ATPγS tetralithium salt Despite the observed declines in
Despite the observed declines in lung cancer incidence rates among men, such favorable results probably do not reflect the recently-implemented tobacco control policies, given the relatively short ATPγS tetralithium salt between adoption and implementation of these measures, and the time lag assessment of disease rates (<10 years). In addition, an inherent limitation of APC modelling is the inability to identify the linear trends attributable to a period or birth cohort. As tobacco uptake and cessation is largely a cohort-related behaviour – most users begin as young adults and carry the habit through to adulthood  – the incidence rate ratios assume that the linear trend is entirely due to birth cohort. In our study, this can be supported by the parallel declines among males in the rates for cohorts born after 1920 and among women by the sharp parallel increments for cohorts beyond 1940, irrespective of age at diagnosis. The observed decrease among women signaled in the very recent cohorts is a marker of the value of such detailed analyses, but requires a cautious interpretation given the sparse number of cases in the numerators of these rates.
Our predictions indicate that lung cancer incidence rates in Uruguayan men are expected to continue to decline, while in women they will further rise as a result of the more recent tobacco epidemic. We cannot however exclude the possibility of an underlying period-based linear trend in the near future, driven by the sharp decrease in the prevalence of smoking and gradual increasing awareness of health hazards of smoking that are supported by the tobacco control laws. The increased taxing and pricing, the most effective measures to reduce tobacco prevalence , have been implemented mainly after 2010. With a further and very recent tax increment (in 2016), cigarette prices have risen by about 29% from 2010 to 2014, indicating a 14% greater increase than seen in global pricing [37,38].
In stratifying the data by histological subtype, adenocarcinoma emerged as the most predominant subtype of lung cancer and exhibited increasing rates across the study periods, consistent with findings from previous international studies , as well as with the common type of cigarettes smoked (e.g. factory–made) in Uruguay [40,41]. Further, although adenocarcinomas increased in both sexes, the proportions were invariably higher among women, possibly because the subtype is the most common type in never-smokers, as well as the fact that women are more likely to smoke reduced yield cigarettes [, , ]. Our data on histological type require caution in their interpretation: they are based on a relatively low proportion of microscopically verified cases (69% among males and 60% among females for the last period), contrasting with a comprehensive international study by Lortet-Tieulent and colleagues that included registries with at least 80% of cases microscopically verified . The decrease in unspecified cancers reported in this study indicates an improvement in data quality, although the histological data are not sufficiently robust to provide insight into the temporal variations in lung cancer incidence rates by subtype. There is therefore an overwhelming need to ensure both the availability of, and access to, high-quality pathology reports [45,46] at the National Cancer Registry of Uruguay, in order to further increase the specificity of morphological diagnoses of lung and other neoplasms.
Conflicts of interest
Acknowledgments This work was undertaken during the tenure of UICC Fellowship to Eng. Rafael Alonso at the International Agency for Research on Cancer (UICC Fellowship ICR-GICR16434469)
Introduction The proportion of Australians aged 65+ years is projected to increase from 16% in 2016 to 22% by 2036, broadly in step with increases for other high-income countries . As older people generally have greater needs for health and community services, this increase has significant implications for cancer and broader health-service delivery .