Fluoroscopic radiation and risk of primary lung cancer following pneumothorax therapy of tuberculosis.

Abstract

STEINITZ has reported a remarkable epidemiological study in Israel which indicated that persons with a tuberculosis history, active or arrested, showed a five to ten-fold increase in the risk of subsequent development of primary lung cancer1. Steinitz was, of course, acutely aware of the excessive risk of lung cancer in cigarette smokers and gave careful attention to this variable. Recently, she has also indicated that there is no reason to believe that persons with a past history of tuberculosis smoked cigarettes more than did those in the general population sample (personal communication). It therefore seems that by some mechanism other than cigarette smoking a record of extensive therapy of tuberculosis implies a high risk of primary lung cancer. The magnitude of excess risk of lung cancer in tuberculous persons is comparable with that for cigarette smoking in non-tuberculous persons. Is tuberculosis per se responsible for the observed excessive risk of future primary lung cancer ? We think not. We propose that frequent nuoroscopies of the chest, associated with the past extensive use of pneumothorax collapse therapy, is the aetiological factor responsible.