State-Specific Trends in Lung Cancer Incidence and Smoking --- United States, 1999-2008
A partir des données des registres américains du cancer, cette étude analyse l'évolution du tabagisme et de l'incidence du cancer du poumon, à l'échelle des Etats sur la période 1999-2008
Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death in the United States (1). Most deaths from lung cancer are caused by cigarette smoking and exposure to secondhand smoke (2). Large variations in lung cancer (1,3), smoking behavior (4), and tobacco control programs and policies (5,6) have been observed among states. Effective tobacco control policies can decrease smoking prevalence, ultimately leading to decreases in lung cancer (7). To assess lung cancer incidence by state, CDC analyzed data from the National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for the period 1999--2008. To assess smoking behavior by state, data from the Behavioral Risk Factor Surveillance System (BRFSS) for the period 1994--2009 were analyzed. This report summarizes the results of these analyses. From 1999 to 2008, decreases in lung cancer incidence were observed among men in 35 states and among women in six states. Regionally, the lowest rates and most rapid rate of decline in lung cancer were concentrated among states in the West, correlating with low smoking prevalence and high ratios of former smokers to ever smokers. Further reductions in smoking prevalence are critical to continue the decline in lung cancer incidence. Data on new cases of invasive lung cancer (International Classification of Diseases for Oncology, Third Edition: C34.0--C34.9) diagnosed during 1999--2008 were obtained from population-based cancer registries affiliated with the NPCR and SEER programs, which, combined, cover all of the U.S. population. Data were evaluated according to United States Cancer Statistics (USCS) data-quality criteria.* Annual incidence rates per 100,000 persons were age-adjusted by the direct method to the 2000 U.S. standard population (19 age groups).† Adjustments to population data were made by the U.S. Census Bureau to account for the Gulf Coast population in Alabama, Mississippi, Louisiana, and Texas displaced by major population shifts resulting from hurricanes Katrina and Rita in 2005.§ Annual percentage change (APC) was used to quantify the change in incidence rates over time and was calculated using joinpoint regression, which involves fitting a series of joined straight lines on a logarithmic scale to the trends in the annual age-adjusted rates. Up to two joined straight lines were allowed for nationwide and region-specific rates; one straight line was used for state-specific rates. Data from all states and the District of Columbia (DC) met USCS data quality criteria for 2008, but data from only 44 states and three U.S. Census regions (covering 90% of the U.S. population) met these criteria for all years 1999--2008; for this report, APC was calculated only for these states and regions.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6036a3.htm?s_cid=mm6036a3_x 2011