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A. Allan



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    ORAL 24 - CT Detected Nodules - Predicting Biological Outcome (ID 122)

    • Event: WCLC 2015
    • Type: Oral Session
    • Track: Screening and Early Detection
    • Presentations: 1
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      ORAL24.03 - Increasing Incidence of Non-Smoking Lung Cancer: Presentation of Patients with Early Disease to a Tertiary Institution in the UK (ID 2717)

      10:45 - 12:15  |  Author(s): A. Allan

      • Abstract
      • Presentation
      • Slides

      Background:
      Lung cancer in never-smokers is recognised as a distinct entity. Many are expected to present late. As there are no established aetiological factors, identification of patients at risk is challenging. The aim of the study is to define the incidence and clinical features of never-smokers presenting sufficiently early for surgery to determine if it is possible to identify patients at risk.

      Methods:
      We retrospectively analysed data from a prospectively collected database of patients who underwent surgery at our institution. The incidence was defined as number of never-smokers versus current and ex-smokers by year. Clinical features at presentation were obtained and collated as frequency (percentage).

      Results:
      A total of 2170 patients underwent surgical resection for lung cancer from March 2008 to November 2014. The annual incidence of developing lung cancer in never-smokers increased from 13, 15, 18, 19, 20, 20 to 28 percent respectively, attributable to an absolute increase in number and not a change in the ratio of never smokers to current and ex-smokers. A total of 436 (20%) patients were never smokers. The mean age at presentation was 60 (16 SD) years and 295 (67%) were female. Good lung function was observed with mean predicted FEV1 of 90% (23 SD) and FVC of 97% (25 SD). The majority histological types were adenocarcinoma 54% and carcinoid 27%. The main presenting features were non-specific consisting of cough in 142 (34%), chest infections in 75 (18%) and haemoptysis in 46 (11%). Recurrent chest infections were predominantly a symptom of central carcinoid tumours (30 versus 15 percent; P=0.004). A total of 59 (14%) were detected on incidental chest film, 127 (30%) on incidental CT, 32 (7%) on incidental PET/CT and 4(1%) on incidental MRI.

      Conclusion:
      We observed more than double the annual incidence of never smokers presenting with non small cell lung cancer, in the last 7 years, increasing from 13 to 28 percent, and hypothesise that this is representative of the UK, as we are one of the highest surgical volume centres in our country. Patients present with non-specific symptoms and the majority were detected on incidental imaging. We conclude that imaging is likely to play a more important role and further efforts need to be expended on early detection of lung cancer in this increasing cohort without any observable risk factors.

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    P3.06 - Poster Session/ Screening and Early Detection (ID 220)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Screening and Early Detection
    • Presentations: 1
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      P3.06-015 - Is the Development of Primary Lung Adenocarcinoma Simply Due To 'Bad Luck'? (ID 2825)

      09:30 - 17:00  |  Author(s): A. Allan

      • Abstract
      • Slides

      Background:
      Recently, Tomasetti and Vogelstein proposed that the variation in cancer risk among tissue is explained by the number of stem cell division, and this was widely interpreted as “bad luck” due to random mutations arising during DNA replication in normal non-cancerous stem cells. Smoking is widely considered as the main aetiological risk factor for the lung cancer and the aim of our study is to evaluate the hypothesis comparing the differences in proportions of the two main histological subtypes in smokers and never smokers in a patients with early stage primary lung cancer to determine the impact of smoking on the development of squamous and adenocarcinoma.

      Methods:
      Data were retrospectively analysed from a prospectively collated database at our institution over a 7 year period. Histological data were extracted and compared for the two main historical subtypes of squamous and adenocarcinoma (subtyped according to the new IASLC adenocarcinoma classification). Frequencies were compared using Fishers exact or Chi square tests as appropriate to the data.

      Results:
      A total of 2170 patients underwent surgical resection for lung cancer at our institution from March 2008 to November 2014 of which 436 (20%) patients were never smokers. The mean age (SD) was 66 (12) years and 48% were female. The relative proportion of patients with squamous carcinoma was significantly different between smokers 323 (27.0%) and never-smokers 16 (5.7%) with P <0.001 with a risk ratio of 4.70 (95% CI 2.9 to 7.6). However the relative proportions between patients with adenocarcinoma were similar between smokers 578 (48.3%) and never-smokers (54.4%) P=0.06 with a risk ratio of 0.89 (0.79 to 1.00).

      Conclusion:
      Our results suggest that smoking remains an important aetiological risk factor for the development of primary lung squamous cell carcinoma. For adenocarcinoma, the relative proportions between smokers and never-smokers were similar (in fact lower for smokers) supporting Tomasetti and Vogelstein hypothesis of random mutations arising during DNA replication in normal non-cancerous stem cells– or simply put as “bad luck”.

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