Effect of cigarette smoking on major histological types of lung cancer: a meta-analysis

A phase 2 study of irinotecan, cisplatin, and simvastatin for untreated extensive-disease small cell lung cancer

BACKGROUND

The objective of this study was to investigate the efficacy of simvastatin in combination with irinotecan and cisplatin in chemotherapy-naive patients with extensive-disease small-cell lung cancer (ED-SCLC).

METHODS

In this phase 2 study, 61 patients received treatment with irinotecan (65 mg/m(2) ) and cisplatin (30 mg/m(2) ) on Days 1 and 8 every 3 weeks until either death or disease progression occurred. Patients also received oral simvastatin (40 mg daily) during the course of chemotherapy. The primary endpoint was 1-year survival. Secondary endpoints included the response rate (RR), progression-free survival (PFS), and toxicity.

RESULTS

The 1-year survival rate was 39.3%. The median overall survival (OS) was 11 months, and the median PFS was 6.1 months. Overall, the RR was 75%. The most common grade 3/4 toxicity was neutropenia (67%). Efficacy of the treatment was associated significantly with smoking status. Compared with never-smokers, ever-smokers had a better RR (40% vs 78%; P = .01), a longer PFS (2.5 months vs 6.4 months; P = .018), and had a trend toward an improved OS (9.0 months vs 11.2 months; P = .095). The effect of smoking on survival was apparent when ever-smokers were subdivided according to pack-years (PY) of smoking. Ever-smokers who had smoked >65 PY had a significantly longer OS compared with ever-smokers who had smoked ≤65 PY or never-smokers (20.6 months vs 10.6 months vs 9.0 months, respectively; log-rank P = 0.032). In multivariate analysis, PY >65 was predictive of longer survival (hazard ratio, 0.280; 95% confidence interval, 0.113-0.694).

CONCLUSIONS

The current results indicated that simvastatin in combination with irinotecan and cisplatin did not improve the survival of patients with ED-SCLC. Although the subgroup analysis by smoking status was exploratory, the addition of simvastatin to irinotecan and cisplatin may improve the outcome of heavy smokers with ED-SCLC.

Occupational toxicology of asbestos-related malignancies

INTRODUCTION

Asbestos is banned in most Western countries but related malignancies are still of clinical concern because of their long latencies. This review identifies and addresses some controversial occupational and clinical aspects of asbestos-related malignancies.

METHODS

Papers published in English from 1980 to 2009 were retrieved from PubMed. A total of 307 original articles were identified and 159 were included.

ASSESSMENT OF EXPOSURE

The retrospective assessment of exposure is usually performed by using questionnaires and job exposure matrices and by careful collection of medical history. In this way crucial information about manufacturing processes and specific jobs can be obtained. In addition, fibers and asbestos bodies are counted in lung tissue, broncho-alveolar lavage, and sputum, but different techniques and interlaboratory variability hamper the interpretation of reported measurements. SCREENING FOR MALIGNANCIES: The effectiveness of low-dose chest CT screening in exposed workers is debatable. Several biomarkers have also been considered to screen individuals at risk for lung cancer and mesothelioma but reliable signatures are still missing. ATTRIBUTION OF LUNG CANCER: Exposures correlating with lung cancer are high and in the same range where asbestosis occurs. However, the unresolved question is whether the presence of fibrosis is a requirement for the attribution of lung cancer to asbestos. The etiology of lung cancer is difficult to define in cases of low-level asbestos exposure and concurrent smoking habits. MESOTHELIOMA: The diagnosis of malignant mesothelioma may also be difficult, because of procedures in sampling, fixation, and processing, and uses of immunohistochemical probes.

CONCLUSIONS

Assessment of exposure is crucial and requires accurate medical and occupational histories. Quantitative analysis of asbestos body burden is better performed in digested lung tissues by counting asbestos bodies by light microscopy and/or uncoated fibers by transmission electron microscopy. The benefits of screenings for asbestos-related malignancies are equivocal. The attribution of lung cancer to asbestos exposure is difficult in a clinical setting because of the need to assess asbestos body burden and the fact that virtually all these patients are also tobacco smokers or former smokers. Given the premise that asbestosis is necessary to causally link lung cancer to asbestos, it follows that the assessment of both lung fibrosis and asbestos body burden is necessary.

Variety in fruit and vegetable consumption and the risk of lung cancer in the European prospective investigation into cancer and nutrition

BACKGROUND

We investigated whether a varied consumption of vegetables and fruits is associated with lower lung cancer risk in the European Prospective Investigation into Cancer and Nutrition study.

METHODS

After a mean follow-up of 8.7 years, 1,613 of 452,187 participants with complete information were diagnosed with lung cancer. Diet diversity scores (DDS) were used to quantify the variety in fruit and vegetable consumption. Multivariable proportional hazards models were used to assess the associations between DDS and lung cancer risk. All models were adjusted for smoking behavior and the total consumption of fruit and vegetables.

RESULTS

With increasing variety in vegetable subgroups, risk of lung cancer decreases [hazard ratios (HR), 0.77; 95% confidence interval (CI), 0.64-0.94 highest versus lowest quartile; P trend = 0.02]. This inverse association is restricted to current smokers (HR, 0.73; 95% CI, 0.57-0.93 highest versus lowest quartile; P trend = 0.03). In continuous analyses, in current smokers, lower risks were observed for squamous cell carcinomas with more variety in fruit and vegetable products combined (HR/two products, 0.88; 95% CI, 0.82-0.95), vegetable subgroups (HR/subgroup, 0.88; 95% CI, 0.79-0.97), vegetable products (HR/two products, 0.87; 95% CI, 0.79-0.96), and fruit products (HR/two products, 0.84; 95% CI, 0.72-0.97).

CONCLUSION

Variety in vegetable consumption was inversely associated with lung cancer risk among current smokers. Risk of squamous cell carcinomas was reduced with increasing variety in fruit and/or vegetable consumption, which was mainly driven by the effect in current smokers.

IMPACT

Independent from quantity of consumption, variety in fruit and vegetable consumption may decrease lung cancer risk.

Fruits and vegetables consumption and the risk of histological subtypes of lung cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Objective

To examine the association between fruit and vegetable consumption and risk of different histological subtypes of lung cancer among participants of the European Prospective Investigation into Cancer and Nutrition study.

Methods

Multivariable Cox proportional hazard models were used to analyze the data. A calibration study in a subsample was used to reduce dietary measurement errors.

Results

During a mean follow-up of 8.7 years, 1,830 incident cases of lung cancer (574 adenocarcinoma, 286 small cell, 137 large cell, 363 squamous cell, 470 other histologies) were identified. In line with our previous conclusions, we found that after calibration a 100 g/day increase in fruit and vegetables consumption was associated with a reduced lung cancer risk (HR 0.94; 95% CI 0.89–0.99). This was also seen among current smokers (HR 0.93; 95% CI 0.90–0.97). Risks of squamous cell carcinomas in current smokers were reduced for an increase of 100 g/day of fruit and vegetables combined (HR 0.85; 95% CI 0.76–0.94), while no clear effects were seen for the other histological subtypes.

Conclusion

We observed inverse associations between the consumption of vegetables and fruits and risk of lung cancer without a clear effect on specific histological subtypes of lung cancer. In current smokers, consumption of vegetables and fruits may reduce lung cancer risk, in particular the risk of squamous cell carcinomas.

Cruciferous vegetable intake is inversely associated with lung cancer risk among smokers: a case-control study

Background

Inverse associations between cruciferous vegetable intake and lung cancer risk have been consistently reported. However, associations within smoking status subgroups have not been consistently addressed.

