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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


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    1. Lung cancer: a preventable disease Epidemiology addresses issues related to  • Heredity, • Life-style, and • Environment. Censina R. Apap, MD FCCP C.R. Apap

    2. 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

    3. 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

    4. C.R. Apap

    5. 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

    6. Genetic factors • Aryl-hydrocarbon-hydroxlase system (AHH) converts weak carcinogens in cigarette smoke into active carcinogens C.R. Apap

    7. 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

    8. 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. C.R. Apap

    9. 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 C.R. Apap

    10. Snap: Lung Cancer: C.R. Apap

    11. In males 35 – 75 years: 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

    12. Biology of lung cancer Oncogenic event  pluripotent cell  • small cell lung cancer • large cell lung cancer • squamous cell lung cancer • adenocarcinoma Souhami C.R. Apap

    13. 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%) C.R. Apap

    14. 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 C.R. Apap

    15. 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 C.R. Apap

    16. 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? C.R. Apap

    17. 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 C.R. Apap

    18. 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. C.R. Apap

    19. 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 • Today’s??-Smoking and Kreyberg Lung Tumors • What if I smoke cigarettes? C.R. Apap