Risk Factors

Cigarette smoking is the major cause of lung cancer and is estimated to cause 87 percent of the lung cancer cases. Environmental tobacco smoke (or second-hand smoking) also increases the risk of lung cancer among non-smokers and is estimated to account for about two percent of the lung cancer cases. Smokers of cigars and pipes also are at an increased risk of lung cancer, though not as much as cigarette smokers. Long-term exposure to high levels of radon gas indoors is a risk factor for lung cancer, particularly among smokers.

Occupational exposure to asbestos (workers in mining and milling of asbestos, manufacture of asbestos products, shipbuilding, construction, building maintenance or demolition, asbestos abatement, vehicle brake repair), radon (uranium miners), inorganic arsenic (mining and smelting involving arsenic, pesticide application, wood preservation), polycyclic hydrocarbons (soots, tars, mineral oils, coke oven emissions), chromium (stainless steel production, welding, chromate production, chrome plating, chrome pigment, tanning), chloromethyl methyl ethers (chemical plant workers, laboratory workers, polymer makers), and vinyl chloride (vinyl chloride polymerization) are associated with lung cancer. Smoking combined with exposure to most of these materials compounds the risk of lung cancer. Occupational exposures are estimated to contribute to 13 percent of the lung cancers.

Individuals with a family history of lung cancer or who have a non-malignant lung disease such as tuberculosis or asthma are at higher risk for lung cancer, as are people of lower socio-economic status. Exposure to high levels of ionizing radiation such as from radiation therapy and atomic bomb fallout in Japan increases the risk of lung cancer. Air pollution, particularly the byproducts of the combustion of fossil fuels, appears to increase lung cancer, but it has been difficult to study. Increased vitamins A, C, and E and other micronutrients from eating fresh fruits and vegetables may protect against lung cancer.

Prevention and Control

Nearly all lung cancer could be prevented by avoiding tobacco. Ten years after quitting the ex-smoker's risk of lung cancer is reduced to half that of a person who continues to smoke. Since smoking usually begins in adolesence it is very important to prevent tobacco use among young people. Workers' exposure to carcinogenic substances should be minimized and homes with elevated levels of radon should be remediated. Diets rich in vegetables and fruits also may decrease the chances of lung cancer. Early detection of lung cancer is difficult because the symptoms do not appear until late in the disease process.

Incidence and Mortality in the U.S.

Lung cancer is the third most common cancer in the U.S. with 171,500 new cases estimated for 1998. The incidence rate is higher among men than women and the incidence increases with age. The incidence rate is now declining in men, but is still increasing, though more slowly, in women. This pattern reflects the growing popularity of cigarette smoking among women over the past several decades. The survival rates for lung cancer are 40 percent for one year and 14 percent for five years. The one-year survival rate has increased due to improved surgical treatment.

Approximately 160,100 deaths due to lung cancer are expected to occur in 1998 in the U.S., making it the leading cause of cancer death. Mortality rates due to lung cancer are higher among black men than among white men. Among men lung cancer mortality rates increased greatly between 1940 and 1979 after which the increase slowed. Currently, the mortality rate is declining among men. Conversely, the lung cancer mortality rates among women began to increase sharply in the 1960s and are still increasing. Since 1987, more U.S. women have died each year from lung cancer than from breast cancer, which was the leading cause of cancer death in women for over 40 years previous to 1987.

Incidence in New Jersey - 1986-1996

Tables 28 through 32 contain lung cancer incidence data for the counties for 1986 through 1996. Figure 11 shows the statewide trends. Statewide, black men had much higher rates of lung cancer than white men. White and black women had very similar rates, which were much lower than the rates for black and white men (see Figure 11). This pattern held for all the counties except in Bergen, Cape May, and Gloucester white men had higher rates than black men (see Table 32). In general, the rates of lung cancer declined over the years for black and, especially, white men, while the rates increased slightly for black and white women (see Figure 11). Changing smoking patterns are thought to be responsible for these trends.

