Racial, ethnic and gender trends in lung cancer mortality rates in the United States-Mexico border and non-border areas

BACKGROUND

Geographic patterns of lung cancer mortality rate differ in the region bordering Mexico in contrast to the US. This study compares lung cancer mortality between border and non-border counties by race/ethnicity and gender.

METHODS

This study utilized population-level death certificate data from US Centers for Disease Control and Prevention Public Internet Wide-Ranging Online Data for Epidemiologic Research dataset between 1999 and 2020. Established algorithms were implemented to examine lung cancer deaths among US residents. We analyzed the age-adjusted data by year, race/ethnicity, gender, and geographic region. Joinpoint regression was used to determine mortality trends across time.

RESULTS

Lung cancer mortality rates were lower in border counties compared to non-border counties across time (p < 0.05). Hispanic lung cancer mortality rates were not different in border counties compared to non-border counties during the same period (p > 0.05). Lung cancer mortality among non-Hispanic White living in border counties was lower than non-Hispanic White residing in non-border counties (p < 0.01), and non-Hispanic Black living in border counties had lower lung cancer mortality than non-Hispanic Black in non-border counties in all but three years (p < 0.05). Both female and male mortality rates were lower in border counties compared to non-border counties (p < 0.05).

CONCLUSION

Differences in lung cancer mortality between border counties and non-border counties reflect lower mortality in Hispanics overall and a decline for non-Hispanic White and non-Hispanic Black living in border counties experiencing lower lung cancer mortality rates than non-border counties. Further studies are needed to identify specific causes for lower mortality rates in border counties.

Effect of cumulative radiation exposure from Coronary catheterization on lung cancer mortality

BACKGROUND

Coronary catheterization (CC) procedure inevitably exposes patients with cardiovascular disease (CVD) to radiation, while cumulative radiation exposure may lead to higher risk of cancer.

METHODS

This multi-center, retrospective study was based on the CC procedure in Cardiorenal ImprovemeNt II cohort (CIN-II, NCT05050877) among five regional central tertiary teaching hospitals in China between 2007 and 2020. Patients without known cancer were stratified according to the times they received CC procedure. Baseline information from their last CC procedure was analyzed. Cox regression and Fine-Gray competing risk models were used to assess the relationship between cumulative radiation exposure from CC procedures and cancer-specific, all-cause and cardiovascular mortality.

RESULTS

Of 136,495 hospitalized survivors without cancer at baseline (mean age: 62.3 ± 11.1 years, 30.9% female), 116,992 patients (85.7%) underwent CC procedure once, 15,184 patients (11.1%) on twice, and 4,319 patients (3.2%) underwent CC procedure more than three times. During the median follow-up of 4.7 years (IQR: 2.5 to 7.4), totally 18,656 patients (13.7%) died after discharge, of which 617 (0.5%) died of lung cancer. Compared with the patients who underwent CC procedure once, the risk of lung cancer mortality increased significantly with the increase of the number of CC procedure (CC 2 times vs. 1 time: HR 1.42, 95% CI 1.13 to 1.78, P < 0.001; CC ≥ 3 times vs. 1 time: HR 1.64, 95%CI 1.13 to 2.39, P < 0.05). Similar results were observed in all-cause mortality and cardiovascular mortality, but not in other cancer-specific mortality.

CONCLUSIONS

Our data suggest that substantial proportion of CVD patients are exposed to multiple high levels of low-dose ionizing radiation from CC procedure, which is associated with an increased risk of cancer mortality in this population.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05050877; URL: http://www.

CLINICALTRIALS

gov ; 21/09/2021.

Short-term association of air pollution with lung cancer mortality in Osaka, Japan

