How does tobacco-related cancer incidence and survival vary among areas with different smoking prevalence? Analysis of Surveillance Epidemiology and End Result (SEER) nine registries database, 1975-2009

Background Tobacco-smoking is an established risk factor of certain cancer types; therefore, variability of smoking prevalence is expected to be associated with variability in the rates of these cancers. Utah has the lowest smoking prevalence in the nation; therefore, our objective is to describe the differences in incidence, survival and temporal trends of tobacco-related cancers between Utah and eight other registries using the Surveillance Epidemiology and End Result (SEER) nine registries database. Methods Invasive primary tobacco-related cancers were identified in the SEER database (1975-2009). SEERstat was used to calculate age-adjusted incidence and five-year relative survival rate. Smoking prevalence was abstracted from the literature and temporal trends were analyzed using JointPoint regression program. Results Between 1975 and 2009, tobacco-related cancer rate dropped by 0.4% per year among men in both areas and increased by 0.5% and 0.2% per year among women in Utah and the other registries respectively. Utah had lower smoking prevalence, higher five year relative survival (43.5% vs. 39.3%) and 40-45% lower rate of tobacco-related cancer than the other areas. In all registries, overall tobacco-related cancer rate declined by 0.9 % per year, however, cancers of the kidney, liver, and pancreas increased among both sexes, while esophageal and oropharyngeal cancers increased only among men. Conclusion Low smoking prevalence is associated with lower rate and better survival of tobacco-related cancer. Overall tobacco-related cancer rate is declining; however, this trend is not consistent for all sub-sites. Further research is necessary to identify why some tobacco-related cancers are increasing.