The future burden of lung cancer attributable to current modifiable behaviours: A pooled study of seven Australian cohorts

Maarit A. Laaksonen, Karen Canfell, Robert MacInnis, Maria E. Arriaga, Emily Banks, Dianna J. Magliano, Graham G. Giles, Robert G. Cumming, Julie E. Byles, Paul Mitchell, Tiffany Gill, Vasant Hirani, Susan McCullough, Jonathan E. Shaw, Anne W. Taylor, Barbara Ann Adelstein, Claire M. Vajdic

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Background: Knowledge of preventable disease and differences in disease burden can inform public health action to improve health and health equity. We quantified the future lung cancer burden preventable by behavioural modifications across Australia. Methods: We pooled seven Australian cohort studies (n = 367 058) and linked them to national registries to identify lung cancers and deaths. We estimated population attributable fractions and their 95% confidence intervals (CIs) for modifiable risk factors, using risk estimates from the cohort data and risk factor exposure distribution from contemporary national health surveys. Results: During the first 10-year follow-up, there were 2025 incident lung cancers and 20 349 deaths. Stopping current smoking could prevent 53.7% (95% CI, 50.0-57.2%) of lung cancers over 40 years and 18.3% (11.0-25.1%) in 10 years. The smoking-Attributable burden is highest in males, those who smoke <20 cigarettes per day, are <75 years of age, unmarried, of lower educational attainment, live in remote areas or are healthy weight. Increasing physical activity and fruit consumption, if causal, could prevent 15.6% (6.9-23.4%) and 7.5% (1.3-13.3%) of the lung cancer burden, respectively. Jointly, the three behaviour modifications could prevent up to 63.0% (58.0-67.5%) of lung cancers in 40 years, and 31.2% (20.9-40.1%) or 43 300 cancers in 10 years. The preventable burden is highest among those with multiple risk factors. Conclusions: Smoking remains responsible for the highest burden of lung cancer in Australia. The uneven burden distribution distinguishes subgroups that could benefit the most from activities to control the world's deadliest cancer.

Original languageEnglish
Pages (from-to)1772-1783
Number of pages12
JournalInternational Journal of Epidemiology
Issue number6
Publication statusPublished or Issued - 1 Dec 2018


  • Cancer burden
  • cohort studies
  • lung cancer
  • population attributable fraction
  • risk factors
  • risk groups

ASJC Scopus subject areas

  • Epidemiology

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