Long-term air pollution exposure has been linked to increased lung cancer mortality. However, little is known about whether day-to-day fluctuations in air pollution levels are in relation to lung cancer mortality, particularly in low-exposure settings. This study aimed to evaluate the short-term associations between air pollution and lung cancer mortality. Daily data on lung cancer mortality, fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), carbon monoxide (CO), and weather conditions were collected from Osaka Prefecture, Japan, from 2010 to 2014. Generalized linear models were combined with quasi-Poisson regression were applied to evaluate the associations between each air pollutant and lung cancer mortality after adjusting for potential confounders. Mean (standard deviation) concentrations of PM_2.5, NO₂, SO₂, and CO were 16.7 (8.6) μg/m³, 36.8 (14.2) μg/m³, 11.1 (4.0) μg/m³, and 0.51 (0.16) mg/m³, respectively. Interquartile range increases in concentrations of PM_2.5, NO₂, SO₂, and CO (2-d moving average) were associated with 2.65% (95% confidence intervals [CIs]: 0.96%-4.37%), 4.28% (95% CIs: 2.24%-6.36%), 3.35% (95% CIs: 1.03%-5.73%), and 4.60% (95% CIs: 2.19%-7.05%) increased risk of lung cancer mortality, respectively. Stratified analyses showed that the associations were strongest in the older population and men. Exposure‒response curves showed a continuously increasing mortality risk from lung cancer with elevation of air pollution levels, without discernible thresholds. In summary, we found evidence of increased lung cancer mortality in relation to short-term elevations in ambient air pollution. These findings may merit further research to better understand this issue.

Lung Cancer Mortality Racial/Ethnic Disparities in Patient Experiences with Care: a SEER-CAHPS Study

BACKGROUND

To determine whether there are racial/ethnic disparities in patient experiences with care among lung cancer survivors, whether they are associated with mortality.

METHODS

A retrospective cohort study of lung cancer survivors > 65 years old who completed a CAHPS survey > 6 months after the date of diagnosis. We used data from the SEER-Consumer Assessment of Healthcare Providers Systems (SEER-CAHPS®) database from 2000 to 2013 to assess racial/ethnic differences in patient experiences with care multivariable Cox proportional hazards models to assess the association between patient experience with care scores mortality in each racial/ethnic group.

RESULTS

Within our cohort of 2603 lung cancer patients, Hispanic patients reported lower adjusted mean score with their ability to get needed care compared to white patients (B: - 5.21, 95% CI: - 9.03, - 1.39). Asian patients reported lower adjusted mean scores with their ability to get care quickly (- 4.25 (- 8.19, - 0.31)), get needed care (- 7.06 (- 10.51, - 3.61)), get needed drugs (- 9.06 (- 13.04, - 5.08)). For Hispanic patients, a 1-unit score increase in their ability to get all needed care (HR: 1.02, 1.00-1.03) care coordination (1.06, 1.02-1.09) was associated with higher risk of mortality. Among black patients, a 1-unit score increase in their ability to get needed care (HR: 0.99, 95% CI 0.98-0.99) care coordination (0.97, 0.94-0.99) was associated with lower risk mortality.

CONCLUSIONS

There are racial/ethnic disparities in lung cancer patient experiences with care that may impact mortality. Patient experiences with care are important risk factors of mortality for certain racial/ethnic groups.

An investigation into the impact of variations of ambient air pollution and meteorological factors on lung cancer mortality in Yangtze River Delta

Lung cancer (LC) mortality, as one of the top cancer deaths in China, has been associated with increased levels of exposure to ambient air pollutants. In this study, different lag times on weekly basis were applied to study the association of air pollutants (PM2.5, PM10, and NO2) and LC mortality in Ningbo, and in subpopulations at different age groups and genders. Furthermore, seasonal variations of pollutant concentrations and meteorological variables (temperature, relative humidity, and wind speed) were analysed. A generalised additive model (GAM) using Poisson regression was employed to estimate the effect of single pollutant model on LC mortality in Yangtze River Delta using Ningbo as a case study. It was reported that there were statistically significant relationships between lung cancer mortality and air pollutants. Increases of 6.2% (95% confidence interval [CI]: 0.2% to 12.6%) and 4.3% (95% CI: 0.1% to 8.5%) weekly total LC mortality with a 3-week lag time were linked to each 10 μg/m³ increase of weekly average PM_2.5 and PM₁₀ respectively. The association of air pollutants (PM_2.5, PM₁₀ and NO₂) and LC mortality with a 3-week lag time was also found statistically significant during periods of low temperature (T < 18 °C), low relative humidity (H < 73.7%) and low wind speed (u < 2.8 m/s), respectively. The female population was found to be more susceptible to the exposure to air pollution than the male population. In addition, the population with an age of 50 years or above was shown to be more sensitive to ambient air pollutant. These outcomes indicated that increased risk of lung cancer mortality was evidently linked to exposure to ambient air pollutant on a weekly basis. The impact of weekly variation on the LC mortality and air pollutant levels should be considered in air pollution-related health burden analysis.

