Lung cancer: a preventable disease

Epidemiology addresses issues related to Heredity, Life-style, and Environment.

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Lung cancer: how did it start?

First described in 1420 in Schneeberg-

Austria after the opening of cobalt- and nickel mines. Incidence was very low in the 19th century. Is now worldwide the commonest form of cancer in men, and the fifth most frequent cancer in women.
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Cause and effect: cigarette smoking lung cancer

Men started smoking cigarettes in 1920s

20 years later, incidence of lung cancer in men climbed sharply. In 1940s, women became cigarette smokers 20 years later, a similar dramatic increase in lung cancer among women.

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Yearly incidence rates of lung cancer

140
Yearly Incidence per 100.000

120 100 80 60 40 20 0 Males Females Sex distribution Maoris in New Zealand American blacks in San Francisco Bay Area Inhabitants of West Scotland Belgium India African populations

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Risk factors
1. Tobacco (and passive) smoking
2. Air pollution in urban areas 3. Chronic conditions: COPD 4. Occupational exposure (man-made

mineral fibre)

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Genetic factors
Aryl-hydrocarbon-hydroxlase system

(AHH) converts weak carcinogens in cigarette smoke into active carcinogens

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Prevention of lung cancer

80% of lung cancer 10% of lung cancer

cases are associated with many years of tobacco smoking, and can therefore be AVOIDED.

cases are associated with exposure to occupational carcinogens, and can therefore be AVOIDED.

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Histological types of lung cancer

2 major types:
small-cell lung cancer, and nonsmall-cell lung cancer, which is further

subdivided into: squamous cell carcinoma, adenocarcinoma, and large-cell carcinoma.

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Origin and characteristics of various types of lung cancer

Squamous cell lung cancer: commonest

type in males, central origin, manifests early Adenocarcinoma: commonest type in females, peripheral origin, manifests late Large cell lung cancer: least common type, peripheral origin Small cell lung cancer: most aggressive type, central origin, spreads quickly
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Snap: Lung Cancer:

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Histological distribution of lung cancer depends on age and sex

In males 35 75 In females 35 75

years: Squamous cell carcinoma Small cell cancer Adenocarcinoma Large cell cancer
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years: Adenocarcinoma Small cell cancer Squamous cell carcinoma Large cell cancer
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Biology of lung cancer

Oncogenic event pluripotent cell small cell lung cancer large cell lung cancer squamous cell lung cancer adenocarcinoma Souhami
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Histological diversity of lung cancer (SCLC)

Pluripotent cell or stem cell can differentiate into: Small cell lung cancer classical cell line (70%) variant cell line (30%)

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Histological diversity of lung cancer (NSCLC)

Pluripotent cell or stem cell can differentiate into: Non-small cell lung cancer Squamous cell lung cancer Non-squamous cell lung cancer

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Early detection of lung cancer

High mortality rate is related to low cure rate

(13%) Low cure rate is related to lack of early detection measures Past screening measures: annual chest x-rays, quarterly sputum cytology have not been successful Biologic and genetic features offer new possibilities
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Prevention of lung cancer

Primary prevention

85 87% of lung cancers are caused by tobacco smoking Secondary prevention Diet and vitamin consumtion may play a role. Prevention strategies based on genetic and biologic changes Replacement of missing suppressor genes?
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Conclusions
No currently established means for the

screening or early detection of lung cancer 85-88% of all lung cancers are caused by active or passive exposure to tobacco smoke Reduction of tobacco consumption still is the most important strategy

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Recommended literature
Doll, Peto et al. Mortality in relation to

smoking: 20 years observation on male British doctors. Br. Med. J., 1976 (2) pp 1525-1536. Law MR. Genetic predisposition to lung cancer. Br J Cancer 1990 (61); 195-206. Carney DN. The biology of lung cancer. Current topics in lung cancer 1991, pp 3-14.
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More Information on the WWW

CancerNet: Statistical Data Sources

UICC GLOBALink
Institute of Epidemiology Department of Epidemiology Links

SEER Cancer Statistics Review, 1973-1996

Cancer Epidemiology, Biomarkers Prevention

Table of Contents Lecture Link Application Todays??-Smoking and Kreyberg Lung Tumors What if I smoke cigarettes?
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