Conclusion

The most important means to continue the reduction in lung cancer among men and to reverse the increase in lung cancer among women is avoidance of smoking. Workers' exposures to carcinogenic substances should continue to be minimized and homes with elevated levels of radon should be remediated. Diets rich in vegetables and fruits also may decrease the risk of lung cancer.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	99	103.3	126	125.8	99	98.9	82	82.0	103	101.7	96	92.9	89	85.5	85	83.4	105	98.0	70	63.4	90	80.6
Bergen	370	79.4	370	80.8	391	85.0	347	74.1	366	78.7	352	75.5	350	73.6	341	71.3	343	71.1	341	71.0	288	59.6
Burlington	130	87.4	137	90.8	146	95.0	148	94.0	156	97.8	162	101.8	170	106.8	152	94.3	134	81.8	140	83.6	135	79.3
Camden	202	101.7	198	97.4	205	98.7	166	80.6	215	103.4	212	104.3	185	87.9	201	96.8	197	93.6	171	80.4	198	94.8
Cape May	67	105.3	66	107.5	58	92.0	66	102.7	63	92.4	69	104.8	78	111.0	51	83.3	62	96.6	58	82.1	71	95.3
Cumberland	55	91.5	57	96.1	65	110.3	65	104.3	77	121.4	56	88.8	58	92.7	56	90.9	55	90.1	42	68.5	64	106.5
Essex	219	77.6	198	70.8	205	74.9	206	77.7	189	73.7	208	80.7	177	68.7	184	71.8	173	67.8	174	70.7	181	72.3
Gloucester	85	104.3	90	104.9	100	112.2	79	87.7	105	114.4	92	98.1	105	111.4	106	112.5	97	101.3	95	98.0	95	98.2
Hudson	263	106.6	240	99.2	225	95.6	227	97.3	211	93.6	195	84.4	193	82.9	210	91.1	177	78.0	176	76.0	195	84.7
Hunterdon	43	102.4	27	62.8	33	76.6	37	85.4	29	65.6	44	95.0	46	96.9	39	82.6	37	77.5	49	98.5	26	51.7
Mercer	109	80.2	112	81.6	117	85.8	114	82.9	128	92.3	128	92.6	112	81.2	141	100.3	109	78.7	100	71.8	93	66.2
Middlesex	265	95.7	255	87.5	251	88.5	262	90.2	259	86.2	245	81.5	259	83.9	218	72.4	243	80.1	268	88.0	262	84.7
Monmouth	208	84.7	236	93.5	235	93.9	192	77.0	218	87.3	250	97.0	252	96.0	223	85.5	203	76.7	204	75.3	201	72.5
Morris	132	75.6	143	83.5	150	81.9	149	80.8	151	81.7	146	78.9	126	66.3	129	67.9	133	69.6	133	68.9	132	68.4
Ocean	268	91.4	265	86.4	304	101.0	290	94.9	290	91.6	296	90.5	294	88.3	263	77.7	281	79.8	291	85.6	289	79.9
Passaic	174	84.5	179	87.1	176	86.4	170	85.3	157	77.8	179	89.2	154	77.2	167	83.1	146	73.3	160	78.6	131	63.7
Salem	26	88.1	28	93.1	30	97.3	21	68.0	27	79.1	32	102.4	35	109.2	26	84.4	31	96.8	30	94.0	20	60.5
Somerset	84	80.1	82	82.5	75	72.5	69	67.8	87	79.2	64	59.7	78	69.7	75	66.2	89	79.1	78	68.1	71	60.7
Sussex	46	96.8	52	109.0	53	113.3	48	98.0	35	73.1	46	89.6	49	97.7	60	119.2	56	108.9	41	77.0	43	81.4
Union	192	76.3	187	74.3	213	86.5	184	75.0	165	66.9	185	75.9	184	76.2	156	63.4	161	65.2	155	63.3	158	66.2
Warren	49	115.1	40	91.0	37	81.3	53	121.7	52	110.7	47	101.6	42	85.7	47	100.5	40	80.4	49	97.6	39	74.8
STATE	3086	88.2	3090	87.5	3170	89.6	2976	83.9	3087	86.3	3104	86.3	3037	83.4	2930	80.3	2872	77.8	2825	76.1	2782	74.1