Indoor radon exposure and excess of lung cancer mortality: the case of Mexico-an ecological study

Radon is a radioactive gas that can migrate from soils and rocks and accumulate in indoor areas such as dwellings and buildings. Many studies have shown a strong association between the exposure to radon, and its decay products, and lung cancer (LC), particularly in miners. In Mexico, according to published surveys, there is evidence of radon exposure in large groups of the population, nevertheless, only few attention has been paid to its association as a risk factor for LC. The aim of this ecological study is to evaluate the excess risk of lung cancer mortality in Mexico due to indoor radon exposure. Mean radon levels per state of the Country were obtained from different publications and lung cancer mortality was obtained from the National Institute of Statistics, Geography and Informatics for the period 2001-2013. A model proposed by the International Commission on Radiological Protection to estimate the annual excess risk of LC mortality (per 10⁵ inhabitants) per dose unit of radon was used. The average indoor radon concentrations found rank from 51 to 1863 Bq m^-3, the higher average dose exposure found was 3.13 mSv year^-1 in the north of the country (Chihuahua) and the mortality excess of LC cases found in the country was 10 ± 1.5 (range 1-235 deaths) per 10⁵ inhabitants. The highest values were found mainly in the Northern part of the country, where numerous uranium deposits are found, followed by Mexico City, the most crowded and most air polluted area in the country. A positive correlation (r = 0.98 p < 0.0001) was found between the excess of LC cases and the dose of radon exposure. Although the excess risk of LC mortality associated with indoor radon found in this study was relatively low, further studies are needed in order to accurately establish its magnitude in the country.

Short-term association between ambient air pollution and lung cancer mortality

RATIONALE

Long-term exposure to air pollution has been associated with increased lung cancer incidence and mortality. However, the short-term association between air pollution and lung cancer mortality (LCM) remains largely unknown.

METHODS

We collected daily data on particulate matter with diameter <2.5 μm (PM_2.5), particulate matter with diameter < 10 μm (PM₁₀), sulfur dioxide (SO₂), and ozone (O₃), and LCM in three of the biggest cities in China, i.e. Beijing, Chongqing, and Guangzhou, from 2013 to 2015. We first estimated city-specific relationships between air pollutants and LCM using time-series generalized linear models, adjusting for potential confounders. A classification and regression tree (CART) model was used to stratify LCM risk based on combinations of air pollutants and meteorological factors in each city. Then we pooled the city-specific associations using random-effects meta-analysis. Meta regression was used to explore if city-specific characteristics modified the air pollution-LCM association. Finally, we stratified the analyses by season, age, and sex.

RESULTS

Over the entire period, the current-day concentrations of PM_2.5 and PM₁₀ in Chongqing and PM_2.5, PM₁₀, and SO₂ in Guangzhou were positively associated with LCM (Excess risk ranged from 0.72% (95% CI 0.27%-1.17%) to 6.06% (95% CI 0.76%-11.64%) with each 10 μg/m³ increment in different pollutants), but the association between current-day air pollution and LCM in Beijing was not significant (P > 0.05). When considering the environmental and weather factors simultaneously, current-day PM_2.5, relative humidity, and PM₁₀ were the most important factors associated with LCM in Beijing, Chongqing, and Guangzhou, respectively. LCM risk related with daily PM_2.5, PM₁₀, and SO₂ significantly increased with the increasing annual mean temperature and humidity of the city, while LCM risk related with daily O₃ significantly increased with the increases of latitude, annual mean O₃ concentration, and socioeconomic level. After stratification, the current-day PM_2.5, PM₁₀, and O₃ during the warm season in Beijing and PM_2.5, PM₁₀, and SO₂ during the cool season in Chongqing and Guangzhou were positively associated with LCM (Excess risk ranged from 0.93% (95% CI 0.42%-1.45%) to 7.16% (95% CI 0.64%-14.09%) with each 10 μg/m³ increment in different pollutants). Male and the elderly lung cancer patients were more sensitive to the short-term effect of air pollution.

CONCLUSIONS

Lung cancer patients should enhance protection measures against air pollution. More attentions should be paid for the high PM_2.5, PM₁₀, and O₃ during the warm season in Beijing, and high PM_2.5, PM₁₀, and SO₂ during the cool season in Chongqing and Guangzhou.

