The strongest risk factor that drives change in the incidence of non-small-cell lung cancer (NSCLC) is the historical prevalence of smoking. The long lag between the initiation of tobacco use and the development of lung cancer is an indicator that we have only seen the tip of the iceberg regarding long-term effects of the smoking epidemic. This finding is compounded by the effect of population aging and growth. Owing to the shift in disease risk, we do not use historical NSCLC incidence to predict future incidence of NSCLC. Changing patterns in risk, based on evolving smoking patterns, following increased awareness and investment in tobacco control strategies need to be incorporated in forecasting NSCLC incidence.

Questions Answered in This Report:

  • What are the trends in smoking prevalence in key pharmaceutical markets and how do these trends impact the risk of NSCLC? Is the risk of NSCLC changing? Despite recent declines in smoking, why is the NSCLC risk still high? How soon will the incident NSCLC population begin to decline? Globally, there have been variations in the evolution of the smoking epidemic and evidence from the literature has consistently demonstrated a strong and significant lagged association between smoking and the risk for NSCLC. The timing of peak smoking prevalence will determine the onset of a downward trend in NSCLC incidence, which for most markets, will not be recognized for at least two more decades. Countries where decline commenced over three decades ago will begin to experience a decline in NSCLC risk in the 2030s.

  • What will drive future change in NSCLC risk and how do we predict these changes? Forecasting based on historical trends over/underestimates NSCLC incidence in countries with an evolving smoking epidemic by as much as 80%. Changing patterns in risk based on evolving smoking patterns globally need to be incorporated in forecasting NSCLC incidence. We use changes in historical smoking prevalence to forecast the decrease/increase in NSCLC risk following increased awareness and investment in tobacco control strategies.

  • To what extent are the growing and aging populations in key markets contributing to the change in diagnosed incident cases of NSCLC? The structure and size of populations in major pharmaceutical markets are changing. Because of the aging of the population, a greater likelihood of developing lung cancer exists in smokers as well as people exposed to secondary smoke. Population aging and growth will drive a 16% increase in diagnosed incident cases of NSCLC.

  • What NSCLC histology is most strongly associated with smoking and how will changes in smoking prevalence impact the histology distribution of NSCLC? Adenocarcinoma and large-cell carcinoma are not as strongly associated with smoking, compared with squamous-cell carcinomas. Adenocarcinomas of the lung will be the more-predominant histology subtype of NSCLC by 2033.


Markets covered: United States, Germany, Japan, Mexico, and Russia.

Epidemiology: Country-specific diagnosed incident cases of NSCLC by histology subtype. Country-specific smoking prevalence by gender. Forecasting methods used.

Forecasting method comparison: Forecast diagnosed incident cases based on historical smoking prevalence were compared with historical NSCLC incidence forecasting methods..

Author(s): Lade Ayodele, MBBS, MPH