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. 2020 Oct 23;10(10):e038937.
doi: 10.1136/bmjopen-2020-038937.

Regional differences in tobacco smoking and lung cancer in Portugal in 2018: a population-based analysis using nationwide incidence and mortality data

Gonçalo Forjaz  1   2 , Joana Bastos  3 , Clara Castro  4   5 , Alexandra Mayer  6 , Anne-Michelle Noone  7 , Huann-Sheng Chen  7 , Angela B Mariotto  7
Affiliations

Regional differences in tobacco smoking and lung cancer in Portugal in 2018: a population-based analysis using nationwide incidence and mortality data

Gonçalo Forjaz et al. BMJ Open. .

Abstract

Objectives: This study aims to estimate the proportion of lung cancer cases and deaths attributable to tobacco smoking in Portugal in 2018, complemented by trends in incidence and mortality, by sex and region.

Design: Cancer cases for 1998-2011 and cancer deaths for 1991-2018 were obtained from population-based registries and Statistics Portugal, respectively. We projected cases for 2018 and used reported deaths for the same year to estimate, using Peto's method, the number and proportion of lung cancer cases and deaths caused by tobacco smoking in 2018. We calculated the age-adjusted incidence and mortality rates in each year of diagnosis and death. We fitted a joinpoint regression to the observed data to estimate the annual percentage change (APC) in the rates.

Setting: Portugal.

Results: In 2018, an estimated 3859 cases and 3192 deaths from lung cancer were attributable to tobacco smoking in Portugal, with men presenting a population attributable fraction (PAF) of 82.6% (n=3064) for incidence and 84.1% (n=2749) for mortality, while in women those values were 51.0% (n=795) and 42.7% (n=443), respectively. In both sexes and metrics, the Azores were the region with the highest PAF and the Centre with the lowest. During 1998-2011, the APC for incidence ranged from 0.6% to 3.0% in men and 3.6% to 7.9% in women, depending on region, with mortality presenting a similar pattern between sexes.

Conclusion: Exposure to tobacco smoking has accounted for most of the lung cancer cases and deaths estimated in Portugal in 2018. Differential patterns of tobacco consumption across the country, varying implementation of primary prevention programmes and differences in personal cancer awareness may have contributed to the disparities observed. Primary prevention of lung cancer remains a public health priority, particularly among women.

Keywords: Portugal; incidence; lung cancer; population attributable fraction; smoking.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Trends in age-adjusted incidence (black dots and lines) and mortality (grey dots and lines) rates for lung cancer by sex and region, Portugal, 1991–2018. The rates are plotted on a log scale. APC, annual percentage change. *The APC is significantly different from zero (p<0.05).
See this image and copyright information in PMC

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