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BMC Cancer. 2018 Jan 31;18(1):115. doi: 10.1186/s12885-018-4002-9.

A statewide investigation of geographic lung cancer incidence patterns and radon exposure in a low-smoking population.

Author information

1
Huntsman Cancer Institute at the University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA. Judy.Ou@hci.utah.edu.
2
Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84112, USA. Judy.Ou@hci.utah.edu.
3
Huntsman Cancer Institute at the University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
4
Study Design and Biostatistics Center, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84112, USA.
5
Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84112, USA.
6
Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Salt Lake City, UT, 84112, USA.
7
Department of Communication, University of Utah, 255 S Central Campus Dr., Rm 2400, Salt Lake City, UT, 84112, USA.
8
College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA.

Abstract

BACKGROUND:

Lung cancer is the leading cause of cancer-related mortality in Utah despite having the nation's lowest smoking rate. Radon exposure and differences in lung cancer incidence between nonmetropolitan and metropolitan areas may explain this phenomenon. We compared smoking-adjusted lung cancer incidence rates between nonmetropolitan and metropolitan counties by predicted indoor radon level, sex, and cancer stage. We also compared lung cancer incidence by county classification between Utah and all SEER sites.

METHODS:

SEER*Stat provided annual age-adjusted rates per 100,000 from 1991 to 2010 for each Utah county and all other SEER sites. County classification, stage, and sex were obtained from SEER*Stat. Smoking was obtained from Environmental Public Health Tracking estimates by Ortega et al. EPA provided low (< 2 pCi/L), moderate (2-4 pCi/L), and high (> 4 pCi/L) indoor radon levels for each county. Poisson models calculated overall, cancer stage, and sex-specific rates and p-values for smoking-adjusted and unadjusted models. LOESS smoothed trend lines compared incidence rates between Utah and all SEER sites by county classification.

RESULTS:

All metropolitan counties had moderate radon levels; 12 (63%) of the 19 nonmetropolitan counties had moderate predicted radon levels and 7 (37%) had high predicted radon levels. Lung cancer incidence rates were higher in nonmetropolitan counties than metropolitan counties (34.8 vs 29.7 per 100,000, respectively). Incidence of distant stage cancers was significantly higher in nonmetropolitan counties after controlling for smoking (16.7 vs 15.4, p = 0.02*). Incidence rates in metropolitan, moderate radon and nonmetropolitan, moderate radon counties were similar. Nonmetropolitan, high radon counties had a significantly higher incidence of lung cancer compared to nonmetropolitan, moderate radon counties after adjustment for smoking (41.7 vs 29.2, p < 0.0001*). Lung cancer incidence patterns in Utah were opposite of metropolitan/nonmetropolitan trends in other SEER sites.

CONCLUSION:

Lung cancer incidence and distant stage incidence rates were consistently higher in nonmetropolitan Utah counties than metropolitan counties, suggesting that limited access to preventative screenings may play a role in this disparity. Smoking-adjusted incidence rates in nonmetropolitan, high radon counties were significantly higher than moderate radon counties, suggesting that radon was also major contributor to lung cancer in these regions. National studies should account for geographic and environmental factors when examining nonmetropolitan/metropolitan differences in lung cancer.

KEYWORDS:

Geography; Lung cancer; Non-genetic risk factors; Public health; Radon

PMID:
29385999
PMCID:
PMC5793382
DOI:
10.1186/s12885-018-4002-9
[Indexed for MEDLINE]
Free PMC Article

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