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.