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.It has been estimated that the lifetime risk of developing lung cancer is 1 in 14 for men and 1 in 21 for women in the UK. These were calculated on February 2009 using incidence and mortality data for 2001-2005 22.

Until the late 1990s, lung cancer was the most frequently occurring cancer in the UK; in 1997 it was overtaken by breast cancer, but still accounts for around 1 in 7 new cancer cases, that is, 39,027 new patients diagnosed in 2006 ( Table 1.1). 2-5

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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 4:3 (22,381 male cases and 16,646 female cases in 2006). Overall, 13% of all new cases of cancer are lung cancers.

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In men, lung cancer is the second most common cancer after prostate cancer, responsible for 15% 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.

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 UK 6.

While cigarette smoking has been linked to all four types of lung cancer, adenocarcinoma, is the most common type in non-smokers 18 and a rise in incidence has been reported in the USA and other countries 7-9.

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 adenocarcinoma 9. The increasing incidence of adenocarcinoma has been linked to low-tar cigarettes 10.

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 England 19. Scottish men and women have amongst the highest rates in the world reflecting the country’s history of high smoking prevalence 11, 12.

Lung cancer incidence rates in Scotland are particularly high in the densely populated belt from Glasgow in the west to Edinburgh in the east 19. 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 contribute 13, 20. In the West of Scotland, about 6% of male lung cancers are attributed to asbestos exposure associated with the ship-building industry 14.

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

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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.

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.

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Between 1997 and 2006 male lung cancer incidence rates decreased by a fifth (21%). Over the same period there was little change in the female rates. For males and females combined the lung cancer incidence rate decreased by 11%.

Longer trends in lung cancer incidence in Great Britain are shown in Figure 1.4. Male lung cancer rates for males have fallen by 46% from 113 per 100,000 in 1975 to 61 in 2006. Over the same time period female lung cancer incidence rates have risen by 64% from 23 to 37 per 100,000 population.

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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 population 15.

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 whites 16.

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 1.5) 17.

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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 21.

The latest analysis of lung cancer incidence by deprivation in England showed that incidence was almost 2.5 times higher in the most deprived groups compared to the least deprived (75.2 compared to 29.8 per 100,000 population).

The difference was greater for women than for men. The lung cancer incidence rate for men in the most deprived group was 2.4 times higher than the least deprived (100.6 compared to 41.3), whereas for women it was almost 2.7 times higher (55.9 compared to 20.9). 22.

Relatively low survival rates for lung cancer mean that despite high incidence rates there are fewer patients alive who have been diagnosed with lung cancer relative to the other major cancers. An estimated 65,000 people are alive in the UK having received a diagnosis of lung cancer. General information about cancer prevalence in the UK can be found in the Prevalence section of the CancerStats website.