Trends in lung cancer incidence and survival: studies based on cancer registries

In this thesis trends in the incidence and survival of patients with lung cancer since 1960 in the southeastern part of the Netherlands are described and interpreted. These trends may provide an insight into changes in mortality due to lung cancer in a region with the oldest cancer registlY in the Netherlands. Chapter 1.2 contains a review of literature on trends in the incidence and survival of lung cancer. The methods used for the studies of this thesis are described in chapter 2. Only since the beginning of this century has lung cancer become fairly common, the incidence increasing dramatically since the 1940s. '·2 It has become by far the most frequent type of cancer among Dutch men since the 1960s, causing 35% of all cancer deaths. Among Dutch women it now ranks third, causing II % of all cancer deaths.3 Smoking is the most important risk factor for lung cancer,4,S now causing about 80% of all lung tumours in men and about 60% of all lung tmllours in women. Changes in smoking habits and lung cancer incidence in the southeastern part of the Netherlands and the marked differences between men and women are described in chapter 3. An aetiological background for each sex could be obtained from birth cohort analyses and from intraregional differences, especially since this region contained many tobaccoprocessing industries. Lung cancer is commonly classified as small-cell carcinoma and non-small-cell carcinoma. The latter includes squamous cell carcinoma, adenocarcinoma, large-cell undifferentiated carcinoma, and some rare subtypes. However, the broad division into small-cell carcinoma and non-small-cell carcinoma may obscure shifts in incidence and prognosis that affect one histological subtype rather than the entire group of nonsmall- cell lung tumours.6 Small-cell carcinoma is a highly aggressive neoplasm, which is rarely amenable to surgical treatment but often responds well to chemotherapy andlor palliative radiotherapy, albeit only for a few months. According to clinical trials, the short-term survival rate for patients with small-cell carcinoma seems to have improved since the introduction of chemotherapy. However, little is known about trends in long-term survival for unselected patients. Changes in survival rates, according to the major histological subtypes of lung cancer, are described and interpreted in chapter 4. Trends in survival rates may give an indication of variations in detection, aggressiveness of the tumour and treatment over time.

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