Methods

We conducted a hospital-based case-control study with lung cancer cases and controls matched on smoking status, and further adjusted for smoking status, duration, and intensity in the multivariate models. A total of 948 cases and 1743 controls were included in the analysis.

Results

Inverse linear trends were observed between intake of fruits, total vegetables, and cruciferous vegetables and risk of lung cancer (ORs ranged from 0.53-0.70, with P for trend < 0.05). Interestingly, significant associations were observed for intake of fruits and total vegetables with lung cancer among never smokers. Conversely, significant inverse associations with cruciferous vegetable intake were observed primarily among smokers, in particular former smokers, although significant interactions were not detected between smoking and intake of any food group. Of four lung cancer histological subtypes, significant inverse associations were observed primarily among patients with squamous or small cell carcinoma - the two subtypes more strongly associated with heavy smoking.

Conclusions

Our findings are consistent with the smoking-related carcinogen-modulating effect of isothiocyanates, a group of phytochemicals uniquely present in cruciferous vegetables. Our data support consumption of a diet rich in cruciferous vegetables may reduce the risk of lung cancer among smokers.

Epidemiology of smoking in Hungary – a national representative study

Tanulmányunkban áttekintjük a magyar felnőtt lakosság körében készült, a dohányzás prevalenciáját becslő országos reprezentatív felméréseket. Célkitűzés: Az Országos lakossági adatfelvétel az addiktológiai problémákról (OLAAP) felmérés dohányzásra vonatkozó eredményeinek bemutatása, valamint ezek összevetése a korábbi vizsgálatok eredményeivel. Módszer: A kutatás célpopulációja a 18–64 éves magyarországi népesség. A nettó minta nagysága 2710 fő volt. Az adatfelvétel részben személyes kérdezéssel, részben önkitöltős módszerrel történt. Eredmények: A magyar felnőtt lakosság 36,1%-a dohányzik (29,9%-a napi rendszerességgel). A nemi arányokat tekintve a férfiak 40,6%-a, míg a nők 31,7%-a dohányos (a napi dohányosok aránya nemek szerint 34,6%, illetve 25,3%). A dohányzás szempontjából kockázati tényezőként azonosítható a férfi nem, az alacsonyabb életkor, az alacsonyabb iskolai végzettség, a kedvezőtlenebb szocioökonómiai státus, valamint a szülők dohányzása. Következtetések: Eredményeink a korábbi évek heterogén eredményei közül a magasabb dohányzási prevalenciákat támasztják alá, illetve enyhe mértékű növekedést feltételeznek, amiért a dohányzás nők körében történt emelkedése felelős. A férfiak esetében stagnálás figyelhető meg.

Alcohol consumption and lung cancer risk in the Environment and Genetics in Lung Cancer Etiology (EAGLE) study

The authors investigated the relation between alcohol consumption and lung cancer risk in the Environment and Genetics in Lung Cancer Etiology (EAGLE) Study, a population-based case-control study. Between 2002 and 2005, 2,100 patients with primary lung cancer were recruited from 13 hospitals within the Lombardy region of Italy and were frequency-matched on sex, area of residence, and age to 2,120 randomly selected controls. Alcohol consumption during adulthood was assessed in 1,855 cases and 2,065 controls. Data on lifetime tobacco smoking, diet, education, and anthropometric measures were collected. Adjusted odds ratios and 95% confidence intervals for categories of mean daily ethanol intake were calculated using unconditional logistic regression. Overall, both nondrinkers (odds ratio = 1.42, 95% confidence interval: 1.03, 2.01) and very heavy drinkers (>/=60 g/day; odds ratio = 1.44, 95% confidence interval: 1.01, 2.07) were at significantly greater risk than very light drinkers (0.1-4.9 g/day). The alcohol effect was modified by smoking behavior, with no excess risk being observed in never smokers. In summary, heavy alcohol consumption was a risk factor for lung cancer among smokers in this study. Although residual confounding by tobacco smoking cannot be ruled out, this finding may reflect interplay between alcohol and smoking, emphasizing the need for preventive measures.

Physical activity and lung cancer prevention

Since lung cancer is among the cancers with the highest incidence and has the highest mortality rate of cancer worldwide, the means of reducing its impact are urgently needed. Emerging evidence shows that physical activity plays an etiological role in lung cancer risk reduction. The majority of studies support the fact that total and recreational physical activity reduces lung cancer risk by 20-30% for women and 20-50% for men, and there is evidence of a dose-response effect. The biological mechanisms operating between physical activity and lung cancer are likely complex and influenced by many factors including inherited or acquired susceptibility genes, gender, smoking, and other environmental factors. Several plausible biological factors and mechanisms have been hypothesized linking physical activity to reduced lung cancer risk including: improved pulmonary function, reduced concentrations of carcinogenic agents in the lungs, enhanced immune function, reduced inflammation, enhanced DNA repair capacity, changes in growth factor levels and possible gene-physical activity interactions. Future research should target the possible subgroup effects and the biologic mechanisms that may be involved.

Population-based trends in lung cancer incidence in women

Lung cancer is the leading cause of cancer mortality in women worldwide. Although the rise and growing epidemic status of lung cancer are overwhelmingly attributed to tobacco use, its rank in nonsmokers as the seventh most common cause of cancer worldwide suggests that other factors contribute to this disease. The majority of lung cancers among nonsmokers occur in women. Aside from geographic, cultural, and genetic differences, hormonal and possibly infectious factors also may play etiologic roles. This review aims to discuss the epidemiology of lung cancer in women, as well as the incidence of second primaries, and presents current opinions on the myriad of causes.

Cancer incidence in Israeli Jewish survivors of World War II

BACKGROUND

Israeli Jews of European origin have high incidence rates of all cancers, and many of them were exposed to severe famine and stress during World War II. We assessed cancer incidence in Israeli Jewish survivors of World War II.

METHODS

Cancer rates were compared in a cohort of 315 544 Israeli Jews who were born in Europe and immigrated to Israel before or during World War II (nonexposed group, n = 57 496) or after World War II and up to 1989 (the exposed group, ie, those potentially exposed to the Holocaust, n = 258 048). Because no individual data were available on actual Holocaust exposure, we based exposure on the immigration date for European-born Israeli Jews and decided against use of the term "Holocaust survivors," implying a known, direct individual Holocaust exposure. Cancer incidences were obtained from the Israel National Cancer Registry. Relative risk (RR) estimates and 95% confidence intervals (95% CIs) were calculated for all cancer sites and for specific cancer sites, stratified by sex and birth cohort, and adjusted for time period.

RESULTS

The nonexposed group contributed 908 436 person-years of follow-up, with 13 237 cancer diagnoses (crude rate per 100 000 person-years = 1457.1). The exposed group contributed 4 011 264 person-years of follow-up, with 56 060 cancer diagnoses (crude rate per 100 000 person-years = 1397.6). Exposure, compared with nonexposure, was associated with a statistically significantly increased risk for all-site cancer for all birth cohorts and for both sexes. The strongest associations between exposure and all-site cancer risk were observed in the youngest birth cohort of 1940-1945 (for men, RR = 3.50, 95% CI = 2.17 to 5.65; for women, RR = 2.33, 95% CI = 1.69 to 3.21). Excess risk was pronounced for breast cancer in the 1940-1945 birth cohort (RR = 2.44, 95% CI = 1.46 to 4.06) and for colorectal cancer in the 1935-1939 cohort (for men, RR = 1.75, 95% CI = 1.19 to 2.59; for women, RR = 1.93, 95% CI = 1.25 to 3.00).

CONCLUSIONS

Incidence of all cancers, particularly breast and colorectal cancer, was higher among Israeli Jews who were potentially exposed to the Holocaust than among those who were not.

