Cancer Research UK : UK Lung Cancer incidence statistics

UK Lung Cancer incidence statistics

Lung cancer is the most common cancer in the world with 1.3 million new cases diagnosed every year 1. The vast majority of lung cancers are caused by cigarette smoking. This page contains lung cancer incidence statistics by age and sex, histology, geographic variation, trends over time, ethnicity and deprivation. The ICD code for lung cancer is ICD9 162 and ICD10 C33-34.

Until the late 1990s, lung cancer was the most frequently occurring cancer in the UK; it has now been overtaken by breast cancer, but still accounts for around 1 in 7 new cancer cases, that is, 38,313 new patients diagnosed in 2004 (Table 1.1).2-5

Table 1.1: Numbers of new cases and rates, lung cancer, UK

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Lung cancer incidence by age and sex

While there are more cases of lung cancer diagnosed in men, the numbers of women being diagnosed has increased. Lung cancer incidence and mortality rates were among the highest in the world but smoking cessation has lead to record falls, particularly among men.

Lung cancer is rarely diagnosed in people younger than 40, but incidence rises steeply thereafter peaking in people aged 75-84 years (Figure 1.1).2-5 Most cases (85%) occur in people over the age of 60.

In the 1950s the male/female ratio for lung cancer cases was 6:1 but with decreasing male rates and increasing female rates, the ratio is now 7:5 (22,495 male cases and 15,818 female cases in 2004). Overall, 13% of all new cases of cancer are lung cancers.

Figure 1.1: Number of new cases and incidence rates by age, lung cancer, UK

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In men, lung cancer is the second most common cancer after prostate cancer, responsible for 16% of all new male cancer cases. For women, it is the third most common cancer after breast cancer and bowel cancer, accounting for 11% of all new female cases.

Lung cancer histology

There are two main types of lung cancers: around 20% are small cell lung cancers (SCLC) and the remainder are non-small cell lung cancers (NSCLC).

The main types of NSCLC are squamous cell carcinoma, adenocarcinoma and large cell carcinoma, which account for approximately 35%, 27% and 10% of all lung cancer cases respectively in the UK6.

While cigarette smoking has been linked to all four types of lung cancer, adenocarcinoma, is the most common type in non-smokers18 and a rise in incidence has been reported in the USA and other countries7-9.

In the USA, adenocarcinoma is now the most common type of lung cancer. In Europe the most common type of lung cancer is still squamous cell carcinoma despite increases in the incidence of adenocarcinoma9. The increasing incidence of adenocarcinoma has been linked to low-tar cigarettes10.

Geographic variation of lung cancer incidence

The poor prognosis for lung cancer means that incidence and mortality patterns are very similar in all parts of the world.

Within the UK, there is a clear north/south divide with high lung cancer incidence rates in Scotland and northern England, and generally lower incidence in Wales, the Midlands and southern England19. Scottish men and women have amongst the highest rates in the world reflecting the country’s history of high smoking prevalence11,12.

Lung cancer incidence rates in Scotland are particularly high in the densely populated belt from Glasgow in the west to Edinburgh in the east19. The higher rates in urban rather than rural areas are mainly the result of higher smoking prevalence in urban areas.20.

Other factors such as poor diet, exposure to industrial carcinogens and air pollution may also contribute13,20. In the West of Scotland, about 6% of male lung cancers are attributed to asbestos exposure associated with the ship-building industry14.

Lung cancer incidence rates vary hugely between different regions of the world. The highest rates of lung cancer in men are found in Europe, especially central and eastern Europe, and northern America.Within Europe the countries with the highest male rates are Hungary and Poland and the lowest in Sweden and Malta (Figure 1.2)1

Figure 1.2: Age standardised (world) incidence rates, lung cancer, selected countries, 2006

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For women the highest rates of lung cancer are found in northern America and northern Europe. Women in the USA have the world's highest lung cancer incidence rates followed by Canada.

The lowest lung cancer incidence rates in both men and women are found in African and Asian countries. Further information on geographical variation in lung cancer incidence rates can be found in the mortality section.

Lung cancer incidence trends

UK incidence trends follow the same pattern as the mortality trends which are described in the mortality section.Figure 1.3 shows the incidence trend for the UK.

Figure 1.3: Age-standardised (European) incidence rates, by sex, lung cancer, UK, 1993-2003

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Between 1995 and 2004 male lung cancer incidence rates decreased by almost a quarter (23%). Over the same ten year period there was almost no change in the female rates. For males and females combined the lung cancer incidence rate decreased by 16%.

Lung cancer incidence and ethnicity

Within the UK, south Asians have a lower incidence of lung cancer than non-south Asians. but increasing incidence has been reported amongst south Asian men, in contrast to the rest of the UK male population.

South Asian women also have increasing lung cancer trends but this is in line with the rest of the UK female population15.

In the USA lung cancer rates in the black population are higher for both males and females compared to the white population. Other ethnic groups such as Hispanics and Asians have lower rates than whites16.

Lung cancer incidence and deprivation

Lung cancer incidence and mortality rates are strongly associated with deprivation.

In an analysis of 1993 lung cancer incidence data for England & Wales by Carstairs deprivation index, incidence was almost 2.5 times higher in the most deprived male groups compared to the least deprived – the difference for women was even greater at 3 times (Figure 1.4)17.

Figure 1.4: Age standardised incidence rates by deprivation category, lung cancer, England and Wales, 1993

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A similar association with deprivation is evident in Scotland where rates for people diagnosed with lung cancer between 1991 and 1995 were twice as high in the most deprived group compared to the least deprived 3.

More recent data from the West Midlands records that between 1981 and 2004 lung cancer age-standardised incidence rates for the most affluent men remained relatively stable at around 56 per 100,000, while in the most deprived male group, they dropped by 56% from 186.4 per 100,000 to 81.5 per 100,000 over the period.

Although the gap between the most deprived male group and the most affluent men was still substantial in 2004 (50% greater for the most deprived) it was far less than in 1981 (200% greater)21. By contrast, lung cancer incidence had increased more for affluent women than deprived women between 1981 and 2004.

References

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Office for National Statistics, Cancer Statistics registrations: Registrations of cancer diagnosed in 2004, England. Series MB1 no.33. 2005, National Statistics: London.
ISD Online. 2007 Information and Statistics Division, NHS Scotland.
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National Institute for Clinical Excellence. Lung Cancer. The diagnosis and treatment of lung cancer; 2005
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Scottish Executive Health Department. Cancer Scenarios: An aid to planning cancer services in Scotland in the next decade. Edinburgh:The Scottish Executive, 2001.
De Vos Irvine, H., et al., Asbestos and lung cancer in Glasgow and the west of Scotland. Bmj, 1993. 306(6891): p. 1503-6
Smith, L.K., M.D. Peake, and J.L. Botha, Recent changes in lung cancer incidence for south Asians: a population based register study. Bmj, 2003. 326(7380): p. 81-2
Ries LA, Eisner MP, Kosary CL, et al. SEER Cancer Statistics Review, 1975-2000.National Cancer Institute, 2003. Bethesda, MD
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Subramanian J, Govindan R, Lung cancer in never smokers J Clin Oncol 2007; 25 (5):561-70
Quinn M, Cooper N, Rowan S Cancer Atlas of the United Kingdom and Ireland 1991-2000 Office for National Statistics, 2005
Pearce J, Boyle P Is the urban excess in lung cancer in Scotland explained by patterns of smoking? Soc Sci Med 2005;60(12):2833-43
West Midlands Cancer Intelligence Unit Lung cancer in the West Midlands 2006