R. Peto et al., Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies, BR MED J, 321(7257), 2000, pp. 323-329
Citations number
25
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Objective and design To relate UK national trends since 1950 in smoking, in
smoking cessation, and in lung cancer to the contrasting results from two
large case-control studies centred around 1950 and 1990.
Setting United Kingdom.
Participants Hospital patients under 75 years of age with and without lung
cancer in 1950 and 1990, plus, in 1990, a matched sample of the local popul
ation: 1465 case-control pairs in the 1950 study, and 982 cases plus 3185 c
ontrols in the 1990 study.
Main outcome measures Smoking prevalence and lung cancer
Results For men in ear-iv middle age in the United Kingdom the prevalence o
f smoking halved between 1950 and 1990 but the death rate from lung cancer
at ages 35-54 fell even more rapidly, indicating some reduction in the risk
among continuing smokers. Ln contrast women and older men who were still c
urrent smokers in 1990 were more likely than those in 1950 to have been per
sistent cigarette smokers throughout adult life and so had higher lung canc
er rates than current smokers in 1950. The cumulative risk of death from lu
ng cancer by age 75 tin the absence of other causes of death) rose from 6%
at 1950 rates to 16% at 1990 rates in male cigarette smokers, and from 1% t
o 10% in female cigarette smokers. Among both men and women in 1990, howeve
r, the farmer smokers had only a fraction of the lung cancer rate of contin
uing smokers, and this fraction fell steeply with time since stopping. By 1
990 cessation had almost halved the number of lung cancers that would have
been expected if the former smokers had continued. For men who stopped at a
ges 60, 50, 40, and 30 the cumulative risks of lung cancer by age 75 were 1
0%, 6%, 3%, and 2%.
Conclusions People who stop smoking, even well into middle age, avoid most
of their subsequent risk of lung cancer, and stopping before middle age avo
ids more than 90% of the risk attributable to tobacco. Mortality in the nea
r future and throughout the first half of the 21st century could be substan
tially reduced by current smokers giving up the habit. In contrast, the ext
ent to which young people henceforth become persistent smokers will affect
mortality rates chiefly in the middle or second half of the 21st century.