Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies

doi:10.1136/bmj.321.7257.323

BMJ 2000;321:323-329 ( 5 August )

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Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies

Richard Peto, professor of medical statistics and epidemiology, ^a Sarah Darby, professor of medical statistics, ^a Harz Deo, statistician, ^b Paul Silcocks, senior lecturer in epidemiology, ^c Elise Whitley, lecturer in medical statistics, ^d Richard Doll, emeritus professor of medicine. ^a

^a Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Radcliffe Infirmary, Oxford OX2 6HE, ^b Cancer Epidemiology Unit, Radcliffe Infirmary, Oxford OX2 6HE, ^c Trent Institute for Health Services Research, Queen's Medical Centre, Nottingham NG7 2UH, ^d Department of Social Medicine, University of Bristol, Bristol BS8 2PR

Correspondence to: S Darby sarah.darby{at}ctsu.ox.ac.uk

Objective and design: To relate UK national trends since 1950 insmoking, in smoking cessation, and in lung cancer to the contrastingresults from two large case-control studies centred around 1950and1990.
Setting: UnitedKingdom.
Participants: Hospital patients under 75 years of age withand without lung cancer in 1950 and 1990, plus, in 1990, a matchedsample of the local population: 1465 case-control pairs in the1950 study, and 982 cases plus 3185 controls in the 1990study.
Main outcome measures: Smoking prevalence and lungcancer.
Results: For men in early middle age in the UnitedKingdom the prevalence of smoking halved between 1950 and 1990but the death rate from lung cancer at ages 35-54 fell even morerapidly, indicating some reduction in the risk among continuingsmokers. In contrast, women and older men who were still currentsmokers in 1990 were more likely than those in 1950 to have beenpersistent cigarette smokers throughout adult life and so hadhigher lung cancer rates than current smokers in 1950. The cumulativerisk of death from lung cancer by age 75 (in the absence of othercauses of death) rose from 6% at 1950 rates to 16% at 1990 ratesin male cigarette smokers, and from 1% to 10% in female cigarettesmokers. Among both men and women in 1990, however, the formersmokers had only a fraction of the lung cancer rate of continuingsmokers, and this fraction fell steeply with time since stopping.By 1990 cessation had almost halved the number of lung cancersthat would have been expected if the former smokers had continued.For men who stopped at ages 60, 50, 40, and 30 the cumulativerisks of lung cancer by age 75 were 10%, 6%, 3%, and 2%.
Conclusions: People who stop smoking, even well into middleage, avoid most of their subsequent risk of lung cancer, and stoppingbefore middle age avoids more than 90% of the risk attributableto tobacco. Mortality in the near future and throughout the firsthalf of the 21st century could be substantially reduced by currentsmokers giving up the habit. In contrast, the extent to whichyoung people henceforth become persistent smokers will affectmortality rates chiefly in the middle or second half of the 21stcentury.

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