East Asia tops global lung cancer incidence and mortality

East Asia topped the world’s incidence and mortality of lung cancer in 2020, according to a global study conducted by the Chinese University of Hong Kong (CUHK) and the Association of Pacific Rim Universities (APRU).

In 2020, the global age-standardized rates (ASRs) of lung cancer incidence and mortality were 22.4 per 100,000 and 18 per 100,000, respectively. Among the world’s major regions, East Asia had the highest ASRs, at 34.4 per 100,000 for incidence and 28.1 per 100,000 for mortality. This was followed by Western Europe, with ASRs of 32.7 per 100,000 and 23.8 per 100,000, respectively. [Chest 2022;doi:10.1016/j.chest.2021.12.655]

Higher lung cancer incidence and mortality were associated with higher Human Development Index (HDI), Gross Domestic Product (GDP) and prevalence of smoking, the researchers noted.

The data, retrieved from global databases and US/European registries, also showed overall increasing trends in females and decreasing trends in males in lung cancer incidence and mortality over the past decade (average annual percentage change [AAPC] in incidence: from 1.06 to 6.43 in females, from -3.53 to -0.64 in males) (AAPC in mortality: from 0.63 to 3.96 in females, from -3.28 to -1.32 in males).

When stratified by age, consistent patterns of increasing incidence in females and decreasing incidence in males were found in individuals aged ≥50 years. In those <50 years of age, trends of decreasing incidence were observed in both sexes.

Among East and Southeast Asian countries/regions, the Philippines had the highest AAPC in lung cancer incidence, in both the overall population (-4.4 in males, -3.58 in females) as well as those aged ≥50 years (-4.17 in males, -3.35 in females) and <50 years (-7.65 in males, -5.41 in females). Singapore had the highest AAPC in lung cancer mortality (-2.73 in males, -2.04 in females).

In Hong Kong, the AAPC in lung cancer incidence in the overall population was -3.23 in males and -0.68 in females. In those aged ≥50 years, the AAPC in incidence was -3.16 in males and -0.80 in females, while corresponding AAPCs in those aged <50 years were -4.07 in males and +0.45 in females, respectively.

“The reasons for the age, sex and regional differences in temporal trends of lung cancer incidence and mortality may be related to tobacco consumption and other risk factors,” the researchers noted.

“For example, a study [using data from the US National Health Interview Surveys] showed significantly higher smoking cessation rates in older males than older females,” said Dr Jun-Jue Huang of the Jockey Club School of Public Health and Primary Care, CUHK, first author of the current global study. [Tob Control 1997;6:175-180] “Second-hand smoke, indoor air pollution and exposure to chemicals also play important roles in the variations.”

“Evidence-based and tailored preventive strategies should be implemented by policymakers to control the increasing trends of lung cancer incidence and mortality in different populations,” suggested senior corresponding author, Professor Martin Wong of the Jockey Club School of Public Health and Primary Care, CUHK. “For example, smoking cessation assistance and health education tailored for females, or early cancer detection among this high-risk population, may help reduce the burden of lung cancer.”