RESEARCH PAPER
Lung cancer and tobacco smoking in Crete, Greece: reflections from a population-based cancer registry from 1992 to 2013
D. Sifaki-Pistolla 1, 2  
,  
C. Lionis 1, 2
,  
V. Georgoulias 3, 2
,  
P. Kyriakidis 4
,  
F. Koinis 3, 2
,  
S. Aggelaki 3
,  
 
 
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1
Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
2
Cancer Registry of Crete, University of Crete, Heraklion, Greece
3
Department of Medical Oncology, School of Medicine, University of Crete, Heraklion, Greece
4
Department of Civil Engineering and Geomatics, Cyprus University of Technology, Limassol, Cyprus
5
Department of Thoracic Medicine, School of Medicine, University of Crete, Heraklion, Greece
CORRESPONDING AUTHOR
D. Sifaki-Pistolla   

Clinic of Social and Family Medicine, School of Medicine, University of Crete, P.O. Box 2208, 71003, Heraklion, Crete, Greece
Publish date: 2017-01-19
 
Tob. Induc. Dis. 2017;15(January):6
KEYWORDS
ABSTRACT
Background:
The Cancer Registry of Crete is a regional population database that collects cancer morbidity/mortality data along with several risk factors. The current study assessed the geographical variation of lung cancer among ever and never smokers in Crete during the last 20 years.

Methods:
Lung cancer patient records (1992–2013) including information on medical history and smoking habits were obtained from the Cancer Registry of Crete. Age-Adjusted Incidence Rates (AAIR), prevalence of smoking among lung cancer patients and the Population-Attributable Fraction (PAF%) of tobacco smoking were estimated. Kaplan-Meier curves, grouped per smoking status were constructed, and spatio-temporal analyses were carried out to assess the geographical variations of lung cancer and smoking (a = 0.05).

Results:
New lung cancer cases in Crete accounted for 9% of all cancers (AAIRboth genders = 40.2/100,000/year, AAIRmales = 73.1/100,000/year, AAIRfemales = 11.8/100,000/year). Ever smokers presented significantly higher incidence compared to ex-smokers (p = 0.02) and never smokers (p < 0.001). The highest increase was observed in ever smokers (AAIR1992 = 19.2/100,000/year, AAIR2013 = 25.4/100,000/year, p = 0.03), while never smokers presented the lowest increase from 1992 to 2013 (AAIR1992 = 5.3/100,000/year, AAIR2013 = 6.8/100,000/year, p = 0.2). The PAF% of lung cancer mortality is 86% for both genders (males: 89%, females: 78%). AAIRs ranged from 25 to 50/100,000/year, while significant geographical differences were observed among the municipalities of Crete (p = 0.02). Smokers living in the south-east urban regions presented higher risk of dying from lung cancer (RR = 2.2; 95%CI = 1.3–3.5).

Conclusions:
The constant increase of lung cancer rates among both genders, especially in females, outlines the need for targeted, geographically-oriented, life-style preventive measures. Design of population-based screening programs, tobacco awareness campaigns and smoking cessation programs in lung cancer hot spots could be guide by these findings.

 
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