¹Incidence rates - per 100,000 males, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Source: New Jersey State Cancer Registry.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	18	121.5	16	107.2	20	139.1	18	115.5	9	54.4	16	100.1	16	100.3	17	98.2	9	49.3	16	81.4	19	105.7
Bergen	11	84.1	5	36.0	11	74.7	12	69.7	16	95.9	20	122.2	14	81.0	15	94.5	6	38.7	10	55.4	13	64.8
Burlington	17	113.3	15	106.4	27	172.6	22	128.5	25	142.8	17	113.8	9	53.0	21	106.2	19	92.4	10	51.3	17	80.1
Camden	31	128.1	34	131.4	34	132.4	33	124.7	35	129.7	25	94.4	39	145.1	36	127.2	24	87.1	32	104.0	30	96.1
Cumberland	7	98.1	15	229.5	15	221.0	13	196.2	12	179.2	13	191.0	10	150.0	15	180.4	8	94.5	17	224.8	12	154.8
Essex	137	140.3	140	137.1	146	147.7	145	141.9	136	130.5	152	148.1	130	127.4	139	129.8	133	126.5	125	118.3	117	108.3
Gloucester	13	161.9	7	84.6	13	158.1	7	83.4	---	---	9	94.6	14	148.2	9	93.3	10	98.7	---	---	11	94.6
Hudson	33	154.0	31	145.4	30	139.9	20	79.9	24	102.3	23	97.0	31	138.4	31	126.9	19	74.2	13	59.4	29	110.7
Mercer	26	127.0	25	123.3	41	200.6	26	134.9	36	161.2	22	99.3	24	102.6	28	121.8	29	131.2	28	110.7	26	106.9
Middlesex	12	91.0	20	149.4	13	92.5	17	125.6	20	140.2	17	122.9	15	91.1	22	162.6	18	112.9	16	98.6	14	83.7
Monmouth	22	118.0	12	64.8	21	114.6	21	111.9	12	65.8	14	74.0	18	85.3	24	116.8	28	130.6	21	94.6	25	104.2
Passaic	28	163.7	27	130.3	16	79.7	22	110.6	14	65.0	18	86.9	20	104.1	28	146.2	15	68.5	22	100.4	20	85.8
Salem	9	208.0	6	155.2	5	103.6	5	125.1	11	238.5	---	---	6	132.7	6	120.6	---	---	7	138.6	---	---
Union	34	117.2	39	122.9	39	138.4	32	96.9	36	108.1	33	102.7	36	109.9	39	126.6	38	112.9	36	100.7	29	79.2
STATE	408	127.0	399	121.3	443	136.2	407	119.8	404	115.4	404	117.2	403	114.1	446	123.2	378	102.2	368	97.5	384	97.0

¹Incidence rates - per 100,000 males, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Counties with six or more years of fewer than five cases each year were removed from the table - Cape May, Hunterdon, Morris, Ocean, Somerset, Sussex, and Warren counties. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	61	44.3	59	47.8	78	62.3	72	50.3	76	57.1	85	61.0	74	58.4	74	52.6	74	52.2	76	57.2	68	46.9
Bergen	226	37.8	251	41.7	251	41.9	234	39.1	258	42.9	277	45.8	270	43.5	255	42.9	251	40.7	229	37.0	264	41.9
Burlington	64	34.4	80	41.6	75	36.3	90	45.8	95	45.6	92	45.8	94	46.2	123	60.6	95	46.9	96	44.8	103	48.9
Camden	97	37.4	130	46.6	129	47.7	128	48.3	124	45.8	142	51.5	142	49.3	139	53.1	163	59.8	155	54.8	125	43.6
Cape May	31	45.9	28	38.0	54	65.9	52	66.0	34	45.3	50	56.1	53	65.5	47	55.9	52	66.0	49	51.7	52	62.4
Cumberland	28	33.3	28	36.8	38	47.8	30	37.1	37	43.5	49	56.8	46	58.2	42	56.9	41	50.3	28	36.3	41	52.3
Essex	152	37.7	126	34.1	155	41.7	135	37.5	131	36.9	132	36.1	142	38.6	133	39.0	139	37.5	169	45.9	149	42.3
Gloucester	52	49.1	47	44.0	58	51.9	61	54.2	56	47.3	51	43.8	50	42.4	66	54.1	68	55.4	70	58.5	71	57.9
Hudson	123	35.6	134	41.9	160	46.7	159	49.1	154	47.7	109	35.4	128	39.9	130	40.6	130	40.4	133	39.9	135	40.9
Hunterdon	18	33.2	17	31.6	24	41.1	21	37.0	29	52.3	24	39.7	36	62.4	22	35.8	36	59.1	29	47.7	22	40.8
Mercer	75	42.1	60	33.3	66	33.4	80	43.4	83	45.3	90	46.4	76	40.6	81	43.2	72	39.4	77	43.5	109	60.3
Middlesex	128	36.7	156	43.5	154	41.7	163	44.1	168	43.3	193	51.1	173	44.2	180	45.8	164	42.1	185	46.9	217	55.2
Monmouth	138	42.4	144	42.8	180	53.3	157	47.7	185	55.9	170	51.1	181	52.1	171	49.6	182	52.5	177	53.2	175	50.2
Morris	88	37.5	102	43.3	97	41.4	109	45.7	86	35.8	107	42.5	101	41.7	110	44.4	110	42.9	116	44.9	115	44.9
Ocean	159	42.8	169	45.1	168	42.8	183	44.3	228	51.0	186	44.1	204	50.0	225	55.1	216	52.1	218	47.7	245	54.4
Passaic	101	36.0	105	37.2	106	39.8	117	44.0	118	43.6	100	35.9	106	38.4	104	36.8	94	35.8	121	44.3	104	38.5
Salem	18	47.1	12	32.0	19	48.2	20	51.0	22	55.5	15	35.1	18	48.4	18	42.1	20	50.6	22	63.2	21	50.0
Somerset	41	34.2	40	32.0	47	35.9	35	26.5	54	37.5	55	42.2	58	40.8	66	46.1	46	30.8	44	30.4	55	36.7
Sussex	24	42.0	24	43.3	31	48.2	28	41.2	30	45.0	45	69.9	29	43.9	38	59.3	25	36.5	36	55.9	29	40.5
Union	116	34.0	118	35.7	114	34.8	123	36.6	130	40.6	136	42.7	103	31.7	127	39.3	118	35.6	118	35.6	120	37.6
Warren	24	37.7	25	41.8	22	38.4	36	58.3	30	51.7	26	44.4	34	54.2	30	42.9	38	63.2	33	54.1	37	61.8
STATE	1764	38.3	1855	40.4	2026	43.5	2033	43.7	2132	45.2	2134	45.3	2118	44.3	2181	46.0	2135	44.6	2181	45.1	2257	46.4

