Male tobacco smoke load and non-lung cancer mortality associations in Massachusetts

Annual lung cancer death rates were used as smoke load bio-indices, and age-adjusted lung/all other (non-lung) cancer death rates were analyzed with linear regression approach. Non-lung cancer death rates include all cancer deaths excluding lung. Smoking-attributable-fractions (SAFs) for the latest period (year 2003) were estimated as: 1-(estimated unexposed cancer death rate/observed rate).Male lung and non-lung cancer death rates have declined steadily since 1992. Lung and non-lung cancer death rates were tightly and steeply associated across years. The slopes of the associations analyzed were 1.69 (95% confidence interval (CI) 1.35–2.04, r = 0.90), and 1.36 (CI 1.14–1.58, r = 0.94) without detected autocorrelation (Durbin-Watson statistic = 1.8). The lung/non-lung cancer death rate associations suggest that all-sites cancer death rate SAFs in year 2003 were 73% (Sensitivity Range [SR] 61–82%) for all ages and 74% (SR 61–82%) for ages 30–74 years.The strong lung/non-lung cancer death rate associations suggest that tobacco smoke load may be responsible for most prematurely fatal cancers at both lung and non-lung sites. The present method estimates are greater than the earlier estimates. Therefore, tobacco control may reduce cancer death rates more than previously noted.Estimation of mortality caused by tobacco use is an essential basis for state, national, and international tobacco control efforts. Cancer mortality, which accounts for an estimated annual 1.4 million or one third of, deaths globally, due to smoking [1], is of particular importance. Recent estimates of smoking-attributable cancer mortality utilize lung cancer mortality data as an indicator of the accumulated hazards of tobacco smoking and tightly link several temporal, ethnic, and geographic cancer mortality disparities to smoking [1,2]. However, those indirect estimates have at least two flaws. In the authors' words, the Peto estimates are based on a "simple halving of the excess risk [linked to smo