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Chapter 1 – Epidemiology, pathogenesis and risk factors

Summary

  • Lung cancer is the leading cause of cancer-related death worldwide in both genders
  • USA incidence rates in both genders increased until the 1990s and began to decline later, similar to the trend in mortality
  • In Europe, lung cancer-related deaths in women are secondary only to breast cancer and, in contrast to the USA scenario, the mortality rate continues to increase
  • Worldwide, every year, as many people die from lung cancer as from the other ‘big killers’ (prostate, breast, and colon cancer) combined
  • Only 15% of all lung cancer cases are diagnosed at an early stage, while the majority present with distant metastases at diagnosis and a 5-year survival rate of about 5%
  • Median age at diagnosis is 71 years and adenocarcinoma is now the most prevalent histotype
  • Lung cancer may arise from all the differentiated and undifferentiated cells of the upper and lower airways. The formation of DNA adducts as a consequence of the inhalation of carcinogens plays a central role in lung cancer pathogenesis
  • Lung cancer pathogenesis is also affected by a genetic multifactorial susceptibility, which may be further influenced by exposure to certain carcinogens
  • Smoking is the principal risk factor for lung cancer, causing more than 80% of all cases
  • Non-smoking-related risk factors include occupational exposure to carcinogens, second-hand smoke, pollution, dietary factors, radon exposure and genetic susceptibility

Further Reading

Boffetta P. Classic epidemiology of lung cancer. Chapter 3 in: Multidisciplinary Approach to Thoracic Oncology. Aurora, Colorado: IASLC Press, 2014.

Couraud S, Zalcman G, Milleron B, et al. Lung cancer in never smokers – a review. Eur J Cancer 2012; 48:1299–1311.

Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med 2011; 32:605–644.

Didkowska J, Wojciechowska U, Mańczuk M, Lobaszewski J. Lung cancer epidemiology: contemporary and future challenges worldwide. Ann Transl Med 2016; 4:150.

Ferlay J, Colombet M, Soerjomataram I, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 European countries and 25 major cancers in 2018. Eur J Cancer 2018; 103:356–387.

Gazdar AF, Zhou C. Lung cancer in never smokers: a different disease. Chapter 4 in: Multidisciplinary Approach to Thoracic Oncology. Aurora, Colorado: IASLC Press, 2014.

Hashim D, Boffetta P, La Vecchia C, et al. The global decrease in cancer mortality: trends and disparities. Ann Oncol 2016; 27:926–933. Malhotra J, Malvezzi M, Negri E, et al. Risk factors for lung cancer worldwide. Eur Respir J 2016; 48:889–902.

Nielsen LS, Bælum J, Rasmussen J, et al. Occupational asbestos exposure and lung cancer – a systematic review of the literature. Arch Environ Occup Health 2014, 69:191–206.

Novello S, Stabile LP, Siegfried JM. Gender-related differences in lung cancer. Chapter 5 in: Multidisciplinary Approach to Thoracic Oncology. Aurora, Colorado: IASLC Press, 2014.

Pallis GA, Syrigos KN. Lung cancer in never smokers: disease characteristics and risk factors. Crit Rev Oncol Hematol 2013; 88:494–503.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019; 69:7–34.

Sun S, Schiller JH, Gazdar AF. Lung cancer in never smokers – a different disease. Nat Rev Cancer 2007; 7:778–790.

Torres-Durán M, Barros-Dios JM, Fernández-Villar A, Ruano-Ravina A. Residential radon and lung cancer in never smokers. A systematic review. Cancer Lett 2014; 345:21–26.

Risk factors

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