Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition)

Our plain-English summary of Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition), by A.J. Alberg, J.G. Ford, J.M. Samet, et al (Chest, 2007).

The study

• Authors: A.J. Alberg, J.G. Ford, J.M. Samet, American College of Chest Physicians
• Journal: Chest
• Published: 2007;132(3 Suppl):29S-55S
• Type of article: Review
• Cited by: 463 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The objective of this study was to summarize the published literature concerning the epidemiology of lung cancer.

Methods: A narrative review of published evidence was conducted, identifying and summarizing key reports that describe the occurrence of lung cancer in populations and factors that affect lung cancer risk.

Results: In the United States, lung cancer remains the leading cause of cancer death in both men and women, even though an extensive list of modifiable risk factors has long been identified. The predominant cause of lung cancer is exposure to tobacco smoke, with active smoking causing most cases but passive smoking also contributing to the lung cancer burden.

Conclusions: The reductions in smoking prevalence in men that occurred in the late 1960s through the 1980s will continue to drive lung cancer mortality rates downward in men during the first portion of this century, but rates in women have not yet begun to decrease. Fortunately, exposures to major occupational respiratory carcinogens have largely been controlled, but the population is still exposed to environmental causes of lung cancer, including radon, the second leading cause of lung cancer death.

In plain English

This article was a narrative review, not a new study. The authors summarized published research on the patterns and causes of lung cancer, drawing on their own files and MEDLINE searches. They said they did not attempt a comprehensive systematic synthesis or grade the evidence. They reported that cigarette smoking accounts for about 90% of lung cancer cases in the United States and other countries where cigarette smoking is common. Most estimates of the share contributed by workplace exposures included values from 9 to 15%. The authors called asbestos a well-established occupational carcinogen. They cited earlier work: a 1955 study by Doll that found a 10-fold elevation in lung cancer risk among asbestos textile workers at a UK factory, and later studies finding a sevenfold excess among US insulation workers. They wrote that asbestos and smoking act together in a way compatible with a multiplicative effect. They also wrote that whether lung cancer results from asbestos itself or from asbestosis remains controversial. The authors concluded that the lung cancer pandemic is a consequence of widespread addiction to cigarettes.

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 of published evidence (not a systematic review; evidence was not graded)
• Who was studied: published reports on the occurrence and risk factors of lung cancer, identified from the authors' files and MEDLINE searches
• Exposure: multiple lung cancer risk factors, including active and passive smoking, asbestos and other occupational agents, radiation and radon, air pollution, diet, and host factors
• Main results:
  • The authors stated that cigarette smoking accounts for approximately 90% of lung cancer cases in the United States and other countries where cigarette smoking is common.
  • Estimates from case-control studies of the proportion of lung cancer contributed by occupational exposures ranged widely, but most included values from 9 to 15%.
  • The authors described asbestos as a well-established occupational carcinogen.
  • The review cited a 1955 retrospective cohort study by Doll (another study) in which asbestos textile workers at a UK factory had a 10-fold elevation in lung cancer risk.
  • The review cited later studies (other studies) reporting a sevenfold excess of lung cancer among insulation workers in the United States.
  • The authors stated that asbestos and cigarette smoking combined act synergistically, in a manner compatible with a multiplicative effect.
  • The authors stated that whether lung cancer results from asbestos itself or from asbestosis remains controversial.
  • The authors stated that asbestos exposure may pose a risk to building occupants, but that concentrations are generally very low.
  • In the beta-carotene trials the review discussed, supplementation was associated with an increased lung cancer risk in high-risk groups. These included smokers and asbestos-exposed workers in the Carotene and Retinol Efficacy Trial.
  • The authors stated that indoor radon is considered the second-leading cause of lung cancer in the United States.
• The authors' conclusion: The authors concluded that the lung cancer pandemic is a consequence of widespread addiction to cigarettes.
• Limitations the authors state:
  • The authors did not attempt a comprehensive review and systematic synthesis.
  • The authors did not grade the evidence or generate formal guidelines.

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.

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