Smoking-attributable cancer mortality in NSW, Australia, 1972-2008.

AIM To estimate the impact of smoking-attributable cancer mortality on trends in cancer mortality in New South Wales (NSW), Australia, between 1972 and 2008. STUDY TYPE The study is a retrospective analysis of cancer mortality in NSW using NSW Central Cancer Registry data. METHODS Smoking-attributable cancer deaths were estimated using the smoking impact ratio method, which provides an indirect estimate of exposure to tobacco in the NSW population using lung cancer mortality. Trends in age-standardised cancer mortality rates by cancer type and the number of years of life lost due to smoking-attributable cancer deaths were estimated. RESULTS In NSW, the cancer mortality rate decreased in males by 26% and females by 19% between 1989 and 2008. Nearly half (44%) of the decrease for males was a result of the decline in smoking-attributable cancer deaths. Despite a decline in the female all-cancer mortality rate, the smoking-attributable cancer mortality rate increased from 20.3 per 100 000 to 26.8 per 100 000 between 1989 and 2008. Smoking-attributable cancer deaths in women increased from around 150 per year in the early 1970s to 1186 in 2008; for men, the number remained stable at just over 2000 deaths per year since the 1980s. Although the lung cancer mortality rate declined in men, lung cancer remains the largest cause of cancer death. Lung cancer has overtaken breast cancer to be the largest cause of cancer death among women, with 17.1% (n = 998) of cancer deaths due to lung cancer in 2008. CONCLUSIONS Despite declining all-cancer mortality in NSW, around 3330 cancer deaths in 2008 were due to the accumulated hazard of smoking in current and ex-smokers. This highlights the importance of tobacco control as part of a comprehensive cancer control plan.