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As lung cancer mainly occurs above the age of 55, the increase in the cumulative risk is mainly because current smokers aged 5574 in 1950 were less likely to have smoked a substantial number of cigarettes throughout adult life than current smokers in 1990.18 19 Among younger men, however, the death rate from lung cancer decreased more rapidly than the prevalence of smoking (figs 1 and 2), indicating lower death rates from lung cancer in 1990 than 1950 among male cigarette smokers in early middle age

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The potential cause might be the high prevalence of ALDH2*2 allele in East Asians, and the evidence of the carcinogenic effect is strong in esophageal cancer and head and neck cancer 48

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