Interactive effect of cigarette smoking with human 8-oxoguanine DNA N-glycosylase 1 (hOGG1) polymorphisms on the risk of lung cancer: a case-control study in Taiwan

Human 8-oxoguanine DNA N-glycosylase 1 (hOGG1) plays an important role in repairing oxidative DNA damage induced by tobacco carcinogens. In this case-control study, the authors examined the interactive effect of hOGG1 gene polymorphisms and cigarette smoking on the risk of lung cancer in Taiwan. A total of 1,096 cases and 1,007 controls were enrolled from 6 medical centers in Taiwan during 2002-2004. hOGG1 Ser326Cys genetic polymorphisms were determined using the MassARRAY system (SEQUENOM, Inc., San Diego, California). Tobacco smoking history was obtained through personal interview according to a structured questionnaire. Logistic regression analysis was used to estimate multivariate-adjusted odds ratios and 95% confidence intervals. The odds of developing lung cancer for persons with the Cys/Cys genotype versus the Ser/Ser genotype were 1.11 (95% confidence interval (CI): 0.74, 1.65) for never smokers, 1.45 (95% CI: 0.74, 2.83) for moderate smokers, and 3.52 (95% CI: 1.54, 8.06) for heavy smokers. The P value for interaction in the logistic model was 0.01. The increased risk associated with the Cys/Cys genotype among heavy smokers remained statistically significant for various histologic types of lung cancer, including adenocarcinoma, squamous cell carcinoma, and small cell carcinoma. The authors conclude that there was a noticeable modifying effect on the association between hOGG1 genotype and lung cancer risk by cigarette smoking status.

Cigarette smoking and K-ras mutations in pancreas, lung and colorectal adenocarcinomas: etiopathogenic similarities, differences and paradoxes

Surprisingly different frequencies and patterns of K-ras mutations are observed in human adenocarcinomas of the pancreas, colorectum and lung. Their respective relationships with smoking are apparently paradoxical. We evaluated all the available types of clinical and epidemiological studies on the relationship between tobacco smoking and the occurrence of K-ras mutations in human adenocarcinomas of the pancreas, colorectum and lung. We identified 8, 7 and 12 studies that analyzed the relationship between K-ras mutations and tobacco smoking in human neoplasms of the pancreas, colorectum and lung, respectively. A meta-analysis was undertaken for each site separately. In pancreatic adenocarcinomas lifetime history of tobacco consumption was not significantly associated with the frequency of K-ras mutations (OR=1.26; 95% CI=0.82-1.94). Similarly, no association was observed between smoking and K-ras mutations in colorectal adenocarcinomas (OR=0.94; CI=0.79-1.12), neither when colorectal adenomas and adenocarcinomas were jointly analyzed (OR=0.96; 95% CI=0.83-1.13). In lung adenocarcinoma, where only 15-25% of cases harbor a K-ras mutation, tumors from smokers were more likely to have K-ras mutations than tumors from non-smokers (OR=3.67; 95% CI=2.47-5.45). Furthermore, in lung adenocarcinomas K-ras mutations have a pattern different from that in pancreatic and colorectal adenocarcinomas. Results support the hypothesis that smoking influences the risk of pancreatic cancer - and possibly colorectal cancer - through events other than K-ras mutations. In adenocarcinoma of the lung, smoking may play a role in the occurrence of K-ras mutations. If the influence of tobacco products in the induction, acquisition and persistence of K-ras mutations had some tissue specificity, or was dependent on different factors in different organs, the corresponding mechanisms would deserve detailed research.

[Female lung cancer trends, staging and histology in Hérault, France]

BACKGROUND

In France, lung cancer is the third most common cancer and the third leading cause of cancer death in women. The main objective of this study is to analyse specificities of lung cancer in the female population in an administrative district in France, focusing on histology, staging and trends over time.

METHODS

Incidence data from 1987 to 2004 were extracted from the Hérault cancer registry. The variables of interest considered at diagnosis were stage, histology and age. Mortality data were extracted from the CépiDc-Inserm database for the same period.

RESULTS

Among the 6,650 patients studied, 16.8% were women. 18.3% of whom were aged less than 50 at diagnosis, (9.9% of men, p<0.001). Lung cancer incidence is increasing in the female population (+6.4% per year) as well as lung cancer mortality (+3.5% per year). This occurred faster for adenocarcinoma, young women and stages III-IV.

CONCLUSION

This population-based study confirmed the specific features of lung cancer in women: younger age at diagnosis, adenocarcinoma and stage at diagnosis with poor prognosis. These results raise the question of possible differences to lung cancer susceptibility between males and females.

Relationships between lung adenocarcinoma and gender, age, smoking and occupational risk factors: A case-case study

BACKGROUND

The hypothesis that some risk factors for lung cancer may have more specific associations with particular histologic types remains controversial. The aim of this study was to investigate possible associations between adenocarcinoma and gender, age, smoking characteristics and selected occupational carcinogens in relation to other histologic types.

METHODS

This study included all histologically confirmed lung cancer cases diagnosed consecutively in two French University hospitals from 1997 to 2006. All medical data were obtained by face-to-face patient interviews. Occupational carcinogen exposures of each patient were assessed by an industrial hygienist. Relationships between risk factors and adenocarcinoma were analyzed by case-case comparisons using unconditional logistic regressions (ULRs).

RESULTS

A total of 1493 subjects were enrolled in this study, comprising 1303 men (87.3%), 67 nonsmokers (4.5%) and 489 adenocarcinomas (32.7%). Using ULR, no associations were observed between adenocarcinoma and age, gender or smoking characteristics except for a negative relationship with smoking duration (p<0.0001). Significant associations were observed between ADC and exposure to welding fumes and silica in the whole population and with polycyclic aromatic hydrocarbons in ever smokers.

CONCLUSION

This study demonstrated that some risk factors, such as duration of smoking and certain occupational exposures but not gender or age, have a more important influence on the incidence of lung ADC than on other histologic types. As the distribution of histologic types may reflect underlying biological mechanisms, these findings also suggest that lung carcinogenesis pathways should be studied in relation to smoking duration and other lung cancer risk factors.

Pulmonary preneoplasia--sequential molecular carcinogenetic events

Bronchial and bronchioloalveolar carcinogenesis is a multicentric and multistep process, leading to a sequential accumulation of molecular and genetic abnormalities, mainly due to exposure to tobacco carcinogens. Concomitantly, a series of morphological alterations of normal bronchial or bronchioloalveolar epithelium occur, resulting in preneoplastic and then neoplastic lesions. The three pulmonary preneoplastic changes recognized to date in the lung include bronchial squamous dysplasia and in situ carcinoma, preceding invasive squamous cell carcinoma and basaloid carcinoma, atypical adenomatous hyperplasia, a preneoplastic condition of bronchioloalveolar carcinoma, and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia, a proposed precursor for carcinoid tumours. Although the gradual accumulation of molecular alterations has been widely investigated in bronchial carcinogenesis, with the aim of determining new biomarkers for early lung cancer detection in high-risk patients and targeted chemoprevention, lung adenocarcinoma pathogenesis has been only recently highlighted, with the recent discovery of epidermal growth factor receptor mutation pathway in non-smokers. This review focuses on the current status of molecular pathology in lung cancer and pulmonary preneoplastic conditions.

CYP1A2 genetic polymorphisms and adenocarcinoma lung cancer risk in the Tunisian population

AIMS

In this study, the effects of four single nucleotide polymorphisms (SNPs), -3860G>A, -2467delT, -739T>G and -163C>A, of CYP1A2 gene on lung cancer were evaluated in Tunisian population.

MAIN METHODS

Four polymorphisms of CYP1A2 gene were analysed in 109 healthy smokers and in 101 lung cancer cases, including 63 with squamous cell carcinoma (SCC) and 41 with adenocarcinoma (AD). The genotyping for the SNPs -3860 G>A, -2467delT, -739T>G and -163C>A was performed by polymerase chain reaction (PCR)-restriction fragment length polymorphism analysis.

