Lung Cancer Incidence in the United States Declines Among All Patient Subgroups

In recent years, the overall cancer death rates in the United States have declined largely due to a rapid decline in deaths from lung cancer. Despite this decline, lung cancer remains the top cause of cancer death in both men and women accounting for 22% of all deaths as a result of cancer. The incidence of lung cancer has also decreased because of a decline in lung cancer risk factors (specifically declines in the number of people smoking cigarettes) along with improved screening and more effective treatment for lung cancer.

This improvement in both death rate and incidence has been observed since the mid-2000s and has accelerated in recent years largely as a result of targeted therapies and other advances for the treatment of patients with non–small-cell lung cancer (NSCLC), the most common lung cancer subtype. In 2003, the FDA approved the first targeted therapy for NSCLC, which was followed by other targeted treatments. In 2012, recommendations were made for genetic mutation testing for all patients with nonsquamous NSCLC and, in 2015 to 2016, 3 immune checkpoint inhibitors were approved for the treatment of patients with NSCLC. Adjuvant therapy, maintenance therapy, Medicaid expansion, and improvement in treatment options for older patients with NSCLC have all contributed to the decline in lung cancer death rates. Patients with small-cell lung cancer experienced smaller declines in incidence rates, but no improvement in survival rates, as there have been no recently approved novel treatments for this lung cancer subtype.

In a 2021 report by Islami and colleagues, national cancer statistics for the United States were analyzed to provide updates on cancer incidence, trends, and mortality by cancer type, sex, age, and racial/ethnic groups. These statistics were obtained from registries participating in the Centers for Disease Control and Prevention’s National Program of Cancer Registries and/or the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Five exclusive racial/ethnic groups were identified: non-Hispanic white (white), non-Hispanic black (black), non-Hispanic American Indian/Alaskan Native (AI/AN), non-Hispanic Asian/Pacific Islander (API), and Hispanic (any race).¹

During the study period of 2013 to 2017, males in all racial/ethnic groups had a decrease in lung cancer incidence with greater declines observed among black males. During the same time, white, black, and Hispanic females had a decrease in lung cancer incidence, while API and AI/AN females had a stable incidence rate. Black females had a greater lung cancer incident decline.¹

Overall cancer death rates for 2014 to 2018 were 155.5 per 100,000 population with males experiencing a higher rate (185.5) than females (133.5). During this time, overall cancer death rates decreased in every racial/ethnic group, but black individuals had the highest overall death rate. While the death rates due to lung cancer decreased, it remains among the top 3 most common causes of death for both males and females of all racial/ethnic groups. Further analysis of death rates was conducted during the 2001 to 2018 period with declines in lung cancer deaths found to be accelerated. The decline in lung cancer death rates outweighed the declines in incident rates.¹

Reference

1. Islami F, Ward EM, Sung H, et al. Annual Report to the Nation on the Status of Cancer, Part 1: National Cancer Statistics. J Natl Cancer Inst. 2021;djab131. doi: 10.1093/jnci/djab131.