Exposure-lag-response associations between lung cancer mortality and radon exposure in German uranium miners

Exposure-lag-response associations shed light on the duration of pathogenesis for radiation-induced diseases. To investigate such relations for lung cancer mortality in the German uranium miners of the Wismut company, we apply distributed lag non-linear models (DLNMs) which offer a flexible description of the lagged risk response to protracted radon exposure. Exposure-lag functions are implemented with B-Splines in Cox models of proportional hazards. The DLNM approach yielded good agreement of exposure-lag-response surfaces for the German cohort and for the previously studied cohort of American Colorado miners. For both cohorts, a minimum lag of about 2 year for the onset of risk after first exposure explained the data well, but possibly with large uncertainty. Risk estimates from DLNMs were directly compared with estimates from both standard radio-epidemiological models and biologically based mechanistic models. For age > 45 year, all models predict decreasing estimates of the Excess Relative Risk (ERR). However, at younger age, marked differences appear as DLNMs exhibit ERR peaks, which are not detected by the other models. After comparing exposure-responses for biological processes in mechanistic risk models with exposure-responses for hazard ratios in DLNMs, we propose a typical period of 15 year for radon-related lung carcinogenesis. The period covers the onset of radiation-induced inflammation of lung tissue until cancer death. The DLNM framework provides a view on age-risk patterns supplemental to the standard radio-epidemiological approach and to biologically based modeling.

Estimating the spatial distribution of environmental suitability for female lung cancer mortality in China based on a novel statistical method

Lung cancer as one of the major causes of cancer mortality has been demonstrated to be closely related to the ambient atmospheric environment, but little has been done in the synthetic evaluation of the linkage between cancer mortality and combined impact of ambient air pollution and meteorological conditions. The present study determined the environmental suitability for female lung cancer mortality associated with air contaminants and meteorological variables. A novel fuzzy matter-element method was applied to identify the spatial distribution and regions for the environmental suitability for the female lung cancer mortality across China in 2013. The membership functions between the cancer mortality and 6 environmental factors, including PM_2.5, NO₂, SO₂, PM₁₀, the annual mean wind speed, and mean temperature, were generated and the weights of each of the environmental factors were established by the maximum entropy (MaxEnt) model. We categorized the environmental suitability combined with GIS spatial analysis into three zones, including low-suitable, medium-suitable, and high-suitable region where the cancer mortality ranging from low to high rate was identified. These three zones were quantified by the MaxEnt model taking different air pollutants and meteorological variables into consideration. We identified that NO₂ was a most significant factor among the 6 environmental factors with the weight of 24.88%, followed by the annual mean wind speed, SO₂, and PM_2.5. The high-suitable area, mainly in the North China Plain which is a most heavily contaminated region by air pollution in China, covers 1.6195 million square kilometers, accounting for 17.85% of the total area investigated in this study. Identification of the impact of various environmental factors on cancer mortality in the different suitable area provides a scientific basis for the environmental management, risk assessment, and lung cancer control.

Lung cancer mortality in Australia in the twenty-first century: How many lives can be saved with effective tobacco control?

OBJECTIVES

To estimate the number of past and future lung cancer deaths that have already been averted by tobacco control initiatives in Australia, and to estimate the number of additional deaths averted under various smoking scenarios.

METHODS

We predicted lung cancer mortality rates and case numbers to 2100 using a previously validated generalized linear model based on age, birth cohort and population cigarette smoking exposure. We estimated the impact of various tobacco control scenarios: 'actual tobacco control' (incorporating the aggregate effect of past and current taxation, plain packaging, mass media campaigns and other initiatives) and scenarios where 10%, 5% and 0% smoking prevalence was achieved by 2025, all of which were compared to a counterfactual scenario with the highest historical smoking consumption level continuing into the future as if no tobacco control initiatives had been implemented.

RESULTS

Without tobacco control, there would have been an estimated 392,116 lung cancer deaths over the period 1956-2015; of these 20% (78,925 deaths; 75,839 males, 3086 females) have been averted due to tobacco control. However, if past and current measures continue to have the expected effect, an estimated 1.9 million deaths (1,579,515 males, 320,856 females; 67% of future lung cancer deaths) will be averted in 2016-2100. If smoking prevalence is reduced to 10%, 5% or 0% by 2025, an additional 97,432, 208,714 or 360,557 deaths could be averted from 2016 to 2100, respectively.

