Epidemiology of Lung Cancer

Our plain-English summary of Epidemiology of Lung Cancer, by A.G. Schwartz, M.L. Cote (Advances in Experimental Medicine and Biology, 2016).

The study

• Authors: A.G. Schwartz, M.L. Cote
• Journal: Advances in Experimental Medicine and Biology
• Published: 2016;893:21-41
• Type of article: Review
• Cited by: 142 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Lung cancer continues to be one of the most common causes of cancer death despite understanding the major cause of the disease: cigarette smoking. Smoking increases lung cancer risk 5- to 10-fold with a clear dose-response relationship. Exposure to environmental tobacco smoke among nonsmokers increases lung cancer risk about 20%. Risks for marijuana and hookah use, and the new e-cigarettes, are yet to be consistently defined and will be important areas for continued research as use of these products increases. Other known environmental risk factors include exposures to radon, asbestos, diesel, and ionizing radiation. Host factors have also been associated with lung cancer risk, including family history of lung cancer, history of chronic obstructive pulmonary disease and infections. Studies to identify genes associated with lung cancer susceptibility have consistently identified chromosomal regions on 15q25, 6p21 and 5p15 associated with lung cancer risk. Risk prediction models for lung cancer typically include age, sex, cigarette smoking intensity and/or duration, medical history, and occupational exposures, however there is not yet a risk prediction model currently recommended for general use. As lung cancer screening becomes more widespread, a validated model will be needed to better define risk groups to inform screening guidelines.

In plain English

This book chapter was a review, not a new study. The authors summarized published research on what raises the risk of lung cancer. Topics included cigarette smoking and other tobacco and marijuana use, second-hand smoke, radon, air pollution, asbestos, diesel exhaust, ionizing radiation, family history, inherited genes, chronic obstructive pulmonary disease (COPD), infections, and models that predict lung cancer risk. All of the figures came from other studies. On asbestos, the chapter called it a well-established occupational risk factor for lung cancer. It cited an estimate that asbestos-related mesothelioma and lung cancer together account for 10,000 deaths a year in the United States. It reported effect sizes (odds ratios) of 2.0 to 6.0 depending on fiber type, without naming the fibers, and described an apparent synergistic relationship between smoking and asbestos exposure. Several of the published risk prediction models it reviewed used asbestos exposure as a variable. The authors stated that 80 to 90 percent of lung cancers are attributable to cigarette smoking. They concluded that smoking remains the overwhelming risk factor and noted that no risk prediction model is yet recommended for general use.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: narrative review (book chapter) of published epidemiologic research on lung cancer risk factors
• Who was studied: No study population of its own. The chapter reviewed published studies, meta-analyses, pooled analyses and risk prediction models from the United States, Europe and Asia.
• Exposure: Cigarette, pipe and cigar smoking, second-hand smoke, marijuana, hookah, e-cigarettes, radon, air pollution, asbestos (fiber types not named), diesel exhaust, ionizing radiation, family history, genetic variants, COPD and infections
• Main results:
  • The chapter described asbestos as a well-established occupational risk factor for lung cancer.
  • Citing another study, the chapter stated that asbestos exposure is related to both mesothelioma and lung cancer, which together account for 10,000 deaths a year in the United States.
  • Citing other studies, the chapter reported lung cancer effect sizes for asbestos of OR = 2.0 to 6.0, depending on fiber type (the fibers were not named).
  • Citing another study, the chapter reported an apparent synergistic relationship between cigarette smoking and asbestos exposure.
  • Asbestos exposure was a variable in several of the published risk prediction models reviewed. One example is the Bach et al. model built on 18,172 Carotene and Retinol Efficacy Trial participants, who were heavy smokers or asbestos-exposed men.
  • Citing a Detroit case-control study in women, the chapter reported that non-small cell lung cancer cases with COPD were more likely than cases without COPD to have a history of asbestos exposure.
  • The authors stated that 80 to 90 percent of all lung cancers are attributable to cigarette smoking.
  • Citing a meta-analysis, nonsmoking women exposed to their spouse's smoking had OR = 1.20 (95% CI 1.10 to 1.29) compared with unexposed women.
  • Citing a meta-analysis of 13 European studies, lung cancer risk increased by 8.4% (95% CI 3.0 to 15.8) per 100 Becquerels per cubic metre increase in measured radon.
  • The authors stated that no lung cancer risk prediction model is yet recommended for general use.
• The authors' conclusion: The authors concluded that cigarette smoking continues to be the overwhelming risk factor for lung cancer, while other identified risk factors include radon, asbestos, family history and genetic susceptibility.
• Limitations the authors state:
  • The authors noted that measuring second-hand smoke exposure is less standardized than measuring personal smoking.
  • The authors noted that most COPD studies rely on self-reported COPD, which is subject to recall bias and misclassification.
  • The authors noted that risk prediction models are better validated on an independent data set than by cross-validation within the same study.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Epidemiology, Lung Cancer, Dose-response relationship, Occupational Exposure, Low-Dose CT Screening.

Related studies

• Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition) — A.J. Alberg, J.G. Ford, et al. (2007)
• Smoking and the molecular epidemiology of lung cancer — D.C. Christiani (2000)
• Epidemiology of asbestos-related diseases — R.A. Lemen, J.M. Dement, et al. (1980)
• Epidemiology of gastrointestinal cancer — I.J. Selikoff (1974)
• Development and validation of a lung cancer risk prediction model for African-Americans — C.J. Etzel, S. Kachroo, et al. (2008)
• Chronic obstructive lung diseases and risk of non-small cell lung cancer in women — A.G. Schwartz, M.L. Cote, et al. (2009)

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