The World Health Organization (WHO) and the Organisation for Economic Cooperation and Development (OECD) provide comprehensive data on the epidemiology of lung cancer in Europe and worldwide. In 2008, there were an estimated 1.6 million new cases worldwide, representing 12.7% of all new cancers. Men are more frequently affected worldwide (1.1 million versus 0.5 million cases in women), with higher rates in central–eastern and southern Europe, North America and eastern Asia. In some Western countries where the tobacco epidemic reached its peak by the middle of the 20th century (e.g. the UK, Finland, and the USA), lung cancer rates have been decreasing slowly in men and plateauing in women.
Lung cancer is the second most common malignancy following prostate cancer in men of OECD countries. Figure 1 shows lung cancer incidence across Europe for men and women combined; figure 2 illustrates the marked difference in incidence between the sexes. In men in the European Union (EU), the highest rates are seen in Hungary (109.5 cases per 100 000 males), Poland (104.5 per 100 000) and Estonia (91.5 per 100 000). In women, Denmark (49.5 cases per 100 000 females), Hungary (39.8 per 100 000) and the UK (38.7 per 100 000) have the highest rates. Among non-EU countries, the highest reported incidence is seen in Armenia (111.1 per 100 000) in men and in Iceland (48.0 per 100 000) in women (figure 2).
Even though lung cancer incidence in women is generally lower than that in men, worldwide, lung cancer is now the fourth most common cancer in women (513 000 cases in 2008, 8.5% of all cancers) and the second most common cause of death from cancer (427 000 deaths, 12.8% of total cancer deaths). It has been estimated that in the UK in 2008, the lifetime risk of developing lung cancer was one in 14 for men and one in 19 for women. The incidence of lung cancer also varies within countries: in the UK, it is higher in Scotland and northern England, reflecting the historically higher rates of smoking in these areas. In Europe, the 388 753 lung cancer cases in 2008 had the following age distribution at diagnosis: approximately 6% were below 50 years of age, 20% were 50–59 years of age, 29% were 60–69 years of age, and 44% were over 70 years of age.
Figure 3 shows lung cancer mortality in Europe. Hungary showed the highest mortality rate of all European countries with an average of 65.9 deaths per 100 000 population, followed by Denmark with 52.3 deaths per 100 000 and Serbia with 51.3 deaths per 100 000. The lowest death rates in the EU were seen in Portugal and Cyprus (23.8 per 100 000). Lower mortality rates were reported in Tajikistan (6.5 per 100 000) and Uzbekistan (8.9 per 100 000); however, the efficiency of case reporting systems in those countries is unclear.
Morbidity from lung cancer
Most patients with lung cancer presenting to healthcare settings have symptoms or signs of the disease. However, these clinical features are nonspecific in their onset and are often attributed initially to benign causes by both patients and healthcare providers. This often results in a delay before patients seek medical attention and a further delay before the practitioner initiates any diagnostic tests.
The most common symptoms and signs are cough, weight loss and dyspnoea, followed by chest pain, haemoptysis, bone pain, finger clubbing and hoarseness. Less common are weakness, superior vena cava obstruction, dysphagia, wheezing and stridor.
A commonly used index of the burden of a disease is the loss of disability-adjusted life-years (DALYs). This is a term developed by the WHO and the World Bank to measure the sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability. Due to its high prevalence and mortality, lung cancer causes the highest losses of DALYs of all the cancers: in Europe, lung cancer accounts for approximately 3.2 million DALYs lost annually.