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. 2018 May 24;378(21):1999-2009.
doi: 10.1056/NEJMoa1715907.

Higher Lung Cancer Incidence in Young Women Than Young Men in the United States

Ahmedin Jemal  1 , Kimberly D Miller  1 , Jiemin Ma  1 , Rebecca L Siegel  1 , Stacey A Fedewa  1 , Farhad Islami  1 , Susan S Devesa  1 , Michael J Thun  1
Affiliations

Higher Lung Cancer Incidence in Young Women Than Young Men in the United States

Ahmedin Jemal et al. N Engl J Med. .

Abstract

Background: Previous studies showed a higher incidence of lung cancer among young women than among young men in the United States. Whether this pattern has continued in contemporary birth cohorts and, if so, whether it can be fully explained by sex differences in smoking behaviors are unknown.

Methods: We examined the nationwide population-based incidence of lung cancer according to sex, race or ethnic group, age group (30 to 34, 35 to 39, 40 to 44, 45 to 49, and 50 to 54 years), year of birth (1945 to 1980), and calendar period of diagnosis (1995-1999, 2000-2004, 2005-2009, and 2010-2014), and we calculated female-to-male incidence rate ratios. We also examined the prevalence of cigarette smoking, using data from the National Health Interview Survey from 1970 to 2016.

Results: Over the past two decades, the age-specific incidence of lung cancer has generally decreased among both men and women 30 to 54 years of age in all races and ethnic groups, but the declines among men have been steeper. Consequently, among non-Hispanic whites, the female-to-male incidence rate ratios increased, exceeding 1.0 in the age groups of 30 to 34, 35 to 39, 40 to 44, and 45 to 49 years. For example, the female-to-male incidence rate ratio among whites 40 to 44 years of age increased from 0.88 (95% confidence interval [CI], 0.84 to 0.92) during the 1995-1999 period to 1.17 (95% CI, 1.11 to 1.23) during the 2010-2014 period. The crossover in sex-specific rates occurred among non-Hispanic whites born since 1965. Sex-specific incidence rates converged among non-Hispanic blacks, Hispanics, and non-Hispanic Asians and Pacific Islanders but crossed over from a higher incidence among men to a higher incidence among women only among Hispanics. The prevalence of cigarette smoking among women born since 1965 has approached, but generally not exceeded, the prevalence among men.

Conclusions: The patterns of historically higher incidence rates of lung cancer among men than among women have reversed among non-Hispanic whites and Hispanics born since the mid-1960s, and they are not fully explained by sex differences in smoking behaviors. Future studies are needed to identify reasons for the higher incidence of lung cancer among young women. (Funded by the American Cancer Society.).

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Figures

Figure 1.
Figure 1.. Age-Specific Incidence Rates of Lung Cancer in All Races and Ethnic Groups According to Sex, Calendar Period of Diagnosis, and Birth Cohort.
Shading indicates 95% confidence intervals. The estimated year of birth was calculated by subtracting the mid-year of age (the age halfway between the youngest and oldest age in each age category) from the mid-year of diagnosis (the year halfway between the first and last year in each 5-year calendar period of diagnosis).
Figure 2.
Figure 2.. Age-Specific Incidence Rates of Lung Cancer According to Race or Ethnic Group, Sex, and Calendar Period of Diagnosis and Birth Cohort.
Shading indicates 95% confidence intervals.
Figure 3 (facing page).
Figure 3 (facing page).. Age-Specific Female-to-Male Incidence Rate Ratios for Lung Cancer According to Race or Ethnic Group and Birth Cohort.
Men served as the reference group, and incidence rate ratios are based on unrounded rates. I bars indicate 95% confidence intervals.
Figure 4.
Figure 4.. Age-Specific Incidence Rates of Lung Cancer According to Histologic Type, Sex, and Birth Cohort among Non-Hispanic Whites.
The incidence rate for large-cell lung carcinoma among men 30 to 34 years of age born around 1980 could not be calculated because of sparse data (fewer than six cases). Shading indicates 95% confidence intervals.
Figure 5.
Figure 5.. Prevalence of Current Smoking According to Race or Ethnic Group, Age, Sex, and Birth Cohort.
Shading indicates 95% confidence intervals.
See this image and copyright information in PMC

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