Page 19 - Deleware Medical Journal - September/October 2019
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PUBLIC HEALTH
LUNG CANCER IN DELAWARE
Lung cancer is the most commonly diagnosed cancer and the leading cause
of cancer death in Delaware, according
to the Division of Public Health (DPH). From 2011 to 2015, lung cancer accounted for 19% of newly diagnosed cancers — the largest share of any single cancer type — and 29% of cancer deaths.1 During this period, 4,117 Delawareans were diagnosed with lung cancer and 2,802 died from the disease.1 From 2011 to 2015, lung cancer incidence and mortality rates per 100,000
for Delaware males relative to females (82.9 vs. 62.8).1 Over the same period, lower lung-cancer incidence rates per 100,000 (37.7) than non-Hispanic whites (74.1) and non-Hispanic blacks (68.5).1 Lung cancer diagnoses and deaths are relatively rare among adults younger than 64. However, the probability of a lung cancer diagnosis, and dying from the disease, increases with age. From 2011 to 2014, lung cancer incidence and mortality peaked among Delaware males aged 85 and older and Delaware females
aged 75-84.1
From 2011-2015, Delaware ranked 9th among states for lung cancer incidence and 14th among states for lung cancer mortality.1 Delaware’s 2011-2015 lung higher than the comparable U.S. rate (71.3 per 100,000 vs. 54.6 per 100,000 population, respectively).1 Similarly, Delaware’s 2011-2015 lung cancer than the comparable U.S. rate (50.0 per 100,000 vs. 43.4 per 100,000, respectively).1
Surviving lung cancer directly correlates with the stage at diagnosis. When lung cancer is detected in the local stage, the 56.3%. When lung cancer is diagnosed in
the distant stage — after metastasizing to distant tissues, organs, or lymph nodes to 4.7%.2 Only 22% of Delaware lung cancer cases and 19% of U.S. lung cancer cases diagnosed in 2011-2015 were local-stage diagnoses; over half of all Delaware and U.S. lung cancer cases were diagnosed in the distant stage (52% and 53%, respectively).1 Patterns of lung cancer stage at diagnosis in Delaware have remained unchanged for nearly
40 years. From 1980-1984 to 2011-
2015, the percentage of Delaware lung cancer cases diagnosed at the local stage slightly increased from 21% to 22%; the percentage of distant stage diagnoses increased from 45% to 52%.1
Cigarette smoking is by far the leading risk factor for lung cancer.3 In the U.S., 87% of lung cancer deaths are attributed to cigarette use.3 One out of every three cancer deaths, regardless of cancer type, is caused by smoking.3 Changes in the design and composition of cigarettes (e.g.,
of certain chemicals) mean that today’s smokers have a higher risk of developing lung cancer despite smoking, on average, fewer cigarettes than smokers in the
past.3 Additional lung cancer risk factors include exposure to secondhand smoke, radon, asbestos, and other cancer-causing agents (e.g., radioactive materials, certain inhaled chemicals or minerals, and diesel exhaust); air pollution; arsenic in drinking water; previous radiation therapy to the chest; and family history of lung cancer.4
Historically, Delaware has had one of
the highest tobacco use rates in the
U.S. However, nearly two decades of successful tobacco control efforts have reduced statewide tobacco use prevalence. In 2002, Delaware enacted the Clean Indoor Air Act banning smoking in workplaces and most indoor public places; in 2015, the ban was expanded to include electronic smoking devices such as e-cigarettes and vape pens. In 2014,
Delaware’s Youth Access to Tobacco law was amended to include e-cigarettes as
a restricted product. Between 2007 and 2017, Delaware’s cigarette tax was raised from $1.15 per pack to $2.10 per pack,
the 14th-highest state cigarette tax in the U.S. (average: $1.79)5 And most recently, in April 2019, the Delaware General Assembly passed Senate Bill 25, raising the legal age to buy tobacco products from 18 to 21; Senate Bill 25 goes into effect July 16, 2019. Legislation, combined with tobacco control initiatives, has directly contributed to reductions in tobacco use prevalence. From 2011 to 2017, cigarette use declined from 22% to 17% among Delaware adults.6 Among Delaware high school students, cigarette use fell from 32% in 1999 to 6% in 2017 and electronic vapor-product use dropped from 24% in 2015 to 14% in 2017.7
Yet, the need for continued tobacco control efforts remains. In 2017, Delaware ranked 27th among states in current cigarette use among adults (17%).8 In
the same year, 22% of Delaware adults used at least one type of tobacco, including cigarettes, cigars, e-cigarettes, smokeless tobacco, hookahs, and/
or other tobacco products.6 Current cigarette-use prevalence is highest among Delawareans age 25-34 (26%).6 In 2017, current smoking prevalence correlated with those who did not complete high school as well as those with lower incomes. Twenty-nine percent of residents who did not complete their high school education currently smoked, compared
to 9% of college graduates.6 Thirty-three percent of Delawareans earning less than $15,000 per year were current smokers, compared to 13% of those earning $75,000 or more per year.6 In 2017, 66% of Delaware smokers reported having tried to quit smoking within the past year,6 underscoring providers’ opportunities to interface with large numbers of tobacco- using patients in the contemplation, preparation, or action stages of
intentional behavior change.9 Finally,
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