CONCLUSION

Tobacco control in Australia has had a dramatic impact on the number of people dying from lung cancer. Several hundred thousand more lung cancer deaths could be averted over the course of the century if close-to-zero smoking prevalence could be achieved in the next decade.

[Establishing a Combination Model in Predicting Mortality of Lung Cancer]

OBJECTIVE

To identify a good combination model for predicting the mortality of lung cancer.

METHODS

Mortality data of lung cancer from 2001-2013 were used to test three prediction model: dynamic series, exponential smoothing, and Joinpoint regression. Weight coefficients of the combination models were calculated using the arithmetic average method, the variance inverse method, the mean square error inverse method, and the simple weighted average method.

RESULTS

The exponential smoothing model had the highest accuracy (79.67%) of prediction, followed by the Joinpoint linear model (74.27%). The combination of these two models resulted in better results. The arithmetic average method and the mean square error inverse method had the best prediction, with an accuracy of 86.87% and 85.80%, respectively.

CONCLUSIONS

The combined model has higher accuracy than the single models in predicting the mortality of lung cancer.

Lung cancer mortality in Australia: Projected outcomes to 2040

OBJECTIVES

The aim was to develop and validate a statistical model which uses past trends for lung cancer mortality and historical and current data on tobacco consumption to project lung cancer mortality rates into the future for Australia.

METHODS

We used generalized linear models (GLMs) with Poisson distribution including either age, birth cohort or period, and/or various measures of population tobacco exposure (considering cross-sectional smoking prevalence, cigarettes smoked and tar exposure per capita). Sex-specific models were fitted to data for 1956-2015 and age-standardized lung cancer mortality rates were projected forward to 2040. Possible lags of 20-30 years between tobacco exposure and lung cancer mortality were examined. The best model was selected using analysis of deviance. To validate the selected model, we temporarily re-fitted it to data for 1956-1990 and compared the projected rates to 2015 with the observed rates for 1991-2015.

RESULTS

The best fitting model used information on age, birth cohort and tar exposure per capita; close concordance with the observed data was achieved in the validation. The forward projections for lung cancer mortality using this model indicate that male and female age-standardized rates will decline over the period 2011-2015 to 2036-2040 from 27.2 to 15.1 per 100,000, and 15.8 to 11.8 per 100,000, respectively. However, due to population growth and ageing the number of deaths will increase by 7.9% for males and 57.9% for females; from 41,040 (24,831 males, 16,209 females) in 2011-2015 to 52,403 (26,805 males, 25,598 females) in 2036-2040.

CONCLUSION

In the context of the mature tobacco epidemic with past peaks in tobacco consumption for both males and females, lung cancer mortality rates are expected to continually decline over the next 25 years. However, the number of lung cancer deaths will continue to be substantial, and to increase, in Australia's ageing population.

Study on PM2.5 pollution and the mortality due to lung cancer in China based on geographic weighted regression model

BACKGROUND

PM2.5 has become a major component of air pollution in China and has led to a series of health problems. The mortality rate caused by lung cancer has reached the point where it cannot be ignored in China. Air pollution is becoming more and more serious in China, which is increasingly affecting people's lives and health.

METHODS

Considering the variations in the geographical environment in China, this paper studied the relationship between PM2.5 concentration and lung cancer mortality based on the geographical weighted regression model in 31 provinces in 2004 and 2008, autonomous regions and municipalities of China.

RESULTS

The results indicated there was a significant positive correlation between PM2.5 concentration and lung cancer mortality (r = 0.0052, P = 0.036). Additionally, the longer the time of exposure to PM2.5 is, the higher morbidity is.

CONCLUSION

It is suggested that the Chinese government should launch some environmental policy, especially in those areas with severe PM2.5 pollutions, and keep the citizens away from exposure to PM2.5 pollution in the long term.

LncRNA LCPAT1 Mediates Smoking/ Particulate Matter 2.5-Induced Cell Autophagy and Epithelial-Mesenchymal Transition in Lung Cancer Cells via RCC2

BACKGROUND/AIMS

Ecological studies have shown that air pollution and prevalence of cigarette smoking are positively correlated. Evidence also suggests a synergistic effect of cigarette smoking and PM2.5 exposure (Environmental Particulate Matter ≤ 2.5 µm in diameter) on lung cancer risk. We aimed to evaluate the interaction between smoking prevalence and PM2.5 pollution in relation to lung cancer mortality and determine its underlying mechanisms in vitro.

