Travis W D, Lubin J, Ries L, Devesa S
Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, D.C. 20306-6000, USA.
Cancer. 1996 Jun 15;77(12):2464-70. doi: 10.1002/(SICI)1097-0142(19960615)77:12<2464::AID-CNCR8>3.0.CO;2-M.
Lung carcinoma is now the most frequently diagnosed major cancer in the world and is also the most common cause of cancer deaths in males and females in the United States and worldwide. Based on trends in cigarette smoking and on analysis of lung cancer rates by birth cohort, it was predicted that a decline would occur in age-adjusted lung cancer rates, initially in males, and approximately 10 years later in females. We evaluated age-adjusted lung cancer incidence rates for changes in trends by race, sex and histologic type to determine if and when rates may have started declining.
We analyzed population-based incidence data from the National Cancer Institute's Third National Cancer Survey conducted between 1969 and 1971 and from the Surveillance, Epidemiology and End-results (SEER) program conducted between 1974 and 1991. Age-adjusted rates were plotted by time period using a logarithmic scale for the ordinate. We used regression methods for grouped time-to-response data to fit a model to the disease rate for age, and calendar year to estimate the calendar year of maximum disease rate.
During this period, the overall age-adjusted lung cancer incidence rate rose from 37.8 to 68.2 per 100,000. Lung cancer rates in both white and black males climaxed around 1984 and declined subsequently. Furthermore, among white and black males, the rates of squamous cell carcinoma, small cell carcinoma, and large cell carcinoma declined after peaks in 1981 and 1982, 1986 and 1987, and 1986 and 1988, respectively. The rates for adenocarcinoma in black males peaked in 1987 whereas the rates in white males appeared to have plateaued between 1989 and 1991. Total lung cancer rates in males exceeded those in females, with rates in black males exceeding rates in white males. Age-adjusted lung carcinoma rates among white and black females continued to increase for all histologic types with the exception of large cell carcinoma among whites, bronchioloalveolar carcinoma among whites and blacks, and adenosquamous carcinoma among blacks.
The cumulative effect of these trends has resulted in a plateau of total lung carcinoma incidence in all persons combined, and a decline might be expected soon, as has already been observed among males. Most of these changes reflect past cigarette smoking patterns. Demonstration of declines and tapering increases among several population subgroups suggests impending reductions in the incidence and mortality rate for this highly fatal cancer.
肺癌目前是世界上最常被诊断出的主要癌症，也是美国和全球男性及女性癌症死亡的最常见原因。根据吸烟趋势以及按出生队列对肺癌发病率的分析，预计年龄调整后的肺癌发病率将会下降，最初是男性，大约10年后是女性。我们评估了年龄调整后的肺癌发病率按种族、性别和组织学类型的趋势变化，以确定发病率是否以及何时可能开始下降。
我们分析了基于人群的发病率数据，这些数据来自1969年至1971年进行的美国国立癌症研究所第三次全国癌症调查以及1974年至1991年进行的监测、流行病学和最终结果（SEER）计划。按时间段绘制年龄调整后的发病率，纵坐标采用对数尺度。我们使用分组时间响应数据的回归方法，为年龄和日历年份的疾病发病率拟合一个模型，以估计疾病发病率最高的日历年份。
在此期间，总体年龄调整后的肺癌发病率从每10万人37.8例上升至68.2例。白人和黑人男性的肺癌发病率在1984年左右达到峰值，随后下降。此外，在白人和黑人男性中，鳞状细胞癌、小细胞癌和大细胞癌的发病率分别在1981年和1982年、1986年和1987年、1986年和1988年达到峰值后下降。黑人男性腺癌的发病率在1987年达到峰值，而白人男性的发病率在1989年至1991年之间似乎趋于平稳。男性的总体肺癌发病率超过女性，黑人男性的发病率超过白人男性。白人女性和黑人女性年龄调整后的肺癌发病率，除白人中的大细胞癌、白人和黑人中的细支气管肺泡癌以及黑人中的腺鳞癌外，所有组织学类型均持续上升。
这些趋势的累积效应导致所有人群的总体肺癌发病率趋于平稳，预计很快可能会下降，正如在男性中已经观察到的那样。这些变化大多反映了过去的吸烟模式。几个亚人群组中发病率下降和上升趋缓的情况表明，这种高度致命癌症的发病率和死亡率即将降低。
