Cancer attributable to cigarette smoking by ethnic group in the US in 2022-2023.

BACKGROUND: Smoking patterns vary in the US population. We aimed at estimating the attributable fraction (AF) of smoking-related cancer across racial/ethnic groups. METHODS: To account for ~ 25-year latency period, sex-specific smoking prevalence data from 1994 to 1996 were linked with recent cancer incidence (2022) and mortality (2023) records from the United States Cancer Statistics (USCS) database. Estimates were calculated for Whites, Blacks, Hispanics, Asians/Pacific Islanders and Alaskans/Native Americans. Relative risks for smoking-cancer associations were derived from meta-analyses. The AF and 95% confidence intervals (CI) were calculated for current and former smokers. RESULTS: Lung, laryngeal and oral-pharyngeal cancers exhibited the highest AF for ever smoking in both sexes across all groups. The AF for lung cancer ranged from 65.0% (0.64-0.67) in Asian/Pacific Islander women to 92.0% (0.91-0.92) in Alaskan/Native American men. In men, ever smoking explained 26.4% (23.0-29.3) and 36.7% (33.1-40.0) of total cancer cases and deaths in Alaskan/Native Americans, 23.3% (20.8-25.6) and 32.9% (29.9-35.6) in Whites, 22.1% (19.3-24.6) and 32.6% (29.2-35.8) in Asians/Pacific Islanders, 19.9% (17.6-21.9) and 31.0% (28.1-33.7) in Blacks, 16.2% (13.6-18.7) and 23.5% ( 20.2-26.6) in Hispanics. In women, Alaskan/Native Americans had the highest attributable burden (19.8%, 17.6-21.9 of cases and 28.8%, 26.2-31.4 of deaths), while Asians/Pacific Islanders showed the lowest (7.7%, 6.9-8.6 and 10.9%, 9.7-12.2). CONCLUSIONS: Past smoking remains a major cause of current cancer disparities in the US. The burden is disproportionately high among Alaskan/Native Americans. Similarities between Whites and Blacks suggest that cancer disparities are driven not by an isolated smoking habit but to other unmeasured factors. Our findings underscore the critical need for culturally tailored smoking cessation strategies to mitigate cancer disparities.