KEY FINDINGS

The results showed that smokers with CYP1A2 gene polymorphisms were associated with an increased risk for the development of lung AD. There was however no significant increased risk of developing lung SCC in smokers having CYP1A2 gene polymorphisms. An increased risk of developing AD was observed in smokers who are carriers of at least one copy of -3680A or -739G giving a significant odds ratio (OR) of 6.02 (CI=2.91-12.9) and 3.01 (CI=1.54-5.98), respectively.

SIGNIFICANCE

These genotyping data are consistent with the hypothesis that tobacco-specific-N-nitrosamines (TSN) such as 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) are major contributors to the development of lung AD and that CYP1A2 gene product plays an important role in the metabolic activation of NNK. This study suggests that SNPs of CYP1A2 could be considered as promising biomarkers in the aetiology of lung AD in smokers.

Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity

BACKGROUND

: We investigated whether independent prognostic factors for overall survival (OS) in non-small cell lung cancer such as ethnicity, smoking history, socioeconomic, and marital statuses are also applicable to extensive stage small cell lung cancer (ED-SCLC).

METHODS

: SCLC patients diagnosed from 1991 to 2005 from 3 Southern California counties were identified. Prognostic factors for ED-SCLC patients were evaluated by univariate and multivariate analysis.

RESULTS

: Of the 4782 SCLC patients analyzed, only 2.5% of the patients were never-smokers and 71.7% of patients presented with ED-SCLC. By multivariate analysis, a positive smoking status was a statistically significant poor prognostic factor for OS in ED-SCLC patients (versus never-smoker; hazard ratio [HR] = 1.310; p = 0.0125), in addition low socioeconomic status (SES) (from the lowest to the highest SES score; ptrend = 0.0128) and being unmarried (versus married; HR = 1.179; p < 0.0001). Asian ethnicity was a favorable prognostic factor in ED-SCLC (versus Caucasian; HR = 0.785; p = 0.0076). Female gender was another independent favorable prognostic factor (versus male; HR = 0.823; p < 0.0001).

CONCLUSIONS

: A positive history of smoking, low SES, and being unmarried are independent unfavorable prognostic factors for OS in ED-SCLC while Asian ethnicity and female gender are independent favorable prognostic factors for OS in ED-SCLC by multivariate analysis.

Is cancer triggered by altered signalling of nicotinic acetylcholine receptors?

Nicotinic acetylcholine receptors (nAChRs) are the central regulators of stimulatory and inhibitory neurotransmitters that control the synthesis and release of growth, angiogenic and neurotrophic factors in cancer cells, the cancer microenvironment and distant organs. Data discussed in this Review suggests that smoking and possibly other environmental and lifestyle factors increase the function of nAChRs that stimulate cancer cells and reduce the function of nAChRs that inhibit cancer cells. This novel paradigm necessitates the development of marker-guided cancer intervention strategies that aim to restore the balance between nAChR-mediated stimulatory and inhibitory neurotransmitters and their downstream effectors.

Prospective study of physical activity and lung cancer by histologic type in current, former, and never smokers

Increased physical activity has been associated with decreased lung cancer risk. However, no previous investigation has examined physical activity in relation to lung cancer histologic types by smoking status. The authors investigated these relations in the National Institutes of Health-AARP Diet and Health Study among 501,148 men and women aged 50-71 years at baseline in 1995-1996. During follow-up to 2003, 6,745 lung carcinomas occurred (14.8% small cell, 40.3% adenocarcinoma, 19.7% squamous cell, 6.1% undifferentiated large cell, 7.2% non-small cell not otherwise specified, and 11.8% carcinoma not otherwise specified). Among former smokers, the multivariate relative risks of small cell, adenocarcinoma, squamous cell, and undifferentiated large cell carcinomas comparing the highest with the lowest activity level (> or =5 times/week vs. inactive) were 0.93 (95% confidence interval (CI): 0.67, 1.28), 0.79 (95% CI: 0.67, 0.94), 0.73 (95% CI: 0.57, 0.93), and 0.61 (95% CI: 0.38, 0.98), respectively. Among current smokers, corresponding values were 0.77 (95% CI: 0.58, 1.02), 0.76 (95% CI: 0.61, 0.95), 0.85 (95% CI: 0.65, 1.11), and 1.10 (95% CI: 0.69, 1.78). In contrast, physical activity was unrelated to lung carcinoma among never smokers (P(interaction) between physical activity and smoking for total lung carcinomas = 0.002). The inverse findings among former and current smokers in combination with the null results for physical activity among never smokers may point toward residual confounding by cigarette smoking as an explanation for the relations observed.

Association of single nucleotide polymorphisms in PIM-1 gene with the risk of Korean lung cancer

PURPOSE

The expression of the PIM-1 gene, which is a proto-oncogene that encodes a serine/threonine kinase, is associated with multiple cellular functions such as proliferation, differentiation, apoptosis and tumorigenesis. In particular, several studies have reported that the PIM-1 gene is associated with the development of lymphoma, leukemia and prostate cancer. Therefore, this study was conducted to evaluate the association between the single nucleotide polymorphisms in the PIM-1 gene and the risk of lung cancer occurrence in the Korean population.

MATERIALS AND METHODS

To evaluate the role of the PIM-1 gene in the development of lung cancer, the genotypes of the PIM-1 gene were determined in 408 lung cancer patients and 410 normal subjects.

RESULTS

We found that the T-C-T-C haplotypes of the PIM-1 gene (-1196 T>C, IVS4 +55 T>C, IVS4 +1416 T>A and +3684 C>A) were associated with an increased risk of lung cancer [adjusted odds ratio (aOR): 3.98; 95% CI: 1.24 approximately 12.75, p-value: 0.020]. In particular, these haplotypes showed an increased risk of lung cancer in males (aOR: 5.67; 95% CI: 1.32~24.30, p-value: 0.019) and smokers (aOR: 7.82; 95% CI: 1.75 approximately 34.98, p-value: 0.007).

CONCLUSIONS

The present results suggest that the T-C-T-C haplotype of the PIM-1 gene could influence the risk of developing smoking-related lung cancer in the Korean population. Additional functional studies with an larger sample sized analysis are warranted to reconfirm our findings.

Differential ErbB receptor expression and intracellular signaling activity in lung adenocarcinomas and squamous cell carcinomas

EGFR (ErbB1) and ErbB2 receptors stimulate several intracellular signaling pathways in non-small-cell lung cancer (NSCLC). Adenocarcinomas (AC) and squamous cell carcinomas (SCC) are NSCLC subtypes with distinct clinico-pathological features, and responses to ErbB-targeted inhibitors treatment. To evaluate the causes of these differences, tissue microarrays with samples from NSCLC patients (189 AC and 56 SCC) were used to study EGFR and ErbB2 expression and phospho-activation of ERK1/2, AKT, STAT3 and SRC ErbB-mediators by immunohistochemistry and Western blot, and EGFR and ErbB2 gene amplification by FISH. EGFR expression was higher in SCC than in AC (P<0.001), while ErbB2 showed similar low levels. Phosphorylated (p) ERK, pAKT, pSTAT3 and pSRC levels were prevalent in AC (P< or =0.002). EGFR levels and signaling mediators activation were differentially associated with each of the pathologies. Whereas in AC the expression and amplification of EGFR were linked to AKT activation (P< or =0.050), in SCC its expression was correlated with pSTAT3 (P=0.024). In addition, pSTAT3 was correlated with pERK and pAKT only in AC (P< or =0.045). Biomarker levels were also differentially associated with the clinico-pathologic variables. In AC, EGFR and pSRC increasing scores correlated with female sex and the smoking habit (P< or =0.008), while ErbB2 amplification increased with advanced age and tumor stage (P< or =0.047), and pERK1/2 and pSTAT3 levels correlated with early tumor stage (P< or =0.045). In SCC, EGFR amplification was stronger in younger patients (P=0.013), pERK1/2 in the older ones (P=0.050), and pSTAT3 amplification was stronger in women (P=0.001). These data support that AC and SCC lung tumors are distinct entities at the molecular level, and that their signaling status in combination with their clinico-pathologic variables may be considered for differential targeted therapies.

