Lung cancer in the heavily smoking society: the evidence from Russia

Vladimir Kozlov, National Research University Higher School of Economics
Sergey Vasin, National Research University Higher School of Economics

The article is devoted to the description, detailed analysis and explanation of the lung cancer mortality phenomenon in Russia. The lung cancer deaths rates have been steady declining in Russia since early 1990-s and this trend went contrary with the overall mortality trend and the smoking prevalence trends in Russia. In this case the strong causal effect of smoking on the lung cancer mortality (Gandini et. al, 2007; Peto et. al, 2000) is likely to be less pronounced in Russia. The first attempt to investigate the Russian lung cancer phenomenon was in the article by Shkolnikov et. al (1999). The authors expected that the decline in lung cancer mortality would be changed rising to a peak about 2003. As this did not happen, the phenomenon deserves further explorations. The preliminary results have shown the robustness of the above mentioned trends in lung cancer mortality: similar changes are observed in all Russian macroregions, rural and urban areas, and in other smoking-related cancers. The phenomenon is not unique: the decreasing level of lung cancer paired by growing or flat trends in smoking prevalence was observed in Ukraine and Belarus, while in some other post-communist countries (Hungary, Poland) the lung cancer mortality was growing in 1990-2000-s. We also found that lung cancer mortality for men was falling in cohorts since 1935-45; for women there was a peak for cohorts born in 1905-1925 and the decline for 1960+ cohort is slight and volatile. We will examine the possible explanations of the current situation with men such as changes in smoking doses, competitive risks, misclassification and achievements in medicine.