This report is the result of a collaborative effort from the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries (NAACCR). The report analyzes trends in lung cancer and tobacco from 1975-2005. It was found that incidence and death rates from all cancers combined decreased significantly in most racial and ethnic populations and for both genders. However, lung cancer among women has only leveled off, with prominant state and regional variation. While overall reductions are promising, these geographic disparities underscore the need for strong state tobacco control programs.