Apoptosis gene polymorphisms, age, smoking and the risk of non-small cell lung cancer

Apoptosis is important for targeting cancer cells for destruction. Various single-nucleotide polymorphisms (SNPs) in apoptotic genes have been associated with increased risks in lung cancer, particularly FAS -1377 G>A (rs2234767), FASLG -844 C>T (rs763110), IL1B +3954 C>T Phe105Phe (rs1143634) and BAT3 Ser625Pro (rs1052486). We studied the association of these SNPs with non-small cell lung cancer (NSCLC) in a large case-control study (N = 4263: 2644 cases and 1619 controls). No associations with NSCLC were observed in the main effects analysis for all four SNPs, adjusting for age, gender, smoking status, pack-years and years since smoking cessation. In subjects under age 60, for FASLG -844 C>T polymorphism, CT compared with the CC genotype, was significantly associated with increased risk of NSCLC, adjusted odds ratio (aOR) = 1.58 (1.22, 2.05), P = 0.0006 and TT aOR = 1.45 (1.01, 2.04), P = 0.04. In contrast, for those over age 60, the CT aOR = 0.91 (0.73, 1.13), P = 0.37 and TT aOR = 0.86 (0.64, 1.16), P = 0.32. The P-value for the age-genotype interaction was 0.004. For the IL1B +3954 C>T polymorphism, compared with the CC genotype, TT showed significant associations in former smokers and in men but tests of interaction were not significant (P(smoking) = 0.24, P(gender) = 0.17). No interactions were observed for FAS -1377 G>A and BAT3 Ser625Pro polymorphisms. Our findings indicate that age and smoking may modify the association of the FASLG -844 and IL1B + 3954 SNPs with the risk of NSCLC.

Women and lung cancer: clinical and molecular profiling as a determinate for treatment decisions: a literature review

In the past decade the incidence of lung cancer among women has risen, whereas among men it has slightly declined. Important differences in lung cancer have been demonstrated between men and women, although many areas still remain controversial. Some biologic differences may justify the increase in response of women to therapy for lung cancer and can partially explain the improved survival of women compared with men. We extensively reviewed the published scientific literature on this topic in order to investigate the clinical and genetic profiling underlying lung cancer in women and to use this information as a tool for medical therapy.

Associations of duration, intensity, and quantity of smoking with adenocarcinoma and squamous cell carcinoma of the esophagus

Smoking has been identified as a risk factor for esophageal cancer; however, there is evidence that magnitudes and patterns of association differ by histologic type. The authors aimed to measure and compare the independent effects of various dimensions of smoking (duration, intensity, total dose, and time since quitting) on risks of esophageal adenocarcinoma (EAC), gastroesophageal junction adenocarcinoma (GEJAC), and esophageal squamous cell carcinoma (ESCC). They used data from a population-based Australian case-control study (2002-2005) comprising 367 EAC cases, 426 GEJAC cases, and 309 ESCC cases and 1,580 controls. Multivariate logistic and generalized additive logistic regression (for nonlinear dose effects) were used. Ever smokers had significantly higher risks of EAC (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.3, 2.3), GEJAC (OR = 2.4, 95% CI: 1.8, 3.2), and ESCC (OR = 2.8, 95% CI: 2.0, 4.0) than did never smokers; however, there were significant differences in magnitude and patterns of association between subtypes. When multiple dimensions of smoking were assessed concurrently, duration was significantly associated with all three subtypes but intensity was associated only with GEJAC and ESCC, and the associations were nonlinear. For all types of esophageal cancer, time since quitting was independently associated with approximately 15-19% risk reductions per decade.

Cigarette smoking and subsequent risk of lung cancer in men and women: analysis of a prospective cohort study

BACKGROUND

Whether women are more susceptible than men to lung cancer caused by cigarette smoking has been controversial. To address this question, we aimed to compare incidence rates of lung cancer by stratum of smoking use in men and women of the National Institutes of Health (NIH)-AARP cohort.

METHODS

Participants in the NIH-AARP Diet and Health study responded to a postal questionnaire between Oct 13, 1995, and May 6, 1996, and were followed up until Dec 31, 2003. The questionnaire asked participants about their past and current smoking status, demographics, alcohol intake, tobacco smoking, physical activity, and included a food-frequency questionnaire of 124 items. Incident lung cancers were identified by linkage to individual state cancer registries. We present age-standardised incidence rates for cancer and multivariate hazard ratios (HRs) adjusted for potential confounders, with 95% CIs. This study conforms to the STROBE guidelines.

FINDINGS

279 214 men and 184 623 women from eight states in the USA aged 50-71 years at study baseline were included in this analysis. During follow-up, lung cancers occurred in 4097 men and 2237 women. Incidence rates were 20.3 (95% CI 16.3-24.3) per 100 000 person-years in men who had never smoked (99 cancers) and 25.3 (21.3-29.3) in women who had never smoked (152 cancers); for this group, the adjusted HR for lung cancer was 1.3 (1.0-1.8) for women compared with men. Smoking was associated with increased risk of lung cancer in men and women. The incidence rate of current smokers who smoked more than two packs per day was 1259.2 (1035.0-1483.3) in men and 1308.9 (924.2-1693.6) in women. In current smokers, in a model adjusted for typical smoking dose, the HR was 0.9 (0.8-0.9) for women compared with men. For former smokers, in a model adjusted for years of cessation and typical smoking dose, the HR was 0.9 (0.9-1.0) for women compared with men. Incidence rates of adenocarcinoma, small-cell carcinoma, and undifferentiated tumours were similar in men and women; incidence rates of squamous tumours in men were about twice that in women.

INTERPRETATION

Our findings suggest that women are not more susceptible than men to the carcinogenic effects of cigarette smoking in the lung. In smokers, incidence rates tended to be higher in men than women with comparable smoking histories, but differences were modest; smoking was strongly associated with lung cancer risk in both men and women. Future studies should confirm whether incidence rates are indeed higher in women who have never smoked than in men who have never smoked.

Lung cancer epigenetics and genetics

Lung cancer is the leading cause of cancer-related death and thus a major health problem. The efficiency of current treatment modalities for lung cancer depends strongly on the time of diagnosis, with better chances of survival if a tumor has been detected at an early stage. Thus, there is an urgent need for rapid and efficient early detection methods. Biomarkers represent a possible alternative to current, rather expensive, screening tools such as spiral computer tomography (CT), or may allow the identification of high risk groups for whom screening would be cost efficient. Although most lung cancers are the consequence of smoking, a substantial fraction of molecular-epidemiological studies point to high-prevalence, low-penetrance genetic polymorphisms as modifiers of environmental lung cancer risk. In the past the genomics field has also made significant advances in identifying genetic lesions that can now be harvested with the goal of identifying novel biomarkers for lung cancer. Furthermore, the importance of epigenetic changes that occur during lung cancer development has been reported, but has been underestimated in the past. Novel high-throughput, quantitative assays for the detection of DNA methylation or histone tail modifications are now applied, to search for alterations in the lung cancer genome and will identify novel cancer-related genes that may become attractive targets for treatment, provide new insight into the biology of lung cancers, and could also become useful biomarkers for the early detection of lung cancer in sputum, or may be used as prognostic markers. Thus, an integrative approach in lung cancer research combining epidemiological, genetic and epigenetic information becomes an important concept for the future.