¹Incidence rates - per 100,000 females, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Source: New Jersey State Cancer Registry.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	15	70.7	15	72.5	12	52.1	14	64.2	8	34.5	18	70.3	15	62.5	14	59.1	8	29.6	15	47.2	16	55.8
Bergen	10	49.2	13	60.1	8	36.7	7	33.0	---	---	7	28.4	7	30.8	6	26.3	14	53.1	7	26.6	6	24.0
Burlington	8	48.9	7	34.9	8	37.8	8	40.5	11	51.4	11	43.4	6	30.6	9	46.3	9	39.4	8	29.7	13	51.4
Camden	19	58.8	14	41.6	11	32.5	13	36.9	15	40.2	17	46.7	27	70.3	19	47.0	20	48.0	21	49.1	20	47.5
Cumberland	---	---	5	54.8	---	---	---	---	5	53.0	6	56.1	10	85.7	5	50.1	7	64.0	---	---	---	---
Essex	59	39.2	65	43.6	76	49.4	64	42.0	69	44.3	65	41.5	68	42.3	75	45.4	92	55.6	78	46.7	69	41.1
Gloucester	5	52.9	---	---	---	---	6	49.2	6	49.6	6	49.5	6	46.2	5	38.6	7	45.2	---	---	6	40.9
Hudson	8	23.3	13	38.1	15	46.7	17	52.2	16	45.1	16	44.6	16	43.5	13	35.3	19	52.1	17	45.6	8	20.4
Mercer	9	33.8	7	25.2	12	40.6	11	36.9	13	43.4	9	29.0	14	43.5	14	43.1	19	57.6	10	30.3	15	42.7
Middlesex	---	---	6	38.0	5	29.4	---	---	6	29.4	7	40.9	6	32.4	9	41.6	10	50.5	10	44.3	10	42.1
Monmouth	14	57.8	---	---	10	41.6	7	26.9	13	51.3	11	42.0	7	24.8	15	49.3	23	76.5	7	22.4	10	32.2
Passaic	9	36.8	11	44.9	12	45.3	7	27.5	6	24.4	14	44.6	9	32.2	10	33.8	10	32.8	17	50.7	5	16.1
Union	13	31.6	15	35.6	20	46.5	23	53.5	16	36.7	25	53.9	19	39.1	17	37.9	16	32.9	22	44.0	18	37.4
STATE	185	41.2	189	41.2	200	42.5	198	41.7	197	40.6	225	45.0	221	43.0	225	42.8	264	49.3	233	42.0	213	38.0

¹Incidence rates - per 100,000 females, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Counties with six or more years of fewer than five cases each year were removed from the table - Cape May, Hunterdon, Morris, Ocean, Salem, Somerset, Sussex, and Warren counties. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.

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