METHODS

"MOVER" method was used to analyze the interaction between smoking prevalence and PM2.5 pollution in relation to lung cancer mortality. Cell autophagy and malignant behaviors induced by cigarette smoke extract (CSE) and PM2.5 exposure were examined in vitro. Gene expression was examined by qRT-PCR and western blot. RNA and protein interaction was determined using a RNA binding protein immunoprecipitation assay.

RESULTS

An increased risk for lung cancer death (RERI (the relative excess risk) =0.28) was observed with a synergistic interaction between cigarette smoking and PM2.5 pollution. Cell migration, invasion, EMT (epithelial-mesenchymal transition) and autophagy were elevated when lung cancer cells were treated with CSE and PM2.5 in combination. A lncRNA, named lung cancer progression-association transcript 1 (LCPAT1), was up-regulated after the treatment of CSE and PM2.5, and knocking down the lncRNA impaired the effect of CSE and PM2.5 on lung cancer cells. In addition, LCPAT1 was shown to bind to RCC2, and RCC2 mediated the effect of LCPAT1 on cell autophagy, migration, invasion and EMT in lung cancer.

CONCLUSIONS

Our results suggest that combined exposure to CSE and PM2.5 induces LCPAT1 expression, which up-regulates autophagy, and promotes lung cancer progression via RCC2.

[Lung cancer screening with thoracic X‑ray and CT : Current situation]

CLINICAL/METHODICAL ISSUE

Attempts at the early detection of lung cancer using imaging methods began as far back as the 1950s.

STANDARD RADIOLOGICAL METHODS

Several studies attempted to demonstrate a reduction of lung cancer mortality by chest radiography screening but all were unsuccessful.

METHODICAL INNOVATIONS

Even the first small screening studies using computed tomography (CT) could not demonstrate a reduction in lung cancer-specific mortality until in 2011 the results of the largest randomized controlled low-dose CT screening study in the USA (NLST) were published. The NLST results could show a significant 20 % reduction of lung cancer mortality in elderly and heavy smokers using CT.

PERFORMANCE

Confirmation of the NLST results are urgently needed so that the data of the largest European study (NELSON) are eagerly awaited.

ACHIEVEMENTS

Pooled with the data from several smaller European studies these results will provide important information and evidence for the establishment of future CT screening programs in Europe.

PRACTICAL RECOMMENDATIONS

Randomized controlled trials are the basis of evidence-based medicine; therefore, the positive results of the methodologically very good NLST study cannot be ignored, even if it is the only such study completed so far with highly convincing conclusions. The NLST results clearly demonstrate that positive effects for the health of the population can only be expected if the processes are clearly defined and the quality is assured.

The burden of lung cancer mortality attributable to fine particles in China

Although studies have examined the associations between fine particles (PM_2.5) and lung cancer mortality in US and European countries, the evidence is still limited for China. In addition, no study has provided estimates of spatial variation in lung cancer mortality attributable to PM_2.5 in China. In this study, we quantified the associations between lung cancer mortality and PM_2.5, using a spatiotemporal model with observed data of lung cancer mortality from 75 communities from the National Cancer Registration of China from 1990 to 2009 and the annual concentrations of PM_2.5 at 0.5°×0.5° spatial resolution. We also estimated lung cancer mortality burden attributable to PM_2.5 in China, with predicted county level lung cancer deaths in 2005. We found that the PM_2.5-lung cancer mortality associations were non-linear, with thresholds of 40μg/m³ overall, 45μg/m³ for male, 42μg/m³ for female, 45μg/m³ for those aged 30-64years, 48μg/m³ for those aged 65-74years, and 40μg/m³ for those aged 75years and more, above which the relative risks were 1.08 (95% CI: 1.07, 1.09), 1.07 (95% CI: 1.05, 1.08), 1.12 (95% CI: 1.1, 1.14), 1.05 (95% CI: 1.04, 1.07), 1.07 (95% CI: 1.06, 1.09), and 1.14 (95% CI: 1.12, 1.16) respectively. There were 51,219 (95% CI: 45,745-56,512) lung cancer deaths attributed to PM_2.5 in 2005, with attributable fractions of 13.7% (95% CI: 12.23-15.11%) overall, 10.01% (95% CI: 8.37-11.58%) for men, 18.06% (95% CI: 15.81-20.18%) for women, 8.35% (95% CI: 6.07-10.51%) for those aged 65-74years, 9.73% (95% CI: 7.6-11.75%) for those aged 65-74years, 21.7% (95% CI: 19.27-23.99%) for those aged 75years or more. In conclusion, assuming a causal relation a reduction in exposure levels of PM_2.5 below thresholds would avert a substantial number of deaths from lung cancer in China.

