eISSN: 2450-5722
ISSN: 2450-5927
Journal of Health Inequalities
Current issue Archive Online first About the journal Editorial board Abstracting and indexing Subscription Contact Instructions for authors Ethical standards and procedures
vol. 3
Original paper

Lung cancer mortality decline among middle-aged men and women in Poland and the UK

Witold A. Zatoński
1, 2
Andrzej Tukiendorf
Mateusz Zatoński
Kinga Janik-Koncewicz
Arlen Marciniak
Katarzyna Wijatkowska

Health Promotion Foundation, Nadarzyn, Poland
Medical University, Wrocław, Poland
J Health Inequal 2017; 3 (2): 123-126
Online publish date: 2017/12/30
Article file
- Lung.pdf  [0.09 MB]
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
PlumX metrics:


Europe has historically been the region with the highest smoking prevalence in the world, and the highest rates of smoking-related diseases [1-6]. The epidemic of smoking and lung cancer in Europe had two peaks. The first one was in the 1950s, when smoking prevalence in the UK stood at 80% among men and 25% among women. The second peak came three decades later, when smoking prevalence in Poland reached 73% among men in 1976, and 30% among women in 1982 [7].
In May 2017 an important article was published summarising the changes in smoking prevalence in 195 countries in the last quarter of century (1990-2015) [8]. European Union (EU) member states were among the countries which made the most significant progress in tobacco control in this period [9]. In several of them including Poland and UK tobacco-related disease incidence and mortality was halved [10-13].
The aim of this article is to compare and contrast the lung cancer epidemic among middle-aged (35-54-year-old) men and women in Poland and the UK.

Material and methods

The lung cancer mortality rates are based on the WHO mortality database, Health and statistics information system [10, 14-15]. We estimated change-points and time trends in lung cancer. The analysis was conducted using the ‘segmented’ R package for regression models with break-points and change-points estimation (Version 0.5-3.0 [16]), which allows to identify the chain points in logistic regression, after which regression function is assumed to be continues [17].

Results and discussion

Similarly to the UK half a century prior, towards the end of the 20th century Poland was one of the world leaders in tobacco consumption [7, 10, 12]. In the late 1980s it had the highest recorded smoking prevalence in Europe, and one of the highest levels of lung cancer among men [10, 12-13, 18-21]. The breakthrough came in the 1990s. According to GBD–2015-1 [8] in the years 1990-2015 Poland had one of the fastest smoking prevalence declines among men (1.7% annually) and women (0.9% annually) in Europe. Polish state tobacco statistics [7, 22] show that in this period the sale of cigarettes in Poland fell from 100 bn per annum to around 40 bn. Smoking prevalence among Polish men decreased from 73% to 29%, and among women from 30% to 19%. Lung cancer among men aged 34-54 hit a peak in 1990, and among women in the early 2000s, after which it began to decrease rapidly (see Figure 1).
While the UK can boast with the unquestionable success of bringing down its lung cancer mortality five-fold between the early 1960s and the 2010s [12-13, 23], it must be remembered that the rate of decline in lung cancer mortality among Polish men in the period 1960-2010 was twice faster (see Figures 1 and 2).
Figures 1 and 2 present the lung cancer mortality time trends among middle-aged (35-54-year-old) men and women in Poland and UK from 1960 to 2015. The peak of lung cancer mortality among men in Poland (60/100,000) was significantly higher than in the UK (50/100,000), and it came several decades later – in 1990 in Poland, as opposed to 1960 in the UK. Among women, the lung cancer mortality peak in the UK came in 1971 and in Poland in 2005. Historically, the highest observed lung cancer mortality among women in in this age group in Poland and the UK was at a very similar rate of around 15/100,000. In the period of observation, 1960-2015, the annual decrease in lung cancer mortality was twice faster in Poland than in the UK in both sexes.
Logistic regression analysis estimating change points and time trends in lung cancer in age group 35-54 in men and women in Poland and UK is presented and described in Figure 2.


Two questions emerge from these observations. The first is how important in promoting these developments was the use on a population scale of the cessation drug cytisine in Poland? [24-27]. The second is how to take the next step towards the eradication of smoking-related diseases in countries which have seen so much progress in tobacco control in the last years, such as the UK or Poland?


Authors report no conflict of interest.


