Cancer Progress and Priorities: Lung Cancer

Abstract

In the United States, lung cancer is the second most common diagnosed cancer and the leading cause of cancer-related death. Though tobacco smoking is the major risk factor accounting for 80 to 90% of all lung cancer diagnoses, there are numerous other risk factors that have been identified as casually associated with lung cancer etiology. However, there are few causally-linked risk factors for lung cancer diagnosed among never smokers which, if considered a unique reportable category, is the 11^th most common cancer and the 7^th leading cause of cancer-related death. Lung cancer survival has only marginally improved over the last several decades, but the availability of screening and early detection by low-dose computer tomography and advances in targeted treatments and immunotherapy will likely decrease mortality rates and improve patient survival outcomes in the near future.

Figure 1.

Age-standardized rates (ASR) for lung cancer incidence worldwide. Figure 1a shows age-standardized incidence rates for lung cancer among males using data from GLOBOCAN, 2018. Lung cancer incidence among males is highest in Micronesia, Polynesia, Central and Eastern Europe, and Eastern Asia and lowest in most of Africa. Figure 1b shows age-standardized incidence rates for lung cancer among females using data from GLOBOCAN, 2018. Lung cancer incidence among females is highest in North America, Northern Europe, Western Europe, and Australia/New Zealand and lowest in most of Africa. Data source: GLOBOCAN 2018. Graph production: IARC (http://gco.iarc.fr/today), World Health Organization.

Figure 1.

Age-standardized rates (ASR) for lung cancer incidence worldwide. Figure 1a shows age-standardized incidence rates for lung cancer among males using data from GLOBOCAN, 2018. Lung cancer incidence among males is highest in Micronesia, Polynesia, Central and Eastern Europe, and Eastern Asia and lowest in most of Africa. Figure 1b shows age-standardized incidence rates for lung cancer among females using data from GLOBOCAN, 2018. Lung cancer incidence among females is highest in North America, Northern Europe, Western Europe, and Australia/New Zealand and lowest in most of Africa. Data source: GLOBOCAN 2018. Graph production: IARC (http://gco.iarc.fr/today), World Health Organization.

Figure 2.

Age-adjusted lung cancer incidence rates in the United States. Figure 2a shows age-adjusted lung cancer incidence rates for males in the United States, 2011 −2015, using data from U.S. Cancer Statistics Working Group. Figure 2b shows age-adjusted lung cancer incidence rates for females in the United States, 2011 −2015, using data from U.S. Cancer Statistics Working Group. Among both males and females, lung cancer incidence is higher in the Midwest and East and the highest rates are observed in the South while the lowest rates are generally found in Western states. Data source: U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on November 2017 submission data (1999-2015): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute (www.cdc.gov/cancer/dataviz), June 2018

Figure 2.

Age-adjusted lung cancer incidence rates in the United States. Figure 2a shows age-adjusted lung cancer incidence rates for males in the United States, 2011 −2015, using data from U.S. Cancer Statistics Working Group. Figure 2b shows age-adjusted lung cancer incidence rates for females in the United States, 2011 −2015, using data from U.S. Cancer Statistics Working Group. Among both males and females, lung cancer incidence is higher in the Midwest and East and the highest rates are observed in the South while the lowest rates are generally found in Western states. Data source: U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on November 2017 submission data (1999-2015): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute (www.cdc.gov/cancer/dataviz), June 2018

Figure 3.

Estimated age-standardized rates (ASR) for lung cancer mortality worldwide. Figure 3a shows age-standardized mortality rates for lung cancer among males using data from GLOBOCAN, 2018. Lung cancer mortality among males is highest in Eastern Europe, Western Asia, Northern Africa, and specific countries in Eastern Asia and lowest in most of Africa. Figure 3b shows age-standardized mortality rates for lung cancer among females using data from GLOBOCAN, 2018. Lung cancer mortality among females in North America, Northern Europe, Western Europe, and Australia/New Zealand and lowest in most of Africa. Data source: GLOBOCAN 2018. Graph production: IARC (http://gco.iarc.fr/today), World Health Organization.

Figure 3.

