Lung cancer incidence and mortality, primary and secondary prevention: Where are we?

The incidence and mortality of lung cancer (LC) have shown significant trends in recent decades, with marked differences in gender patterns. This study is based on a literature review, analysis of trends in LC incidence and mortality, and evaluation of health-educational measures for smoking prevention in the Mačva District (MD) and Central Serbia (CS). Data were obtained from the Serbian Cancer Registry (2003-2022) and the Health-Educational Activity Protocol of the Institute of Public Health Šabac (2007-2019). The first part includes a literature review (Web of Science, PubMed, Google Scholar) using key terms such as "lung cancer", "incidence", "mortality", "smoking" and "prevention". The second part utilizes data from the Serbian Cancer Registry, analysed using standardized incidence and mortality rates (the Segi-Doll methodology). The third part evaluates health-educational activities in MD. Trends were examined using descriptive statistics and linear trend analysis, with comparisons conducted using Student's t-test for independent samples. The average incidence and mortality rates of LC in MD for the period 2003-2022 were 63.8 and 52.6/100,000 in men, and 19.3 and 15.4/100,000 in women. The male-to-female ratio in incidence decreased from 4.5 (2003) to 2.6 (2022), and in mortality from 3.2 to 2.3. In CS, from 2000 to 2019, the average incidence and mortality rates in men were 63.5 and 50.0/100,000, and in women, 20.7 and 16.1/100,000. The male-to-female ratio in incidence decreased from 3.8 to 2.6, and in mortality from 3.3 to 2.4. The annual incidence increase in women was 3.1% in MD (R²=0.64) and 2.8% in CS (R²=0.78), while mortality increased by 0.9% in MD (R²=0.64) and 1.7% in CS (R²=0.68). In MD, incidence and mortality in men slightly decreased by 0.6% per year, while in CS, incidence stagnated, and mortality decreased by 0.8% per year. The differences in rates between MD and CS were not statistically significant. Preventive measures covered 25,150 individuals, with coverage increasing by 8.3% per year (R²=0.69), but activities were suspended during the COVID-19 pandemic. LC incidence and mortality have decreased in men but continue to rise in women. Decreasing smoking prevalence and implementing LDCT screening are crucial.