1. Kubik AK, Parkin DM, Plesko I, et al. Patterns of cigarette sales and lung cancer mortality in some central and eastern European countries, 1960-1989. Cancer 1995; 75: 2452-2460.
2. Tyczyński J, Zatoński W. Tobacco-related cancers in Poland in 1963-1989. Pol Pop Rev 1993; 3: 95-102.
3. Zatoński WA, Mańczuk M, Powles J, Negri E. Convergence of male and female lung cancer mortality at younger ages in the European Union and Russia. Eur J Pub Health 2007; 17: 450-454.
4. Zatoński W, Didkowska J. Closing the gap: Cancer in Central and Eastern Europe (CEE). Eur J Cancer 2008; 44: 1425-1437.
5. Zatoński W, Mańczuk M. Tobacco smoking and tobacco-related harm in the European Union with special attention to the new EU member states. In: Tobacco Science, Policy and Public Health (2nd ed.). Boyle P, Gray N, Henningfield J, Sefrin J, Zatoński W (eds.). Oxford University Press 2010: 221-240.
6. Zatoński WA, Sulkowska U, Didkowska J. Kilka uwag o epidemiologii nowotworów w Polsce [Few comments on cancer epidemiology in Poland]. Nowotwory J Oncol 2015; 65: 179-196.
7. Zatoński WA, Zatoński M, Janik-Koncewicz K, et al. Hundred years of cigarette smoking in Poland: three phases of the tobacco epidemic. J Health Inequal 2017; 2: 118-123.
8. GBD 2015 Tobacco Collaborators. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 2017; 389: 1885-1906.
9. Ng M, Freeman MK, Fleming TD, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA 2014; 311: 183-192.
10. Zatoński W; the HEM Project team. Closing the health gap in European Union. Cancer Center and Institute of Oncology, Warsaw 2008.
11. Zatoński WA, Bhala N. Changing trends of diseases in Eastern Europe: Clos Public Health 2012; 126: 248-252.
12. Peto R, Lopez A, Boreham J, et al. Mortality from tobacco in developed countries: indirect estimates from national vital statistics. Lancet 1992; 339: 1268-1278.
13. Peto R, Darby S, Deo H, et al. Smoking, smoking cessation and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. Br Med J 2000; 321: 323-329.
14. World Health Organization Mortality Database. Health and statistic information systems, 2014. Available from: http://www. who. int/healthinfo/mortality_data/en/ (accessed: 11 July 2017).
15. Zatoński W, Przewoźniak K (eds). Palenie tytoniu w Polsce: postawy, następstwa zdrowotne i profilaktyka [Tobacco smoking in Poland: attitudes, health consequences and prevention]. 2nd ed. Centrum Onkologii – Instytut im. M. Skłodowskiej-Curie, Warszawa 1999.
16. Muggeo V. Package ‘segmented’. Regression models with break-points/change-points estimation. Version 0.5-3.0; 2017; Available from: https://cran.r-project.org/web/packages/segmented/segmented.pdf (accessed: 12 September 2017).
17. Ahmad Khodadadi A, Asghariany M. Change-point problem and regression: an annotated bibliography. Collection of Biostatistics Research Archive, Paper 44. The Berkeley Electronic Press 2008. Available from: http://biostats.bepress.com/cobra/art44 (accessed: 12 September 2017).
18. Zatoński WA. Powołanie Narodowego Instytutu Onkologii i Hematologii – warunek konieczny do skutecznej walki z rakiem w Polsce [Establishment of the National Institute of Oncology and Hematology - a necessary condition for effective fight against cancer in Poland]. Nowotwory J Oncol 2013; 63: 375-381.
19. Zatoński WA, Zatoński M. Poland’s rapid lung cancer decline in the years 1990-2016. The first step towards the eradication of lung cancer in Poland. Health Probl Civil 2017; 11: 211-225.
20. Doll R. Uncovering the effects of smoking: historical perspective. Stat Methods Med Res 1998; 7: 87-117.
21. Doll R, Peto R, Bjartveit K, et al. Tobacco and death in Eastern Europe. In: Cancer prevention in Europe. Bodmer W, Zaridze D (eds.). Organization of European Cancer Institutes, London 1993: 71-97.
22. Główny Urząd Statystyczny. Rocznik Statystyczny Rzeczypospolitej Polskiej 2016 [Central Statistical Office of Poland. Statistical Yearbook 2016]. Główny Urząd Statystyczny, Warszawa 2016.
23. Peto R, Lopez AD, Pan H, et al. Mortality from smoking in developed countries 1950-2020 (updated September 2015) Available from: http://gas.ctsu.ox.ac.uk/tobacco/index.htm (accessed: 11 February 2017).
24. Zatoński W, Cedzyńska M, et al. An uncontrolled trial of cytisine (Tabex) for smoking cessation. Tob Control 2006; 15: 481-484.
25. West R, Zatoński W, et al. Placebo-controlled trial of cytisine for smoking cessation. NEJM 2011; 365: 1193-1200.
26. Zatoński W, Zatoński M. Cytisine versus nicotine for smoking cessation. New Engl J Med 2014; 372: 1072.
27. Tutka P, Zatoński W. Cytisine for the treatment of nicotine addiction: form a molecule to therapeutic efficacy. Pharmacol Rep 2006; 58: 777-798.

Authors’ contributions

WAZ and MZ prepared the concept and draft of the article. AT prepared calculations. All authors contributed to preparing the final text and figures of the publication.
This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Quick links
© 2023 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.