Jihyoun Jeon, PhD; Theodore R. Holford, PhD; David T. Levy, PhD; Eric J. Feuer, PhD; Pianpian Cao, MPH; Jamie Tam, PhD; Lauren Clarke, MSc; John Clarke, MSc; Chung Yin Kong, PhD; Rafael Meza, PhD
Grant Support: By the National Cancer Institute, National Institutes of Health (U01CA152956 and U01CA199284).
Disclosures: Dr. Tam reports a grant from the National Institute on Drug Abuse and personal fees from the U.S. Food and Drug Administration outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1250.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Proctor & Gamble, Pfizer, and Johnson & Johnson.
Reproducible Research Statement:Study protocol: The protocol and model details are available in the Supplement. Statistical code: An earlier version of the smoking history generator is available by request (e-mail, email@example.com). Data set: Smoking prevalence, initiation, cessation, and intensity rates from 1964 to 2065 are available at https://resources.cisnet.cancer.gov/projects/#shg/sbc2.
Corresponding Author: Rafael Meza, PhD, Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Jeon and Meza and Ms. Cao: Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029.
Dr. Holford: Department of Biostatistics, Yale University, PO Box 208034, 60 College Street, New Haven, CT 06520-8034.
Dr. Levy: Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007.
Dr. Feuer: Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892.
Dr. Tam: Department of Health Management and Policy, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029.
Mr. L. Clarke and Mr. J. Clarke: Cornerstone Systems Northwest, 8665 Berthusen Road, Lynden, WA 98264.
Dr. Kong: Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac Street, Suite 1010, Boston, MA 02114.
Author Contributions: Conception and design: J. Jeon, T.R. Holford, D.T. Levy, E.J. Feuer, L. Clarke, C.Y. Kong, R. Meza.
Analysis and interpretation of the data: J. Jeon, T.R. Holford, D.T. Levy, E.J. Feuer, P. Cao, L. Clarke, C.Y. Kong, R. Meza.
Drafting of the article: J. Jeon, T.R. Holford, D.T. Levy, J. Tam, C.Y. Kong, R. Meza.
Critical revision of the article for important intellectual content: J. Jeon, T.R. Holford, D.T. Levy, E.J. Feuer, J. Tam, L. Clarke, J. Clarke, C.Y. Kong, R. Meza.
Final approval of the article: J. Jeon, T.R. Holford, D.T. Levy, E.J. Feuer, P. Cao, J. Tam, L. Clarke, J. Clarke, C.Y. Kong, R. Meza.
Statistical expertise: J. Jeon, T.R. Holford, D.T. Levy, E.J. Feuer, P. Cao, C.Y. Kong, R. Meza.
Obtaining of funding: T.R. Holford, D.T. Levy, C.Y. Kong, R. Meza.
Administrative, technical, or logistic support: P. Cao, L. Clarke, J. Clarke, C.Y. Kong.
Collection and assembly of data: J. Jeon, D.T. Levy, P. Cao, C.Y. Kong, R. Meza.
Tobacco control efforts implemented in the United States since the 1960s have led to considerable reductions in smoking and smoking-related diseases, including lung cancer.
To project reductions in tobacco use and lung cancer mortality from 2015 to 2065 due to existing tobacco control efforts.
Comparative modeling approach using 4 simulation models of the natural history of lung cancer that explicitly relate temporal smoking patterns to lung cancer rates.
U.S. population, 1964 to 2065.
Adults aged 30 to 84 years.
Models were developed using U.S. data on smoking (1964 to 2015) and lung cancer mortality (1969 to 2010). Each model projected lung cancer mortality by smoking status under the assumption that current decreases in smoking would continue into the future (status quo trends). Sensitivity analyses examined optimistic and pessimistic scenarios.
Under the assumption of continued decreases in smoking, age-adjusted lung cancer mortality was projected to decrease by 79% between 2015 and 2065. Concomitantly, and despite the expected growth, aging, and longer life expectancy of the U.S. population, the annual number of lung cancer deaths was projected to decrease from 135 000 to 50 000 (63% reduction). However, 4.4 million deaths from lung cancer are still projected to occur in the United States from 2015 to 2065, with about 20 million adults aged 30 to 84 years continuing to smoke in 2065.
Projections assumed no changes to tobacco control efforts in the future and did not explicitly consider the potential effect of lung cancer screening.
Tobacco control efforts implemented since the 1960s will continue to reduce lung cancer rates well into the next half-century. Additional prevention and cessation efforts will be required to sustain and expand these gains to further reduce the lung cancer burden in the United States.
National Cancer Institute.
Jeon J, Holford TR, Levy DT, et al. Smoking and Lung Cancer Mortality in the United States From 2015 to 2065: A Comparative Modeling Approach. Ann Intern Med. [Epub ahead of print 9 October 2018]169:684–693. doi: 10.7326/M18-1250
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Published: Ann Intern Med. 2018;169(10):684-693.
Published at www.annals.org on 9 October 2018
Cardiology, Coronary Risk Factors, Hematology/Oncology, Lung Cancer, Pulmonary/Critical Care.
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