Impact of reduced tobacco smoking on lung cancer mortality in the United States during 1975-2000

Abstract

Background: Considerable effort has been expended on tobacco control strategies in the United States since the mid-1950s. However, we have little quantitative information on how changes in smoking behaviors have impacted lung cancer mortality. We quantified the cumulative impact of changes in smoking behaviors that started in the mid-1950s on lung cancer mortality in the United States over the period 1975-2000.

Methods: A consortium of six groups of investigators used common inputs consisting of simulated cohort-wise smoking histories for the birth cohorts of 1890 through 1970 and independent models to estimate the number of US lung cancer deaths averted during 1975-2000 as a result of changes in smoking behavior that began in the mid-1950s. We also estimated the number of deaths that could have been averted had tobacco control been completely effective in eliminating smoking after the Surgeon General's first report on Smoking and Health in 1964.

Results: Approximately 795,851 US lung cancer deaths were averted during the period 1975-2000: 552,574 among men and 243,277 among women. In the year 2000 alone, approximately 70,218 lung cancer deaths were averted: 44,135 among men and 26,083 among women. However, these numbers are estimated to represent approximately 32% of lung cancer deaths that could have potentially been averted during the period 1975-2000, 38% of the lung cancer deaths that could have been averted in 1991-2000, and 44% of lung cancer deaths that could have been averted in 2000.

Conclusions: Our results reflect the cumulative impact of changes in smoking behavior since the 1950s. Despite a large impact of changing smoking behaviors on lung cancer deaths, lung cancer remains a major public health problem. Continued efforts at tobacco control are critical to further reduce the burden of this disease.

Figure 1

Process shared by all models. Population and smoking inputs were used to develop the smoking history generator, which, in turn, simulates detailed individual-level smoking and other-cause mortality histories. These individual histories were used by each of the modeling groups to estimate lung cancer mortality rates in the population.

Figure 2

Percentage of current smokers in the US population by sex and birth cohort, assuming three different tobacco control scenarios. This is one of the outputs that can be generated from the smoking history generator. The output from the actual tobacco control scenario describes the observed data well (not shown).

Figure 3

Lung cancer death rates and counts for men and women aged 30-84 years as observed and for modeled tobacco control scenarios. ATC = Actual Tobacco Control; CTC = Complete Tobacco Control; NTC = No Tobacco Control.