Metabolic syndrome and total cancer mortality in the Third National Health and Nutrition Examination Survey

PURPOSE

Although metabolic syndrome incidence has substantially increased during the last few decades, it largely remains unclear whether this metabolic disorder is associated with total cancer mortality. The present study was carried out to investigate this important question.

METHODS

A total of 687 cancer deaths were identified from 14,916 participants in the third National Health and Nutrition Examination Survey by linking them to the National Death Index database through December 31, 2006. Cox proportional hazards regression was performed to calculate hazard ratios (HR) and 95% confidence intervals (CI) for total cancer mortality in relation to metabolic syndrome and its individual components.

RESULTS

After adjustment for confounders, a diagnosis of metabolic syndrome was associated with 33% elevated total cancer mortality. Compared with individuals without metabolic syndrome, those with 3, 4 and 5 abnormal components had HRs (95% CIs) of 1.28 (1.03-1.59), 1.24 (0.96-1.60), and 1.87 (1.34-2.63), respectively (p-trend = 0.0003). Systolic blood pressure and serum glucose were associated with an increased risk of death from total cancer [HR (95% CI) for highest vs. lowest quartiles: 1.67 (1.19-2.33), p-trend = 0.002 and 1.34 (1.04-1.74), p-trend = 0.003, respectively]. Overall null results were obtained for lung cancer mortality. The effects of metabolic syndrome and its components on non-lung cancer mortality were generally similar to, but somewhat larger than, those for total cancer mortality.

CONCLUSION

Our study is among the first to reveal that metabolic syndrome is associated with increased total cancer mortality.

[Lung cancer screening - risk stratification : Who should undergo screening?]

Lung cancer is one of the leading causes of deaths in Europa and the USA. In approximately 75 % of lung cancer patients, bronchogenic carcinoma is detected at an advanced tumor stage; therefore, therapeutic options which aim at curing the disease in these patients are limited and treatment is mostly palliative. A relatively good prognosis is reserved for the minority of patients where the tumor is detected at an early stage and treatment is potentially curative. For this reason, early diagnosis of lung cancer could save lives. Retrospective analyses of the US national lung screening trial (NLST) showed that especially high-risk populations (e. g. higher age, positive smoking history, overweight and a positive family history for lung cancer) benefit most from lung cancer screening. Thus, the effectiveness of computed tomography (CT) screening can be improved by focusing on high-risk populations. This review article summarizes the risk stratification models of the large European and American screening studies and discusses possible future biomarkers for risk stratification.

Estrogen Plus Progestin and Lung Cancer: Follow-up of the Women's Health Initiative Randomized Trial

INTRODUCTION

In the Women's Health Initiative (WHI) estrogen plus progestin trial, after 5.6 years' intervention and 8 years' median follow-up, more women died from lung cancer in the hormone therapy group (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.16-2.52; P = .01). Now after 14 years' median follow-up, we reexamined combined hormone therapy effects on lung cancer mortality.

PATIENTS AND METHODS

In the WHI placebo-controlled trial, 16,608 postmenopausal women aged 50 to 79 years and with an intact uterus were randomly assigned to once-daily 0.625 mg conjugated equine estrogen plus 2.5 mg medroxyprogesterone acetate (n = 8506) or placebo (n = 8102). Incidence and mortality rates for lung cancer were assessed from multivariant proportional hazard models.

RESULTS

After 14 years' cumulative follow-up, there were 219 lung cancers (0.19% per year) in the estrogen plus progestin group and 184 (0.17%) in the placebo group (HR, 1.12; 95% CI, 0.92-1.37; P = .24). While there were more deaths from lung cancer with combined hormone therapy (153 [0.13%] vs. 132 [0.12%], respectively), the difference was not statistically significant (HR, 1.09; 95% CI, 0.87-1.38; P = .45). The statistically significant increase in deaths from lung cancer observed during intervention in women assigned to estrogen plus progestin was attenuated after discontinuation of study pills (linear trend over time, P = .042).

