Lung cancer is the leading cause of cancer-related death both globally and in China, accounting for roughly 40% of the world's lung cancer deaths in 2022—a disproportionate burden given that China represents about 18% of the global population. Smoking remains pervasive: in 2018, 26.6% of Chinese adults smoked, and 68.1% of non-smokers were exposed to secondhand smoke in public spaces—rates far exceeding global averages. Rapid industrialization, air pollution, and an accelerating shift toward an older population compound the challenge. With the proportion of people aged 60 and older projected to surpass 500 million by 2050, the intersection of an aging demographic and persistent risk-factor exposure demands a closer look at how these forces are shaping lung cancer outcomes. Based on these challenges, an in‑depth investigation into the relative contributions of aging, population growth, and risk factors to lung cancer mortality trends is urgently needed.
Now, researchers from the National Cancer Center (China), Chinese Academy of Medical Sciences and Peking Union Medical College have published (DOI: 10.20892/j.issn.2095-3941.2025.0625) a comprehensive analysis of lung cancer mortality trends in Cancer Biology & Medicine. The team, led by Xin Liang and Xiaoqiu Dai, analyzed data from the China Causes of Death Surveillance Dataset—covering 2.37 billion person‑years across 605 surveillance sites from 2013 to 2021. Using Joinpoint regression, decomposition analysis, and Bayesian age‑period‑cohort modeling, they projected mortality through 2030 and quantified how much of the rising death toll is driven by demographic shifts versus changes in risk.
The study uncovered a striking divergence: between 2013 and 2021, the crude lung cancer mortality rate rose by 2.3% annually, yet the age‑standardized mortality rate (ASMR)—which removes the effect of an aging population—remained stable overall and actually declined by 2.9% per year after 2015. This suggests that prevention and treatment efforts are working, but their impact is being masked by demographic changes. Urban areas saw the sharpest ASMR declines (−2.9% per year), followed by eastern regions (−1.5% per year). The mean age at death from lung cancer increased across all regions, with rural areas showing the fastest rise—men gained roughly 0.27 years annually and women 0.30 years. Decomposition analysis revealed that population aging contributed 32% to 43% of the increase in lung cancer deaths, population growth added 8% to 31%, while changes in risk factors actually reduced deaths by 3% to 29%. By 2030, the projected death toll of 760,200 represents a roughly 16.6% increase compared with 2022, driven almost entirely by aging.
"We're seeing a real paradox," the authors said. "On one hand, the age‑standardized mortality rate is falling—that means our tobacco control efforts, air pollution measures, and screening programs are having a genuine impact. But on the other hand, China's population is aging so rapidly that the total number of lung cancer deaths is still going up. By 2030, we expect roughly 760,000 deaths, and the main reason isn't that risk factors are getting worse—it's that there are simply more older people, and older people are more vulnerable to lung cancer. The challenge now is to make sure our prevention and treatment systems keep pace with this demographic shift, especially in rural and western areas where the gains have been slowest."
The findings carry clear policy implications. First, tobacco control efforts must be intensified in rural and western regions, where smoking rates remain stubbornly high and the benefits of national policies have been slowest to arrive. Second, low‑dose spiral computed tomography screening—already proven to reduce lung cancer mortality—should be expanded to grassroots and rural health facilities, potentially with mobile screening units and artificial intelligence‑assisted interpretation to reduce false positives. Third, as the population ages, China will need a precision prevention and control system tailored to older adults, including regular screening, community‑based health surveillance, and innovative smoking‑cessation programs that pair behavioral support with tangible incentives. Without these measures, the gains achieved through risk‑factor control will continue to be eclipsed by demographic forces.
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References
DOI
10.20892/j.issn.2095-3941.2025.0625
Original Source URL
https://doi.org/10.20892/j.issn.2095-3941.2025.0625
Funding information
This study was supported by Capital's Funds for Health Improvement and Research (Grant No. CFH2024-2G-40214) and the CAMS Innovation Fund for Medical Sciences (Grant No. 2021-I2M-1-011).
About Cancer Biology & Medicine
Cancer Biology & Medicine (CBM) is a peer-reviewed open-access journal sponsored by China Anti-cancer Association (CACA) and Tianjin Medical University Cancer Institute & Hospital. The journal monthly provides innovative and significant information on biological basis of cancer, cancer microenvironment, translational cancer research, and all aspects of clinical cancer research. The journal also publishes significant perspectives on indigenous cancer types in China. The journal is indexed in SCOPUS, MEDLINE and SCI (IF 12.4), with all full texts freely visible to clinicians and researchers all over the world.