Smoking and risk of parotid gland tumors: a nationwide case-control study

BACKGROUND

Because existing data regarding the relation between smoking and salivary gland tumors are sparse, tobacco is currently not classified as a salivary gland carcinogen. The objective of the current study was to assess the association between smoking and benign and malignant parotid gland tumors (PGTs) in a nationwide study.

METHODS

The sample included 459 patients with incident PGT, aged > or =18 years, who were diagnosed between 2001 and 2003 and a group of 1265 individually matched, population-based controls. Analyses of the risk of PGT associated with various smoking variables were performed by using conditional logistic regression. Data also were stratified by histologic type; statistical significance tests were 2-sided.

RESULTS

Ever smoking cigarettes was associated with an odds ratio (OR) of 1.66 (95% confidence interval [95% CI], 1.31-2.11) for developing a PGT. The risk was strongest for early ages at smoking initiation, and trends of increasing risk were observed with increasing smoking intensity, pack-years, latent period, and smoking duration (P for trend <.001 for each). Analysis by histologic type indicated remarkably high risks for Warthin tumor (OR for ever cigarette smokers: 15.3; 95% CI, 6.1-38.5). For pleomorphic adenomas and malignant tumors, the risks associated with ever smoking were 1.01 (95% CI, 0.75-1.37) and 1.69 (95% CI, 0.81-3.51), respectively.

CONCLUSIONS

Smoking plays an important role in the development of Warthin tumor. Although no association was observed for pleomorphic adenoma, the possible indication of increased risk of malignant tumors requires further investigation in larger studies.

Putative association of the single nucleotide polymorphisms in RASSF1A promoter with Korean lung cancer

SUMMARY

The RASSF1 gene, a putative tumor suppressor gene located on human chromosome 3p21, has attracted a great deal of attention because of frequent allelic loss and gene silencing via promoter hypermethylation in a variety of human malignancies. To evaluate the role of RASSF1A gene in lung cancer risk, genotypes of the RASSF1A promoter region (-710 C>T and -392T>C) were determined in 410 lung cancer patients and 410 normal subjects. Furthermore, to examine potential effects of the common haplotypes (C-C, T-T and C-T haplotypes) on RASSF1A transcription, luciferase reporter assays were performed in H2009 and H358 non-small cell lung cancer (NSCLC) cell lines. We found that ht2 C-T haplotype was associated with susceptibility to the risk of lung cancer in dominant (odds ratio (OR): 0.69; 95% CI: 0.46-0.99) model. In particular, we found that C-T haplotype showed a decreased risk of lung cancer in males (codominant OR: 0.59; 95% CI: 0.38-0.93 and dominant OR: 0.58; 95% CI: 0.35-0.96) and in smokers (codominant OR: 0.58; 95% CI: 0.36-0.93 and dominant OR: 0.56; 95% CI: 0.33-0.96). Interestingly, C-T haplotype induced transcriptional activity by 50-60% compared with other haplotypes in NSCLC cell lines. These results suggest that RASSF1A promoter polymorphisms affect RASSF1A expression, further contributing to the genetic susceptibility to lung cancer.

Polymorphisms in nucleotide excision repair genes, smoking and intake of fruit and vegetables in relation to lung cancer

Polymorphisms in nucleotide excision repair genes have been associated with risk for lung cancer. We examined gene-environment interactions in relation to lung cancer in 430 cases and 790 comparison persons identified within a prospective cohort of 57,053 persons. We included polymorphisms in the XPC, XPA and XPD genes involved in the nucleotide excision DNA repair pathway and analysed possible interactions with smoking and dietary intake of fruit and vegetables in relation to risk for lung cancer. We found that intake of fruit was associated with lower risk for lung cancer only among carriers of the XPA A23G variant genotype. The incidence rate ratio for lung cancer was 0.60 (95% confidence interval: 0.43-0.84; p=0.003) per 50% increase in fruit intake. No convincing interactions were detected between the polymorphisms and smoking.

Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition)

BACKGROUND

The objective of this study was to summarize the published literature concerning the epidemiology of lung cancer.

METHODS

A narrative review of published evidence was conducted, identifying and summarizing key reports that describe the occurrence of lung cancer in populations and factors that affect lung cancer risk.

RESULTS

In the United States, lung cancer remains the leading cause of cancer death in both men and women, even though an extensive list of modifiable risk factors has long been identified. The predominant cause of lung cancer is exposure to tobacco smoke, with active smoking causing most cases but passive smoking also contributing to the lung cancer burden.

CONCLUSIONS

The reductions in smoking prevalence in men that occurred in the late 1960s through the 1980s will continue to drive lung cancer mortality rates downward in men during the first portion of this century, but rates in women have not yet begun to decrease. Fortunately, exposures to major occupational respiratory carcinogens have largely been controlled, but the population is still exposed to environmental causes of lung cancer, including radon, the second leading cause of lung cancer death.

Lung cancer in never smokers--a different disease

Although most lung cancers are a result of smoking, approximately 25% of lung cancer cases worldwide are not attributable to tobacco use, accounting for over 300,000 deaths each year. Striking differences in the epidemiological, clinical and molecular characteristics of lung cancers arising in never smokers versus smokers have been identified, suggesting that they are separate entities. This Review summarizes our current knowledge of this unique and poorly understood disease.

CEBPG regulates ERCC5/XPG expression in human bronchial epithelial cells and this regulation is modified by E2F1/YY1 interactions

Marked inter-individual variation in lung cancer risk cannot be accounted for solely by cigarette smoke and other environmental exposures. Evidence suggests that variation in bronchial epithelial cell expression of key DNA repair genes plays a role. Variation in these genes correlates with variation in expression of CEBPG and E2F1 transcription factors. Here, we investigated the mechanistic basis for correlation of the DNA repair gene ERCC5 (previously known as XPG) with CEBPG and E2F1. CEBPG expression vector transfected into H23 or H460 cell lines up-regulated endogenous ERCC5 and also luciferase from a reporter construct containing 589 bp of ERCC5 5' regulatory region. A recognition site for CEBPG and a region containing sites for YY1 on the sense strand and E2F1 on the anti-sense strand participated in CEBPG up-regulation of ERCC5. CEBPG, E2F1 and YY1 binding to their respective sites were confirmed by electrophoretic mobility shift assay. Thus, we conclude that CEBPG regulates ERCC5 expression and this regulation is modified by E2F1/YY1 interactions. Several polymorphisms have been identified in these regions and, based on the data presented here, it is reasonable to hypothesize that they may contribute to risk for bronchogenic carcinoma.

Economic evaluation of docetaxel/gemcitabine versus docetaxel as frontline treatment of patients with advanced/metastatic non-small cell lung cancer in Greece

OBJECTIVES

The combination of docetaxel/gemcitabine is an acceptable chemotherapy regimen for the treatment of non-small cell lung cancer. An economic evaluation is undertaken alongside a multi-centre randomized phase III trial, which compares docetaxel/gemcitabine combination with docetaxel monotherapy, in untreated patients with advanced/metastatic non-small cell lung cancer.

METHODS

Trial resource utilisation data are combined with unit price data used to evaluate the cost of chemotherapy, concomitant medications, hospitalisations, diagnostic and laboratory tests and second-line chemotherapy. Treatment cost is combined with survival to estimate the incremental cost per-life-year-saved with the combination therapy versus monotherapy. To deal with uncertainty, stochastic analysis is used to plot cost-effectiveness acceptability curves.

