Lung cancer epidemic 'may have peaked' in women

The fifty-year epidemic of lung cancer which has claimed at least one million lives in Britain may have peaked among women, figures show.

Female deaths from lung cancer in the UK are the highest in Europe, reflecting high rates of smoking 30 years ago. But the UK is the only country where the death rate is stable or falling – in all other countries it is still rising, European scientists say.

Death rates among UK men from lung cancer peaked more than 20 years ago, in the mid 1980s. Men took up smoking earlier than women and in the 1940s around 80 per cent of adult men smoked.

Women did not take up smoking until later, with the numbers peaking in the mid 1960s at around 45 per cent. Growing evidence of the link between smoking and lung cancer from the 1960s onwards, accompanied by advertising bans and tighter restrictions on smoking, gradually persuaded smokers of both sexes to give up the habit. Today, around 20 per cent of men and 24 per cent of women smoke.

Because women took up smoking later, the rise in lung cancer death rates lagged behind that of men and has only begun to level off in the last decade. There is a gap of 30 to 40 years between the date of starting smoking and the onset of cancer.

Writing in the journal Annals of Oncology, researchers from the Universities of Milan in Italy and Lausanne in Switzerland estimate there will be 1.3 million deaths from all cancers across Europe in 2011.

This is a small rise on 2007, but when corrected for the ageing of the population it represents a fall in the overall death rate of 7 per cent among men and 6 per cent among women.

The researchers predict that 15,632 women will die of lung cancer in the UK this year, a slight fall in the age standardised death rate from 20.57 per 100,000 women in 2007 to 20.33 in 2011.

However, the UK female lung cancer death rate is more than three times higher than in Spain (6.5 per 100,000) and almost twice that in France (11.66 per 100,000).

"The number of women dying from lung cancer is increasing everywhere except the UK," said Professor Carlo la Vecchia, of the Mario Negri institute in Milan, who led the research.

"British women started smoking in the 1940s but in France they did not start until the 1970s. France and Spain have the most unfavourable prospects for lung cancer – if French women do not stop smoking their death rate will reach 20 per 100,000 but my guess is they will probably stop."

Death rates from lung cancer start to decline within five years of smokers stopping. Smoking was taken up earlier and more widely in Britain than in other European countries because the UK was host to three of the worlds major tobacco firms – British American Tobacco, Imperial Tobacco and Gallahers.

Amanda Sandford, of the anti-smoking organisation, Ash, said: "Smoking was promoted widely in the UK in the 1950s and 1960s, there were no restrictions and the tobacco companies were major employers. The US and Britain led the world in smoking."

Cancer Research UK said lung cancer death rates among women appeared to level off in the mid-1990s, "but since then there is a suggestion rates may be increasing further." Catherine Thomson, head of statistical information, said: "Smoking prevention is the key."

Professor Stephen Spiro, vice chair of the British Lung Foundation and honorary consultant in respiratory medicine at University College and the Royal Brompton Hospitals, London, said it was too early to say if the lung cancer rate in women was declining.

"The line is nearly flat but it is certainly not dropping. It has gone up slowly over the last 20 years but it does not yet convincingly show evidence of a decline. In other Mediterranean countries it is going to be an absolute epidemic," he said.

"Thirty years ago 66 per cent of men smoked and 20 per cent of women. Over the last 30 years men have quit smoking very strongly but in women it has gone up from 20 to 24 per cent. The huge incidence of lung cancer in men has fallen but we have seen a rise in women and it is now nearly as common as among men.

"The biggest number of smokers is among girls and young women aged 15 to 25. They don't smoke more cigarettes than older women but more of them smoke and they may well smoke more as they get older."

One in five cases of lung cancer among women is in non-smokers, accounting for around 5,000 cases a year. Women who don't smoke are more susceptible to lung cancer than men, for reasons that are not fully understood.

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