title: The lung cancer epidemic in Spanish women: an analysis of mortality rates over a 37-year period.
abstract: BACKGROUND
  Lung cancer continues to be the leading cause of cancer-related mortality in the European Union (EU) and deaths from lung cancer have been projected to escalate to epidemic proportions amongst females over the next years. We examined lung cancer mortality rates in men and women from Andalusia (Spain) over a 37-year period [1975-2012].
  
  
  METHODS
  Longitudinal epidemiological study analyzing lung cancer mortality trends in males and females. Data on lung cancer mortality in Andalusia for the period 1975-2012 were obtained from the official cause-of-death publications of the Institute of Statistics of Andalusia. For each sex, age-standardized (European standard population) mortality rates (ASR) from lung cancer were calculated for all ages and truncated at 30-64, 65-74, and >75 years using the direct method. Standardized rate trends by age and sex were estimated by joinpoint regression analysis.
  
  
  RESULTS
  In men, the ASR steadily increased through the period 1993-1995, reaching a peak of 145.72 deaths/100,000 people. Subsequently, lung cancer deaths decreased to a rate of 125.47 in the 2011-2012 period. A moderate increase was seen in women until the late 1990s and early 2000s. Thereafter, a very notable rise was observed in females for all age groups, the only exception being older subjects. The sex differences decreased from 8.6:1 in the 1975-1977 period to 6.8:1 in the 2011-2012 period.
  
  
  CONCLUSIONS
  Lung cancer mortality rates decreased significantly in Andalusian men from 1975 to 2012. More importantly, we demonstrate for the first time the beginning of the lung cancer epidemics in Andalusian women as previously predicted for this area.
authors.affiliation: 1 Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Spain ; 2 CIBER de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, Spain ; 3 Consejería de Salud y Bienestar Social de Andalucía, Seville, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: López-Campos
authors.affiliation: 1 Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Spain ; 2 CIBER de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, Spain ; 3 Consejería de Salud y Bienestar Social de Andalucía, Seville, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ruiz-Ramos
authors.affiliation: 1 Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Spain ; 2 CIBER de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, Spain ; 3 Consejería de Salud y Bienestar Social de Andalucía, Seville, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Calero
keywords: Lung cancer; epidemics; females; males; mortality