Increasing lung cancer incidence among Israeli Arab men reflects a change in the earlier paradox of low incidence and high smoking prevalence.

Lung cancer in Israel has previously appeared to be less common than expected, relative to the prevalence of smoking. The objective is to examine trends in lung cancer rates and smoking prevalence in Israeli Arab and Jewish men compared with the United States. Age-adjusted lung cancer incidence and mortality rates in Israel were calculated for 1980-2004 using the National Cancer Registry, and compared with the United States' rates, on the basis of the Surveillance Epidemiology and End Results program. Smoking rates were obtained from national surveys carried out during the years 1970-2004. During the period 1980-2004, among Israeli Arab men, there was an increase in lung cancer incidence rates, particularly during 1990-2004, when they increased by 17.8%. During the latter period, the incidence of lung cancer among Israeli Jewish men and men in the United States declined by 5.2 and 22.8%, respectively. In 2003-2004, the age-adjusted smoking rates were 41.3 and 31.6% among Israeli Arab and Jewish men, respectively, and past smoking habits reflect higher rates among Arab men over the past three decades. The marked increase in the incidence of lung cancer among Israeli Arab men during the last decade, without any evidence of increased smoking prevalence, might reflect a gradual loss of some apparent protection in this subpopulation. The possible explanations are changes in lifestyle, particularly in dietary habits.