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

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7257.323 (Published 05 August 2000) Cite this as: BMJ 2000;321:323
  1. Richard Peto, professor of medical statistics and epidemiologya,
  2. Sarah Darby (sarah.darby{at}ctsu.ox.ac.uk), professor of medical statisticsa,
  3. Harz Deo, statisticianb,
  4. Paul Silcocks, senior lecturer in epidemiologyc,
  5. Elise Whitley, lecturer in medical statisticsd,
  6. Richard Doll, emeritus professor of medicinea
  1. a Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Radcliffe Infirmary, Oxford OX2 6HE
  2. b Cancer Epidemiology Unit, Radcliffe Infirmary, Oxford OX2 6HE
  3. c Trent Institute for Health Services Research, Queen's Medical Centre, Nottingham NG7 2UH
  4. d Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  1. Correspondence to: S Darby
  • Accepted 7 July 2000

Abstract

Objective and design: To relate UK national trends since 1950 in smoking, in smoking cessation, and in lung cancer to the contrasting results from two large case-control studies centred around 1950 and 1990.

Setting: United Kingdom.

Participants: Hospital patients under 75 years of age with and without lung cancer in 1950 and 1990, plus, in 1990, a matched sample of the local population: 1465 case-control pairs in the 1950 study, and 982 cases plus 3185 controls in the 1990 study.

Main outcome measures: Smoking prevalence and lung cancer.

Results: For men in early middle age in the United Kingdom the prevalence of smoking halved between 1950 and 1990 but the death rate from lung cancer at ages 35–54 fell even more rapidly, indicating some reduction in the risk among continuing smokers. In contrast, women and older men who were still current smokers in 1990 were more likely than those in 1950 to have been persistent cigarette smokers throughout adult life and so had higher lung cancer rates than current smokers in 1950. The cumulative risk of death from lung cancer by age 75 (in the absence of other causes of death) rose from 6% at 1950 rates to 16% at 1990 rates in male cigarette smokers, and from 1% to 10% in female cigarette smokers. Among both men and women in 1990, however, the former smokers had only a fraction of the lung cancer rate of continuing smokers, and this fraction fell steeply with time since stopping. By 1990 cessation had almost halved the number of lung cancers that would have been expected if the former smokers had continued. For men who stopped at ages 60, 50, 40, and 30 the cumulative risks of lung cancer by age 75 were 10%, 6%, 3%, and 2%.

Conclusions: People who stop smoking, even well into middle age, avoid most of their subsequent risk of lung cancer, and stopping before middle age avoids more than 90% of the risk attributable to tobacco. Mortality in the near future and throughout the first half of the 21st century could be substantially reduced by current smokers giving up the habit. In contrast, the extent to which young people henceforth become persistent smokers will affect mortality rates chiefly in the middle or second half of the 21st century.

Footnotes

  • Funding direct support to Clinical Trial Service Unit from the Medical Research Council (which also funded the 1950 study), the British Heart Foundation, and the Imperial Cancer Research Fund. The 1990 study was funded by the Imperial Cancer Research Fund; the National Radiological Protection Board; the Department of Health; the Department of the Environment, Transport and the Regions; and the European Commission.

  • Competing interests None declared.

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