Burus Todd, Patel Manali I, Christian W Jay, Huang Bin, Lang Kuhs Krystle A
Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA.
Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Int J Cancer. 2025 May 1;156(9):1716-1725. doi: 10.1002/ijc.35268. Epub 2024 Nov 21.
Decreases in lung cancer incidence in the United States (US) have paralleled decreasing smoking prevalence for several decades; however, recent data has revealed slower declines among females than males. Sex-based differences in histologic lung cancer-and specifically adenocarcinoma-for all 50 US states and the District of Columbia have never been investigated. Using population-based cancer registry data from the US Cancer Statistics, we examined age-adjusted histologic lung cancer incidence rates and trends by sex and state of residence at diagnosis. We compared state-level adenocarcinoma incidence to lung cancer screening (LCS) adherence and smoking prevalence estimates. Average annual percentage change (AAPC) and incidence rate ratios (IRR) were used to assess changes over time. Nationally, females experienced faster increases in adenocarcinoma incidence than males (1.75%/year vs. 0.35%/year), and slower decreases in incidence of squamous cell (-0.06%/year vs. -1.58%/year) and small cell carcinoma (-2.06%/year vs. -3.19%/year). Adenocarcinoma incidence increased significantly (AAPC>0) in 41 states among females compared to 10 among males. Significant adenocarcinoma increases in individuals under age 55 (IRR >1) occurred among females in six states (four in the southeastern US) and none among males. State-level LCS adherence was significantly associated with adenocarcinoma incidence among females (r = 0.39; p<.01) but not males, though screening cannot account for increases among females under age 55. Our results highlight sex-based differences in histologic lung cancer incidence trends, with specific concern for increases in adenocarcinoma in the southeastern US. Further research is needed into appropriate LCS eligibility criteria and the risk factors driving sex-based disparities.
几十年来，美国肺癌发病率的下降与吸烟率的降低同步；然而，最近的数据显示，女性的下降速度比男性慢。美国所有50个州和哥伦比亚特区在组织学肺癌（特别是腺癌）方面基于性别的差异从未被研究过。利用美国癌症统计中心基于人群的癌症登记数据，我们按诊断时的性别和居住州检查了年龄调整后的组织学肺癌发病率和趋势。我们将州一级的腺癌发病率与肺癌筛查（LCS）依从性和吸烟率估计值进行了比较。平均年度百分比变化（AAPC）和发病率比（IRR）用于评估随时间的变化。在全国范围内，女性腺癌发病率的增长速度比男性快（每年1.75%对0.35%），而鳞状细胞癌（每年-0.06%对-1.58%）和小细胞癌（每年-2.06%对-3.19%）发病率的下降速度比男性慢。与男性的10个州相比，女性中有41个州的腺癌发病率显著上升（AAPC>0）。55岁以下个体中腺癌显著增加（IRR>1）的情况在女性的六个州（美国东南部四个州）出现，男性中则没有。州一级的LCS依从性与女性腺癌发病率显著相关（r = 0.39；p<.01），但与男性无关，不过筛查无法解释55岁以下女性发病率的上升。我们研究结果突出了组织学肺癌发病率趋势中基于性别的差异，尤其令人担忧美国东南部腺癌发病率的上升。需要进一步研究合适的LCS资格标准以及导致基于性别的差异的风险因素。
