Cancer Death Epidemics in United States Black Males: Evaluating Courses, Causation, and Cures

Background: Estimates that smoking contributes 38-72% of the United States (US) Black male cancer death rate leave a wide range of uncertainty. This paper uses additional and regional data, and refined methods, to reassess that range.

Methods: This study uses lung cancer rates as an exposure index, linear regression, age adjusted US 1950-2001 and US regional 1969-2001 death rates (rates), and the formula: smoking-attributable fraction (SAF)=(1-((rate in the unexposed) / (rate in the exposed))). Estimated lung cancer rates in the unexposed range between rates predicted for a population with no smoking-attributable lung cancers to rates seen in "nonsmokers."

Results: Lung cancer death rates predicted 99.9% and 99.8% of the variances in non-lung non-stomach cancer death rates from 1950-1980 and 1950-1988, respectively (each P<0.0001). That suggests 2001 all-sites cancer death SAFs of 63% (sensitivity range 60-66%) nationally and from 43% in the Northeast to 67% in the South.

Conclusions: Smoking may cause most premature cancer deaths and temporal and regional cancer death rate disparities in Black men.