Trends in lung cancer incidence by sex, age, tumour stage, and histological subtype in Bavaria, 2006–2023: A registry-based study

BACKGROUND: Lung cancer is the leading cancer worldwide. We aimed to describe recent trends of lung cancer incidence in males and females in Bavaria, Germany, stratified by age, tumour stage, and histological subtype. METHODS: We retrieved 116,087 incident lung cancer cases from the population-based Bavarian Cancer Registry from 2006 to 2023 and calculated age-standardised incidence rates (ASR) per 100,000 by sex, age, tumour stage (Union of International Cancer Control (UICC) I, II, III, IV) and histological subtype. We performed Joinpoint regression analysis to estimate short- and long-term trends in lung cancer incidence based on annual percent change (APC) and average annual percent change (AAPC) with respective 95% confidence intervals (CI). Missing data on stage and histology were addressed using multiple imputation. RESULTS: Between 2006 and 2023, ASRs of lung cancer in males continuously decreased from 53.0 to 36.4 (AAPC: -2.2 [95% CI: -2.5, -1.9]), while they increased in females from 19.1 to 25.6 (AAPC: 1.4 [95% CI: 1.0, 1.8]) and reached a plateau after 2017 (APC 2006-2017: 2.4 [95% CI: 1.9, 3.4]; 2017-2023: -0.3 [95% CI: -2.6, 0.8]). Among males, declines in ASRs were observed for most tumour stages, especially for stage IV tumours. For females, ASR increased for earlier tumour stages, but not for stage IV. Adenocarcinoma was the most common subtype throughout the study period for both sexes. CONCLUSION: Sex-specific incidence trends of lung cancer varied by tumour stage and histological subtype. The plateau reached among females in 2017 suggests beginning trend reversal.