CONCLUSION

The increased risk of death from lung cancer observed during estrogen plus progestin use was attenuated after discontinuation of combined hormone therapy.

Using lung cancer mortality to indirectly approximate smoking patterns in space

Smoking is the leading cause of lung cancer. Non-smoking factors have been associated with the disease. Existing Swiss survey data only capture the country partially and temporal coverage does not allow for a time lag between exposure to tobacco and lung cancer outbreak. Knowledge about the distribution of tobacco-use is essential to estimate its contribution to disease burden. Bayesian regression models were applied to estimate spatial smoking patterns. Data were provided from the Swiss Health Survey (14521 participants). Regression models with spatial random effects (SREs) were employed to obtain smoking proxies based on mortality rates and SREs adjusted for environmental exposures. Population attributable fractions were estimated to assess the burden of tobacco-use on lung cancer mortality. Correlation between observed smoking prevalence with smoking proxies was moderate and stronger in females. In the absence of sufficient survey data, smooth unadjusted mortality rates can be used to assess smoking patterns in Switzerland.

Exposure-specific lung cancer risks in Chinese chrysotile textile workers and mining workers

OBJECTIVE

Whether there is a difference in the exposure-response slope for lung cancer between mining workers and textile workers exposed to chrysotile has not been well documented. This study was carried out to evaluate exposure-specific lung cancer risks in Chinese chrysotile textile workers and mining workers.

SUBJECTS AND METHODS

A chrysotile mining worker cohort and a chrysotile textile worker cohort were observed concurrently for 26 years. Information on workers' vital status, occupational history and smoking habits were collected, and causes and dates of deaths were verified from death registries. Individual cumulative fiber exposures were estimated based on periodic dust/fiber measurements from different workshops, job title and duration, and categorized into four levels (Q1-Q4). Standardized mortality ratios (SMRs) for lung cancer were calculated and stratified by industry and job title with reference of the national rates. Cox proportional hazard models were fit to estimate the exposure-specific lung cancer risks upon adjustment for age and smoking, in which an external control cohort consisting of industrial workers without asbestos exposure was used as reference group for both textile and mining workers.

RESULTS

SMRs were almost consistent with exposure levels in terms of job titles and workshops. A clear exposure-response relationship between lung cancer mortality and exposure levels was observed in both cohorts. At low exposure levels (Q1 and Q2), textile workers displayed higher death risks of lung cancer than mining workers. However, similarly considerably high risks were observed at higher exposure levels, with hazard ratios of over 8 and 11 at Q3 and Q4, respectively, for both textile and mining workers, after both age and smoking were adjusted.

CONCLUSION

The chrysotile textile workers appeared to have a higher risk of lung cancer than the mining workers at a relatively low exposure level, but no difference was observed at a high exposure level, where both cohorts displayed a considerably high risk.

A fundamental cause approach to the study of disparities in lung cancer and pancreatic cancer mortality in the United States

This study examines how associations between socioeconomic status (SES) and lung and pancreatic cancer mortality have changed over time in the U.S. The fundamental cause hypothesis predicts as diseases become more preventable due to innovation in medical knowledge or technology, individuals with greater access to resources will disproportionately benefit, triggering the formation or worsening of health disparities along social cleavages. We examine socioeconomic disparities in mortality due to lung cancer, a disease that became increasingly preventable with the development and dissemination of knowledge of the causal link between smoking cigarettes and lung cancer, and compare it to that of pancreatic cancer, a disease for which there have been no major prevention or treatment innovations. County-level disease-specific mortality rates for those ≥45 years, adjusted for sex, race, and age during 1968-2009 are derived from death certificate and population data from the National Center for Health Statistics. SES is measured using five county-level variables from four decennial censuses, interpolating values for intercensal years. Negative binomial regression was used to model mortality. Results suggest the impact of SES on lung cancer mortality increases 0.5% per year during this period. Although lung cancer mortality rates are initially higher in higher SES counties, by 1980 persons in lower SES counties are at greater risk and by 2009 the difference in mortality between counties with SES one SD above compared to one SD below average was 33 people per 100,000. In contrast, we find a small but significant reverse SES gradient in pancreatic cancer mortality that does not change over time. These data support the fundamental cause hypothesis: social conditions influencing access to resources more greatly impact mortality when preventative knowledge exists. Public health interventions and policies should facilitate more equitable distribution of new health-enhancing knowledge and faster uptake and utilization among lower SES groups.