Lung cancer

“ Our estimate that approximately 16,000 lung cancer deaths would have occurred among individuals of European descent and African Americans, ages 40–79 y in 2004, had the never-smoker rates applied, is larger than the number reported for five of the 12 most common fatal cancers in the US in that year. Lung cancer is obviously a significant public health and medical problem, even beyond the overwhelming disease burden caused by tobacco smoking.
Do Women Have Higher Risk Than Men? ”

“ Not all lung cancers caused by factors other than active smoking occur in people who have never smoked; the background risk resulting from other exposures and their interactions with genetic and epigenetic processes also affects current and former smokers. However, lung cancer occurrence among never-smokers is of special interest for several reasons. First, geographic and temporal variations in risk caused by other environmental exposures and/or differences in biological susceptibility should, in principle, be more easily detected in populations that have never smoked. ”

“ The lung cancer incidence and death rates among never-smokers are predictably much lower than those of smokers. Men who report never smoking have a 1.1% cumulative risk of dying from lung cancer before age 85 y in the pooled analysis of individuals of European descent ”

“ To our knowledge, this is the first comprehensive effort to pool and compare data on lung cancer incidence and death rates in lifelong nonsmokers from multiple sources. The combination of data from cohort studies and population registries provides a more coherent picture of how background lung cancer risk varies by age, sex, geographic location, race/ethnicity, and time period than can be obtained from any single study. ”

“ The researchers' detailed statistical analyses reveal, for example, that lung cancer death rates in African Americans and in Asians living in Korea and Japan (but not among Asians living in the US) are higher than those in people of the European continental ancestry group. They also show that men have higher death rates from lung cancer than women irrespective of racial group, but that women aged 40–59 years have a slightly higher incidence of lung cancer than men of a similar age. ”

“ Furthermore, a person's cumulative lifetime risk of developing lung cancer is related to how much they smoke, to how many years they are a smoker, and—if they give up smoking—to the age at which they stop smoking. ”

“ These technologies particularly affect the rates in older patients, increasing the likelihood that primary lung cancers will be detected, and decreasing the chances that pulmonary metastases will be misdiagnosed as lung cancer. ”

“ Men and women of European descent who smoked actively had lung cancer death rates that were 21.9 and 13.7 times higher, respectively, than the rates of never-smokers, when the rates were standardized to all ages 40+ y. ”

“ Two and one-half million Americans have emphysema, while almost eight million suffer from chronic bronchitis. Furthermore, it is expected that deaths from lung cancer will surpass breast cancer as the leading cause of cancer deaths among American women during this decade.
Leading the fight in the voluntary sector to prevent illness, disability, and death from lung disease is the American Lung Association-the Christmas Seal people-a nonprofit public health organization supported by individual contributions to Christmas Seals and other donations. ”

“ It is sobering to realize that strong, scientific evidence links many forms of cancer to the way we live, especially the foods we eat and the use of tobacco. We know, for example, that smoking causes 30 percent of all cancer deaths. Just as important, though, we know that quitting smoking, even after many years, can reduce the risk of cancer. For two years now, we have seen a decreasing incidence of lung cancer among white males, and it looks as if the rate for white females is moving in the same direction. ”

“ Diagnostic errors are especially problematic when comparing lung cancer rates across different time periods or countries at different stages of economic development. Missed diagnoses almost certainly contribute to the low recorded rates of lung cancer in Africa and parts of India during the 1980s, and to the lower incidence and death rates recorded in the oldest age groups. ”

“ Similarly, the incidence of lung cancer is higher in African American women than in women of European descent who have never smoked (RR = 1.56, 95% CI = 1.1–2.1) ; there are too few cases among African American men to make meaningful comparisons. ”

“ The basic assumption of cigarette-equivalents procedures is that the lung cancer risks in passive and active smokers are equivalently indexed by the common measure of exposure to tobacco smoke, i.e., a common value of the surrogate measure of exposure in an active and a passive smoker would imply the same lung cancer risk in both. ”

“ Smoking-related cancers are the most preventable. This past year, new data showed that the incidence of lung cancer in white men decreased significantly for the first time in at least half a century. This decrease comes 20 years after men began to stop smoking in substantial numbers. This proves that individuals can successfully reduce their cancer risk by not smoking. ”

“ Some 50 million Americans smoke-most are adults, but a significant number are teenagers. Smokers bear the brunt of our annual national tragedy of more than 200,000 cases of lung and mouth cancers and more than 100,000 cases of pancreatic, kidney, and bladder cancers. No new drug-no new prevention or screening technique-would strike as powerful a blow in our fight against cancer as the single decision by millions of smokers to quit their habit once and for all. ”

“ The history of cancer in the lung in the main corresponds with cases of similar types of cancer elsewhere. The grave symptoms appear earlier in cases of mediastinal cancer than in cancer of the lungs proper. Death may result from asphyxia; from bronchial obstruction; from pulmonary oedema occurring suddenly, as in chronic alcoholism; from embolism of the pulmonary artery; or from pleural effusion. Life may gradually ebb away through general asthenia with malnutrition ”

“ Biomarker studies in humans were included if they examined endpoints directly related to lung cancer risk or pathogenesis. All types of lung cancers (SCLC, NSCLC, mesothelioma) were included.
In order to be included, observational studies had to employ an objective measure of preformed vitamin A status, such as serum, plasma, or lung tissue retinol levels, and had to examine the risk of lung cancers either prospectively or be conducted in patients with lung cancers comparing vitamin A status to patients without cancer. ”

“ EPA explains that its biological plausibility findings rest on three considerations. First, active smoking causes lung cancer in humans, and MS is chemically similar to ETS. Second, considerable evidence exists that nonsmokers exposed to ETS absorb and metabolize significant amounts of ETS, including carcinogenic compounds. Third, laboratory studies show ETS can cause cancer in animals and damage DNA, which scientists recognize as being an instrumental mechanism for cancer development. ”

“ Healthy behavior can greatly reduce the risk of cancer. About 45 million Americans have already quit smoking, but this most preventable cause of cancer continues to damage public health. Tobacco use causes nearly all cases of lung cancer and more than one-third of all cancer deaths. Children can become addicted to tobacco in a very short time, placing a serious responsibility on adults to help young people stop smoking, or ideally, never start. ”

“ EPA further revealed that such differences affect carcinogenicity; "Pipe and cigar smokers, who inhale less deeply than cigarette smokers, have lower risks of lung cancer than cigarette smokers." Id. at 4-10.
In a draft response to comments, Kenneth Brown, the primary author of Chapters 5 and 6, and Appendices C and D, rejects using a cigarette-equivalents analysis because "there are differences between active and passive smoking that may affect carcinogenic risk that are not fully understood." ”

“ Among women in the United States who develop cancer, lung cancer claims the most lives, followed closely by breast cancer. An estimated 1 in 8 women will be diagnosed with breast cancer at some point in their lives-up from 1 in 20 just two decades ago. ”

“ Embolism and thrombosis, with the ordinary symptoms, may complicate the course of pulmonary cancer and obscure the diagnosis.
The duration of cancer of the lung is fixed by Walsh at 13.2 months, mean average, maximum, at 27 months; minimum, at 3.5 months; but this is based on a confessedly small contingent of cases. The first symptoms, dry cough, pain in the chest, difficulty of breathing, may last for some years without alarming the patient. After the more dangerous phenomena appear the course is often more rapid. ”