RESULTS

Median survival is 9.1 months (range 1-36.2) and 8.3 months (range 1-26.8) (p: 0.025) in the combination and monotherapy groups, respectively. The mean total treatment cost of patients with docetaxel is estimated at Euro5736 and with docetaxel/gemcitabine at Euro7417, a difference of Euro1542 (95%CI: Euro499-2561). The incremental cost per-life-year-saved of the combination therapy is euro9538 and the probability to be cost-effective is 91% at a threshold of Euro20,000, 97% at a threshold of Euro35,000 and 98% at a threshold of Euro50,000.

CONCLUSIONS

The data support that docetaxel/gemcitabine combination represents a cost-effective treatment option in relation to docetaxel monotherapy for patients with non-small cell lung cancer in the Greek NHS setting.

Lifetime history of tobacco consumption and K-ras mutations in exocrine pancreatic cancer

OBJECTIVES

We analyzed the relation between mutations in codon 12 of the K-ras oncogene and lifetime consumption of tobacco in patients with exocrine pancreatic cancer (EPC).

METHODS

Incident cases of EPC were prospectively identified and interviewed during hospital admission about smoking and other factors. Exact logistic regression was used to compare EPC cases (N = 107) with and without K-ras mutations (case-case study).

RESULTS

Mutated cases were nonsignificantly less likely to have been smokers than wild-type cases: the odds ratio adjusted by age and sex was 0.54 (95% confidence interval, 0.10-2.69; P = 0.613). With respect to never smokers, adjusted odds ratios for former and current smokers were 0.79 and 0.36, respectively (P = 0.193). Pack-years smoked, years of smoking, and cigarettes smoked per year also tended to be higher in nonmutated than in mutated cases. Neither age at onset of smoking nor the time between quitting and diagnosis were associated with K-ras.

CONCLUSIONS

Tobacco does not play a major part in the acquisition of K-ras mutations in the pancreatic epithelium. Although both smoking and K-ras mutations have important roles in the etiopathogenesis of EPC, the 2 processes may act independently.

Cigarette filter and the incidence of lung adenocarcinoma among Tunisian population

Increasing incidence of lung adenocarcinoma (Ad) is observed for the last two decades in all over the world and may become the most frequent lung cancer subtype in the next years. Its increasing prevalence has been well documented in United States for the last two decades. Geographical differences in the increase of Ad prevalence was also reported in Europe where the Squamous Cell Carcinoma (SCC) still predominates but the increase of Ad incidence was shown in the beginning of 1980s. In Tunisia, the incidence of Ad was relatively low in 1990 when compared to western countries and was shown to continue to increase with a more important rise of Ad incidence over SCC type. In this study the time-dependent increased incidence of Ad is reported between USA, Europe and Tunisia. A lag-time period of 10 years is observed between Tunisia and Europe for this increased incidence in smokers and about 20 years between USA and Tunisia. According to the literature, changes in the types of cigarettes smoked as well as modifications in time and geographical trends seem to explain partly the increased incidence of Ad lung cancer.

Specific Features of Non-small Cell Lung Cancer in Women: A Retrospective Study of 1738 Cases Diagnosed in Bas-Rhin between 1982 and 1997

INTRODUCTION

The literature suggests that lung cancer may represent a different disease in women compared with men and that gender specificities have been reported mostly in clinical trials patients.

METHODS

We conducted a retrospective, population-based study of a sample of 1738 patients diagnosed with a non-small cell lung cancer (NSCLC) in the department of Bas-Rhin (northeastern France) between 1982 and 1997. Our study aimed to describe symptoms at presentation, stage, histological distribution, treatment modalities, and survival, according to sex.

RESULTS

Tobacco exposure differed significantly according to sex: 28.9% of women were nonsmokers versus 1.4% of the men. More NSCLC were metastatic at diagnosis in women than in men (41.1% versus 29.9%). Adenocarcinoma predominated in women (54.4%), whereas squamous cell carcinoma predominated in men (65.9%). Invasive procedures, such as transthoracic needle biopsy, contributed more frequently to histological diagnosis in women. Men and women underwent the same procedures for disease staging, excepted for the abdominal computed tomography scan, which was performed more frequently in women. Treatment also differed: in resectable disease, fewer pneumonectomies were performed in women; in locally advanced disease, the mean doses of thoracic irradiation were significantly lower in women (48.0 grays versus 55.5 grays); in metastatic-stage disease, fewer women received platin-based chemotherapy, but this difference was not significant. Sex was not a significant prognostic factor in our study, contrary to most North American studies, where women seem to have had better survival rates.

CONCLUSIONS

This study emphasizes gender differences in smoking exposure, presentation (stage, histological subtype), and diagnostic and therapeutic management of NSCLC.

The association between the anti-inflammatory protein CC10 and smoking status among participants in a chemoprevention trial

CC10, the secretory product of bronchiolar Clara cells, is infrequently expressed in non-small cell lung cancer (NSCLC), and its overexpression in NSCLC cell lines results in a less malignant phenotype. CC10 levels in bronchoalveolar lavage fluid (BAL) and serum are significantly lower in current smokers than healthy nonsmokers, but the effect of long-term smoking cessation on CC10 is unknown. We measured CC10 in baseline BAL and plasma collected from current (n = 81) and former (n = 23) smokers participating in a chemoprevention trial. Former smokers had significantly higher plasma CC10 levels compared with current smokers [mean, 62.1 ng/mL (95% CI, 43.0-81.2); range, 23.0-175.0 ng/mL for former smokers; and mean, 37.1 ng/mL (95% CI, 29.8-44.4); range, 5.0-171.0 ng/mL for current smokers; P < 0.001]. BAL CC10 levels also trended in the same direction. A significant positive correlation was found between CC10 plasma and BAL levels. After adjustment for age, sex, and pack-years of cigarette consumption, former smokers had 1.70 (95% CI, 1.23-2.36) times higher plasma CC10 levels than current smokers (P < 0.01), whereas former smokers also had nonsignificantly higher baseline BAL CC10 levels compared with current smokers [adjusted mean ratio (95% CI), 1.60 (0.92-2.80), P = 0.094 and 1.35 (0.86-2.10), P = 0.193 for the absolute and normalized BAL CC10, respectively]. These results show that sustained smoking cessation is associated with higher plasma CC10 levels, suggesting that at least some of the damage associated with tobacco smoke may be repaired by long-term smoking cessation.

Gene-environment interactions between smoking and a haplotype of RAI, ASE-1 and ERCC1 polymorphisms among women in relation to risk of lung cancer in a population-based study

Homozygous carriers of a haplotype consisting of ERCC1 Asn118Asn(A), ASE-1 G-21A(G), RAI IVS1 A4364G(A) are at increased risk of lung cancer especially among women. Here, we analyse for gene-environment interactions with the predefined haplotype in a case cohort study including 428 lung cancer cases and a comparison group of 800 persons, all from the prospective Diet, Cancer and Health cohort of 57,000 Danes. At high smoking intensity (>20g tobacco/day), there was only additional risk of smoking intensity among women who were homozygous carriers of the haplotype (IRR=2.03; 95% CI: 1.10-3.73 per 5 additional g tobacco/day).

Lung cancer risk and workplace exposure to environmental tobacco smoke

OBJECTIVES

We sought to quantitatively evaluate the association between work-place environmental tobacco smoke exposure and lung cancer.

METHODS

We performed a meta-analysis in 2003 of data from 22 studies from multiple locations worldwide of workplace environmental tobacco smoke exposure and lung cancer risk. Estimates of relative risk from these studies were analyzed by fitting the data to fixed and mixed effects models. Analyses of highly exposed workers and of the relationship between duration of exposure and lung cancer were also performed.

