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Lung cancer: a preventable disease. Epidemiology addresses issues related to  Heredity, Life-style, and Environment. Censina R. Apap, MD FCCP. Lung cancer: how did it start?. First described in 1420 in Schneeberg-Austria after the opening of cobalt- and nickel mines.

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Lung cancer a preventable disease l.jpg
Lung cancer: a preventable disease

Epidemiology addresses issues related to 

  • Heredity,

  • Life-style, and

  • Environment.

Censina R. Apap, MD FCCP

C.R. Apap


Lung cancer how did it start l.jpg
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.

C.R. Apap


Cause and effect cigarette smoking l ung cancer l.jpg
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.

C.R. Apap



Risk factors l.jpg
Risk factors

  • 1. Tobacco (and passive) smoking

  • 2. Air pollution in urban areas

  • 3. Chronic conditions: COPD

  • 4. Occupational exposure (man-made

    mineral fibre)

C.R. Apap


Genetic factors l.jpg
Genetic factors

  • Aryl-hydrocarbon-hydroxlase system (AHH) converts weak carcinogens in cigarette smoke into active carcinogens

C.R. Apap


Prevention of lung cancer l.jpg

80% of lung cancer cases are associated with many years of tobacco smoking, and can therefore be AVOIDED.

10% of lung cancer cases are associated with exposure to occupational carcinogens, and can therefore be AVOIDED.

Prevention of lung cancer

C.R. Apap


Histological types of lung cancer l.jpg
Histological types of lung cancer tobacco smoking, and can therefore be

  • 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.

C.R. Apap


Origin and characteristics of various types of lung cancer l.jpg
Origin and characteristics of various types of lung cancer tobacco smoking, and can therefore be

  • 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

C.R. Apap


Snap lung cancer l.jpg
Snap: Lung Cancer: tobacco smoking, and can therefore be

C.R. Apap


Histological distribution of lung cancer depends on age and sex l.jpg

In males 35 – 75 years: tobacco smoking, and can therefore be

Squamous cell carcinoma

Small cell cancer

Adenocarcinoma

Large cell cancer

In females 35 – 75 years:

Adenocarcinoma

Small cell cancer

Squamous cell carcinoma

Large cell cancer

Histological distribution of lung cancer depends on age and sex

C.R. Apap


Biology of lung cancer l.jpg
Biology of lung cancer tobacco smoking, and can therefore be

Oncogenic event  pluripotent cell

  • small cell lung cancer

  • large cell lung cancer

  • squamous cell lung cancer

  • adenocarcinoma

    Souhami

C.R. Apap


Histological diversity of lung cancer sclc l.jpg
Histological diversity of lung cancer (SCLC) tobacco smoking, and can therefore be

Pluripotent cell or stem cell can differentiate into:

  • Small cell lung cancer

  • classical cell line (70%)

  • variant cell line (30%)

C.R. Apap


Histological diversity of lung cancer nsclc l.jpg
Histological diversity of lung cancer (NSCLC) tobacco smoking, and can therefore be

Pluripotent cell or stem cell can differentiate into:

  • Non-small cell lung cancer

  • Squamous cell lung cancer

  • Non-squamous cell lung cancer

C.R. Apap


Early detection of lung cancer l.jpg
Early detection of lung cancer tobacco smoking, and can therefore be

  • 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

C.R. Apap


Prevention of lung cancer16 l.jpg
Prevention of lung cancer tobacco smoking, and can therefore be

  • 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?

C.R. Apap


Conclusions l.jpg
Conclusions tobacco smoking, and can therefore be

  • 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

C.R. Apap


Recommended literature l.jpg
Recommended literature tobacco smoking, and can therefore be

  • 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.

C.R. Apap


More information on the www l.jpg
More Information tobacco smoking, and can therefore be 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

  • Today’s??-Smoking and Kreyberg Lung Tumors

  • What if I smoke cigarettes?

C.R. Apap


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