Estimated age-standardized rates (ASR) for lung cancer mortality worldwide. Figure 3a shows age-standardized mortality rates for lung cancer among males using data from GLOBOCAN, 2018. Lung cancer mortality among males is highest in Eastern Europe, Western Asia, Northern Africa, and specific countries in Eastern Asia and lowest in most of Africa. Figure 3b shows age-standardized mortality rates for lung cancer among females using data from GLOBOCAN, 2018. Lung cancer mortality among females in North America, Northern Europe, Western Europe, and Australia/New Zealand and lowest in most of Africa. Data source: GLOBOCAN 2018. Graph production: IARC (http://gco.iarc.fr/today), World Health Organization.

Figure 4.

Age-adjusted lung cancer mortality rates in the United States. Figure 4a shows age-adjusted lung cancer mortality rates for males in the United States, 2011 −2015, using data from U.S. Cancer Statistics Working Group. Figure 4b shows age-adjusted lung cancer mortality rates for females in the United States, 2011 −2015, using data from U.S. Cancer Statistics Working Group. Among both males and females, lung cancer morality is higher in the Midwest, East, and South and lowest in most Mountain states and California. Data source: U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on November 2017 submission data (1999-2015): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute (www.cdc.gov/cancer/dataviz), June 2018.

Figure 4.

Age-adjusted lung cancer mortality rates in the United States. Figure 4a shows age-adjusted lung cancer mortality rates for males in the United States, 2011 −2015, using data from U.S. Cancer Statistics Working Group. Figure 4b shows age-adjusted lung cancer mortality rates for females in the United States, 2011 −2015, using data from U.S. Cancer Statistics Working Group. Among both males and females, lung cancer morality is higher in the Midwest, East, and South and lowest in most Mountain states and California. Data source: U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on November 2017 submission data (1999-2015): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute (www.cdc.gov/cancer/dataviz), June 2018.

Figure 5.

Temporal trends in 5-year relative percent survival for lung and bronchus cancer. Figure 5 shows observed and modeled trends in lung and bronchus cancer 5-year survival from 1975-2015 using data from SEER 18 (https://seer.cancer.gov/statfacts/html/lungb.html).

Figure 6.

Percent of lung cancer cases at diagnosis and 5-year relative survival by stage. Figure 6 shows the percentage of lung cancer cases diagnosed in the U.S. by stage and their respective 5-year survival rates using data from SEER 18 (https://seer.cancer.gov/statfacts/html/lungb.html). “Localized” is confined to the primary sites, “regional” has spread to the regional lymph nodes, and “distant” is a cancer that has metastasized. “Unknown”, which accounts for 4% of diagnoses and has an 8.2% 5-year survival, is not shown.

Figure 7.

Histological classification of lung cancer. Figure 7 shows the two major lung cancer histological categories (non-small cell lung carcinoma [NSCLC] and small-cell lung carcinoma) and the most common histological subtypes among NSCLC (adenocarcinoma, squamous cell carcinoma, and large cell carcinoma).

Figure 8.

Age-adjusted incidence rates (per 100,000) for lung and bronchus cancer by year of diagnosis and histology. Figure 8a shows age-adjusted incidence rates among females for lung and bronchus cancer by year of diagnosis and histology using SEER 9, 1973-2015. Figure 8b shows age-adjusted incidence rates among males for lung and bronchus cancer by year of diagnosis and histology using SEER 9, 1973-2015. The incidence rates are age-adjusted to the 2000 U.S. population.

Figure 8.

Age-adjusted incidence rates (per 100,000) for lung and bronchus cancer by year of diagnosis and histology. Figure 8a shows age-adjusted incidence rates among females for lung and bronchus cancer by year of diagnosis and histology using SEER 9, 1973-2015. Figure 8b shows age-adjusted incidence rates among males for lung and bronchus cancer by year of diagnosis and histology using SEER 9, 1973-2015. The incidence rates are age-adjusted to the 2000 U.S. population.

Figure 9.

Trends in cigarette and lung cancer death rates. Figure 9 shows the temporal trends in cigarette use versus lung cancer death rates for both males and females in the U.S. using data from the Centers for Disease Control and Prevention. Data sources from: National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention, 2017 and CDC Report on Consumption of Combustible and Smokeless Tobacco — United States, 2000-2015, page 1359.

Figure 10.

Lung cancer mortality by smoking status. Figure 10 shows lung cancer mortality (per 100,000) among current smokers, former smokers, and never smokers based on published figures that were adapted from Halpern et al ([reference 148] J Natl Cancer Inst 1993; 85:457-464). Former smokers are presented by age-at-quit.