Global lung cancer burden shifting to middle-income countries

More than 40% of men in China smoke, and the country has become the center of the global lung cancer epidemic. Lung cancer historically affected rich industrialized nations, but the burden is shifting toward middle-income countries where high smoking rates combine with rapid population growth, urbanization, and air pollution. In upper-middle-income countries such as China, Brazil, and Iran, deaths from tracheal, bronchus, and lung cancers rose by almost two-thirds from 2003 to 2023 while populations grew by about 16%. In lower-middle-income countries in Asia and Africa, deaths more than doubled while populations increased by just over one-third. Tobacco smoking drives about 85% of lung cancer cases, and smoking rates in China are starting to decline, though lung cancer outcomes will lag for decades due to latency.

"China - a country where more than 40% of men smoke - has become the epicentre of the global lung cancer epidemic. Historically, lung cancer has been predominantly a disease of rich industrialized nations. But the burden of disease in China is indicative of a global shift, with middle-income countries facing the greatest increase in cases as high rates of smoking combine with rapid population growth, urbanization and the associated air pollution."

"Between 2003 and 2023, yearly deaths from tracheal, bronchus and lung cancers (lower respiratory tract cancers for which data is typically combined by health-tracking organizations because the causes are so similar) grew by almost two-thirds while populations grew by only about 16% in upper-middle-income countries (see 'An unequal burden'). A similar pattern is evident in lower-middle income countries in Asia and Africa - particularly India and Nigeria. There, the number of tracheal, bronchus and lung cancer deaths more than doubled while populations increased by just over one-third."

"The main driver is tobacco smoking, which contributes to 85% of lung cancer cases. "This is the next wave of the tobacco epidemic," says Yannick Romero, who advises governments on lung cancer policy at the Union for International Cancer Control in Geneva, Switzerland. China, the world's second most populous country, has the highest number of smokers. In 2023, around 40% of the world's two million lung cancer deaths occurred in China."

"Smoking rates in China have begun to fall. In 2024, 23% of the country's population smoked, down from 27% in 2018. But lung cancer cases will take decades to follow, owing to "the latency between the time you smoke and the time"

Read at Nature