State Programs Credited for Dip in Lung Cancer

California’s lung cancer rate decreased by 14% between 1988 and 1997, far outpacing declines in other regions of the country and prompting jubilant federal health officials to credit the state’s stringent anti-tobacco programs.

“We are very, very excited about this,” said Terry Pechacek of the office on smoking and health at the federal Centers for Disease Control and Prevention. The center office released a study Thursday comparing California’s lung cancer rates with those in five other states and three metropolitan areas.

California has consistently been ahead of other states in initiating aggressive public health efforts to discourage tobacco use. In 1988, it became the first state to pass a voter-approved initiative--Proposition 99--that raised tobacco taxes by 25 cents per pack and dedicated part of the revenue to a comprehensive anti-smoking program.

“This study sends a clear message that an effective tobacco control program not only can reduce and prevent tobacco use but may reduce lung . . . cancers and other health consequences attributed to tobacco use,” said center Director Jeffrey P. Koplan. “We must take serious steps to fully implement science-based approaches that can nearly eradicate the level of lung cancer incidence in our nation.”

While the center’s most current data came from 1997, state officials said that statistics for 1998 show that the healthier trend is accelerating.

“There’s no mystery as to why California has witnessed a significant decline . . . while other regions nationwide have seen little or no change,” said state Health Director Diana M. Bonta. “Fewer Californians smoke and those who still smoke are smoking less.”

California health officials estimated that adult smoking in the state has dropped by 21% as a result of Proposition 99 and that per-capita cigarette consumption has plummeted by more than 52%.

As a result, there will be an estimated 3,000 to 4,000 fewer lung cancer cases and 2,000 fewer deaths in California this year than if the incidence had remained at 1988 levels, the California Department of Health Services said in a statement.

Lung cancer is the deadliest of cancers and the leading cause of cancer deaths. Patients have a poor survival rate, with only about 14% alive five years after diagnosis. There are about 164,000 new cases annually, with nearly 157,000 deaths from cases diagnosed earlier.

More than 80% of lung cancer cases are directly attributable to cigarette smoking.

The center studied lung cancer rates in California--provided by the state’s cancer registry--and compared the trends with those in Connecticut, Hawaii, Iowa, New Mexico and Utah, as well as the metropolitan areas of Atlanta, Detroit and Seattle-Puget Sound.

These regions--and California--make up the National Cancer Institute’s Surveillance, Epidemiology and End Results database, which tracks cancer incidence nationwide. For purposes of this study, however, California was treated separately so that comparisons could be made.

California’s lung cancer rate decrease of 14% between 1988 and 1997 compared with a 2.7% drop in the other regions combined.

The other states and regions did not have anti-smoking programs in place during the period of the study “and even now programs are only just beginning in a couple of these areas,” Pechacek said.

Other states have followed California’s lead in implementing statewide comprehensive tobacco control programs, among them Massachusetts in 1992, Arizona in 1994, Oregon in 1996 and Maine in 1998, the center said.

While lung cancer can take many years to develop after exposure to cigarette smoking, center officials said that risk of the disease declines immediately once someone quits smoking and that the impact of anti-smoking efforts on the incidence of lung cancer can be seen in as little as five years.

“To get the full benefit, it takes from 10 to 15 years. But during the initial few years, there is already a decline. And in our studies, you can see a difference in the risk after five years,” Pechacek said. “It is biologically plausible. And it makes sense.”

For example, the rate in California dropped from 71.9 cases per 100,000 population in 1988--the year Proposition 99 was approved--to 68 cases in 1991 and 67.3 cases in 1992--a significant decrease.

And by 1997, the rate in California had declined even further, to 60.1 per 100,000.

In the other regions, the incidence was 64.7 cases in 1997, a 2.7% drop from the 67.7 recorded in 1988.

Even more dramatic, the state reported, the 1998 numbers showed that cases had dropped from 60.1 to 57.6 per 100,000 residents.

In the 10-year period studied, the decline in lung cancer rates among men in California was 1.5 times greater than the decline in men in the other regions combined. Among women in California, lung cancer cases dropped by 4.8%, while they increased 13.2% in the other regions combined.

Bonta, the state health director, said: “Californians have only begun to see the tremendous health benefits from more than a decade of comprehensive tobacco education programs, which have helped to change how they view tobacco use. We must continue these programs in full force. . . . Far too many Californians still suffer the severe physical, emotional and financial consequences caused by tobacco use.”