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

C.R. Apap

prevention of lung cancer
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
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

origin and characteristics of various types of lung cancer
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

histological distribution of lung cancer depends on age and sex
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

biology of lung cancer
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

histological diversity of lung cancer sclc
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

histological diversity of lung cancer nsclc
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

early detection of lung cancer
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

prevention of lung cancer16
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

conclusions
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

recommended literature
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

more information on the www
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