States?
a) It is highest in people between 50-60 years of age
b) It is higher in women than in men
c) It is highest in African-American men
d) It is higher in African-American women than in white
men
 Pre-Lecture Question
Which of the following is true regarding the incidence
rate of lung cancer in the United States?
a) It is highest in people between 50-60 years of age
b) It is higher in women than in men
c) It is highest in African-American men
d) It is higher in African-American women than in
white men
 Pre-Lecture Question
The lung cancer-specific mortality rate in the United States is
now declining.
What is the primary reason for this decline?
a) The development of filtered cigarettes
b) The decreasing prevalence of tobacco smoking
c) The increasing popularity of mentholated cigarettes
d) The introduction of “low-tar” cigarettes
e) The increasing use of lung cancer screening
 Pre-Lecture Question
The lung cancer-specific mortality rate in the United States is
now declining.
What is the primary reason for this decline?
a) The development of filtered cigarettes
b) The decreasing prevalence of tobacco smoking
c) The increasing popularity of mentholated cigarettes
d) The introduction of “low-tar” cigarettes
e) The increasing use of lung cancer screening
 Take Home Points
• Lung cancer is the #1 cause of cancer-related death
• Tobacco smoking accounts for 85-90% of lung cancer
• Smoking cessation is the most effective way to decrease
lung cancer incidence and mortality
• Lung cancer incidence is higher in African-Americans
and in men