title: Reduced lung cancer deaths attributable to decreased tobacco use in Massachusetts.
abstract: BACKGROUND
  Approximately 88% of the lung cancer deaths in men and 71% in women occurring in the US are attributable to cigarette smoking, with almost 3,700 annual lung cancer deaths in Massachusetts. In the state, male lung cancer death rates are showing a per year annual decline following a peak in the early 1990s. Such recent declines could be mostly attributed to tobacco control efforts over the past 40 years.
  
  
  METHODS
  This study predicts how many fewer lung cancer deaths have occurred in Massachusetts possibly attributable to tobacco control activities. The study employs the US National Cancer Institute's "Joinpoint" Regression Analysis Program (version 3.0) using statewide age-standardized (2000 US Standard Population) lung cancer death rates from 1931 to 2003 for each of the sexes. 95% confidence intervals (CI) were also calculated.
  
  
  RESULTS
  Modeled male lung cancer death rates stabilized from the calendar year 1977 onwards but showed significant decline from 1992 onwards, while females showed a deceleration in rising lung cancer rates from 1993 onwards. Therefore, based on their corresponding beta-coefficients (slope) and standard error for each of the two calendar years 19,665 (95% CI: 18,655; 20,765) fewer lung cancer deaths in males and 3,855 (95% CI: 3,630; 4,055) fewer lung cancer deaths in females were estimated to have occurred from 1977 to 1993 onwards, respectively, largely because of the anti-smoking interventions in the past.
  
  
  CONCLUSIONS
  Reductions in tobacco smoking are a major factor in the decrease in lung cancer mortality rates. Sustained progress in tobacco control is essential.
authors.affiliation: Division of Public Health Practice, Harvard School of Public Health, 401 Park Drive, Landmark Center (3rd Floor, East), Boston, MA 02215, USA. zkabir@hsph.harvard.edu
authors.forename: Zubair
authors.initials: Z
authors.lastname: Kabir
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Connolly
authors.forename: Luke
authors.initials: L
authors.lastname: Clancy
authors.forename: Ahmedin
authors.initials: A
authors.lastname: Jemal
authors.forename: Howard K
authors.initials: HK
authors.lastname: Koh
mesh_terms: D002423:Cause of Death; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000401:mortality* / Q000517:prevention & control; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D015995:Prevalence; D018426:SEER Program; D016540:Smoking Cessation; D000074606:Smoking Prevention; D015996:Survival Rate; D014026:Nicotiana