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D. Christiani

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    PLEN 01 - Lung Cancer Prevention and Screening (ID 50)

    • Event: WCLC 2015
    • Type: Plenary
    • Track: Plenary
    • Presentations: 1
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      PLEN01.02 - Epidemiology of Lung Cancer/Smoking in the World (ID 2039)

      08:15 - 09:45  |  Author(s): D. Christiani

      • Abstract
      • Presentation
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      Lung cancer remains the most common cancer in the world. Worldwide, the leading cause of cancer mortality in men and the second leading cause in women. 1.8 million new cases were diagnosed in 2012. About 58% of lung cancer cases occurred in low and middle income countries. Although by far not the only known or suspected lung carcinogen, cigarette smoking remains the principal cause of lung cancer and is estimated to be responsible for 85% of all types of this cancer. The major risk factors and risk modifiers for lung cancer include: Cigarette Smoking Secondhand Smoke (SHS) Air Pollution Radon Occupational Exposures (e.g., asbestos, silica, Chromium, radon) Lung Cancer Susceptibility Genes Aspirin/NSAIDs Use (protective) Dietary vitamin D (protective) HRT – possibly protective. I will cover updates on our understanding of the major risk factors for lung cancer in the USA and globally. Smoking Smoking causes an estimated 170,000 cancer deaths in the U.S. every year (American Cancer Society) and the incidence among women is rising. Lung cancer now surpasses breast cancer as the number one cause of death among women. Globally, cigarette consumption has changed over the decades, with China now the number one consumer (44%) of cigarettes in the world, while the USA is consumes about 5%. In the USA, “Second Hand Smoke” is the third leading cause of lung cancer and responsible for an estimated 3,000 lung cancer deaths every year. Globally, the number of SHS related cancer deaths is unknown, but surely rising. SHS is also referred as ‘environmental tobacco smoke (ETS)’, ‘passive smoking’ or ‘involuntary smoking’. IARC has deemed SHS is “carcinogenic to humans”, with an increased risk of 20% for women and of 30% for men among never smokers who are exposed to SHS (i.e., environmental tobacco smoke) from their spouse. Ambient Air Pollution IARC has classified outdoor air pollution - as a whole - as “carcinogenic to humans (Group 1)”. Outdoor air pollution has been shown to cause lung cancer and bladder cancer, pointing to the role of overlapping carcinogen exposure to compounds such as polycylic aromatic compounds (PAC). The most recent data from the Global Burden of Disease (GBD) Project indicate that in 2010, 3.2 million deaths worldwide resulted from air pollution alone, including 223,000 from lung cancer. Radon Radon is an odorless, colorless, radioactive gas that causes lung cancer. IARC classifies radon and its progeny as “carcinogenic to humans” (Class I), and the US EPA lists radon as the second leading cause of lung cancer in the US and the number one cause of lung cancer among non-smokers. Originally described as a risk factor in underground miners (among both smokers and non-smokers, with synergistic interaction with smoking), the U.S. EPA estimates that 1 of 15 homes in the US (as many as 1 of 3 homes in some states)-about 7 million homes-have high radon levels. Occupational Exposures: Asbestos In North America, and most other high income countries, asbestos has been the most prevalent occupational lung carcinogen exposure. All forms of asbestos have been classified as a known human carcinogen (by the U.S. Department of Health and Human Services, EPA, and the IARC). About 125 million people in the world are exposed to asbestos at the workplace. According to WHO estimates, more than 107,000 deaths each year are attributable to occupational exposure to asbestos. Exposure to asbestos, including chrysotile, causes cancer of the lung, larynx and ovaries, and also mesothelioma. Co-exposure to tobacco smoke and asbestos fibers substantially increases the risk for lung cancer (multiplicative interaction). Heritable Factors: Common Genetic Variants GWAS provide novel insights into the development of LC. Genetic factors are increasingly recognized to be important in the etiology of LC: 15q25.1 (CHRNA5-CHRNA3-CHRNB4) 5p15.33 (TERT-CLPTM1) 6p21.33 (BAT3-MSH5) Follow up studies that pool data international as part of a large consortium (International Lung Cancer Consortium - ILCCO) have identified other common variants at multiple loci influencing LC risk, and these include BRACA1. Studies of pleiotropy are well underway. Additionally, GWAS studies globally, such as one from China, have identified unique, population-specific, risk loci. COPD and Lung Cancer risk COPD and LC are the 4[the] and 7[th] leading causes of death worldwide. The coexistence of COPD is an important marker of future risk of LC among smokers. Epidemiologic studies have shown that 50-70% of LC patients have co-existing impaired lung function or COPD. And, not surprisingly, 90% of combined LC and COPD cases are attributable to cigarette smoking. Recently, we have found that the co-existence of COPD with lung cancer also negatively influences survival among patients with all stages. Conclusion Lung cancer remains the number one cancer threat to the world’s populations. Lung cancer epidemiology continues to evolve and as we understand more about the origins and behavior of lung cancer, the more opportunities we will have for prevention and control of this deadly disease.

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