10/16/2015C.R. Apap1 Lung cancer: a preventable disease Epidemiology addresses issues related to   Heredity,  Life-style, and  Environment.

10/16/2015C.R. Apap2 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.

10/16/2015C.R. Apap3 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.

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10/16/2015C.R. Apap5 Risk factors  1. Tobacco (and passive) smoking  2. Air pollution in urban areas  3. Chronic conditions: COPD  4. Occupational exposure (man-made mineral fibre)

10/16/2015C.R. Apap6 Genetic factors  Aryl-hydrocarbon-hydroxlase system (AHH) converts weak carcinogens in cigarette smoke into active carcinogens

10/16/2015C.R. Apap7 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.

10/16/2015C.R. Apap8 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.

10/16/2015C.R. Apap9 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

10/16/2015C.R. Apap10 Snap: Lung Cancer:

10/16/2015C.R. Apap11 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

10/16/2015C.R. Apap12 Biology of lung cancer Oncogenic event  pluripotent cell   small cell lung cancer  large cell lung cancer  squamous cell lung cancer  adenocarcinoma Souhami

10/16/2015C.R. Apap13 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%)

10/16/2015C.R. Apap14 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

10/16/2015C.R. Apap15 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

10/16/2015C.R. Apap16 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?

10/16/2015C.R. Apap17 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

10/16/2015C.R. Apap18 Recommended literature  Doll, Peto et al. “Mortality in relation to smoking: 20 years observation on male British doctors”. Br. Med. J., 1976 (2) pp  Law MR. “Genetic predisposition to lung cancer”. Br J Cancer 1990 (61);  Carney DN. “The biology of lung cancer”. Current topics in lung cancer 1991, pp 3-14.

10/16/2015C.R. Apap19 More Information on the WWW  CancerNet: Statistical Data Sources CancerNet: Statistical Data Sources  UICC GLOBALink UICC GLOBALink  Institute of Epidemiology Institute of Epidemiology  Department of Epidemiology – Links Department of Epidemiology – Links  SEER Cancer Statistics Review, SEER Cancer Statistics Review,  Cancer Epidemiology, Biomarkers Prevention Table of Contents Cancer Epidemiology, Biomarkers Prevention Table of Contents  Lecture Link Application Lecture Link Application  Today’s??-Smoking and Kreyberg Lung Tumors Today’s??-Smoking and Kreyberg Lung Tumors  What if I smoke cigarettes? What if I smoke cigarettes?