RESULTS

The meta-analysis indicated a 24% increase in lung cancer risk (relative risk [RR]=1.24; 95% confidence interval [CI]=1.18, 1.29) among workers exposed to environmental tobacco smoke. A 2-fold increased risk (RR=2.01; 95% CI=1.33, 2.60) was observed for workers classified as being highly exposed to environmental tobacco smoke. A strong relationship was observed between lung cancer and duration of exposure to environmental tobacco smoke.

CONCLUSIONS

The findings from this investigation provide the strongest evidence to date that exposure to environmental tobacco smoke in the workplace is associated with an increased risk of lung cancer.

Lung cancer

Lung cancer is the most frequently occurring cancer in the world, and in the United States it is the second most common cancer diagnosed. Accurate staging by imaging can have a significant impact on appropriate treatment and surgical options. Familiarity with the different histologic subtypes of lung cancer and the typical and atypical appearances of lung cancer is vital. Radiologists serve a critical role in the diagnosis, staging, and follow-up of patients with lung cancer.

Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database

PURPOSE

Small-cell lung cancer (SCLC) is a histologic subtype of lung cancer with a distinct biology and clinical course. It has been observed that the incidence of SCLC has been decreasing over the last several years.

METHODS

We used the Surveillance, Epidemiologic, and End Results (SEER) database to determine the incidence of SCLC over the last 30 years. In addition, we sought to determine sex- and stage-based differences in the incidence and survival of SCLC among a proportion of reported cases of lung cancer over the last 30 years (1973 to 2002). Joinpoint analyses were applied to test the trends in annual percentage change for statistical significance.

RESULTS

The proportion of SCLC (among all lung cancer histologic types) decreased from 17.26% in 1986 to 12.95% in 2002. Of all patients with SCLC, the proportion of women with SCLC increased from 28% in 1973% to 50% in 2002. A modest but statistically significant improvement in 2- and 5-year survival was noted among both limited-stage SCLC and extensive-stage SCLC cohorts during the study period.

CONCLUSION

Our analysis indicates that the incidence of SCLC is decreasing in the United States, and only modest improvements have been seen in survival over the last 30 years. Possible explanations for the decreasing incidence include the decrease in the percentage of smokers and the change to low-tar filter cigarettes. Despite trends toward modest improvement in survival, the outcome remains very poor.

Worldwide trends in lung cancer pathology

Molecular profiling studies serve to remind us that lung cancer is a complex disease, with different phenotypes that are characterized by variation in morphology as well as molecular composition. Over recent decades, there appear to be worldwide shifts in the relative frequencies of various phenotypic patterns of lung cancer, which are even more striking than changes in the overall incidence of lung cancer. This review summarizes major worldwide trends in lung cancer pathology, which can be explained in part, but not entirely, by changes in cigarette design. Characterizing these trends will be important for recognizing contributions of carcinogens other than tobacco smoke to the worldwide problem of lung cancer.

Perceived risk and interest in screening for lung cancer among current and former smokers

Factors associated with perceived risk, interest in screening information, and interest in being screened for lung cancer were examined among current and recent former smokers. Cross-sectional data were analyzed from 585 current and former smokers who participated in 12-month follow-up telephone interviews as part of a population-based cessation intervention trial. Current smokers who were thinking about or preparing to quit were more likely to perceive risk of lung cancer and be interested in lung cancer screening information than those who were not motivated to quit or who were in the process of actively quitting or maintaining abstinence. Smokers who participate in lung cancer screening may be motivated to participate in a broad range of tobacco dependence treatment options.

Bronchogenic carcinoma of squamous cells in a young pregnant woman

Lung cancer continues to be the most incident neoplasia in the world and also the most frequent cause of death by cancer, with more than 900000 new cases per year. Women present greater risk of developing bronchogenic carcinoma, possibly because of differences in metabolism of the carcinogens associated with tobacco and also because of hormonal differences because estrogens can promote the appearance of lung cancer, including during pregnancy. We have described the case of a 25-year-old patient who developed squamous cell carcinoma of the lung during her third pregnancy, with a progressive worsening of her general condition and progression until death. We believe that the pregnancy could have contributed to the evolution of the disease, especially because of the increased levels of gestational hormones, particularly the estrogen, because its receptors have an important role in regulating growth and in the differentiation of several tissues facilitating like this, the development of the neoplasia, and complicating its early diagnosis.

Évolution de l’incidence du cancer broncho-pulmonaire en France (1978-2000)

INTRODUCTION

Lung cancer is the most common cause of death from malignant disease in the world. Our objective was to describe the progression of this cancer's incidence, and the changing distribution of histological types in France between 1978 and 2000.

METHODS

National incidence rates were obtained by modelling lung cancer incidence data provided by the French cancer registries, taking into account national mortality data. These registries also provided information about histological type.

RESULTS

In the year 2000, with 28,000 estimated new diagnoses, lung cancer represented 10.0% of all incident cancers and was responsible for 18.1% of deaths from cancer. From 1980 to 2000, the incidence rose from 47.4 to 52.2 per hundred thousand in men and from 3.7 to 8.6 per hundred thousand in women. The risk of developing lung cancer, which remained constant in men, has increased considerably (+451%) between the generation of women born in 1953 and those born in 1913. The proportion of epidermoid cancers has dropped whilst that of adenocarcinomas has risen sharply.

CONCLUSIONS

The last few years have seen a large increase in the incidence of lung cancer in women and an increasing incidence of adenocarcinoma in both men and women.

Incidence du cancer du poumon dans le Bas-Rhin : tendance et projections en 2014

INTRODUCTION

In France lung cancer is the second most common cancer in men and the fourth most common in women. In the department of Bas-Rhin the incidence is increasing by 0.1% per annum in men and by 4.4% in women. The aim is to analyse and predict the trend of lung cancer incidence in Bas-Rhin from 1975 to 2014.

METHODS

The incidence data from 1975 to 1999 were extracted from the Bas-Rhin cancer registry. Population estimates (2594 years) were made for the period 1975-2014. Predictions were based on a Bayesian age-period-cohort model.

RESULTS

Between 1975 and 1999 the incidence of lung cancer increased by 4.5% p.a. in women. In men it increased by 1.6% p.a. between 1975 and 1989 and then diminished. For the periods 2000-2004, 2005-2009 and 2010-2014 respectively the rates should reach 25.6, 32.9 and 42.8 per 100,000 in women and 117.5, 111.6 and 110.1 per 100,000 in men.

CONCLUSIONS

Increasing tobacco smoking among women and a reduction among men could be one of the reasons for the respective increasing and decreasing incidences.

Socio-economic status and lung cancer risk including histologic subtyping—A longitudinal study

We investigated prospectively the risk of lung cancer in relation to socio-economic status (SES) in 22,387 middle-aged individuals who attended a screening program in the city of Malmö, Sweden between 1974 and 1992. We also examined the relationship between SES and histologic subtype in smokers. By 2003, a total of 550 lung cancer cases had been identified. Relative risks (RR) were calculated with adjustment for age, current smoking, inhalation habits and marital status at baseline in the low SES group compared to high SES group. Among smokers, the RR (95% confidence interval (CI)) for lung cancer in the low SES group of men was 1.39 (1.11-1.73), and women 1.56 (1.04-2.34). Also among smokers, low SES was associated with an increased risk of squamous cell carcinoma in men; RR 1.89 (1.16-2.81) and women; RR 7.10 (1.63-30.86), and with an increased risk of mesothelioma in men RR 9.97 (1.29-76.96). We conclude that low SES groups run an increased risk of lung cancer despite accounting for smoking habits. Furthermore, low SES was positively associated with squamous cell carcinoma and mesothelioma. Our results suggest that the association between low SES and lung cancer could be mediated by unaccounted for smoking exposure, lifestyle or occupational hazards.