Lung Cancer Incidence Rates Research Articles

Lung Cancer Screening by Race and Ethnicity in an Integrated Health System in Hawaii

Racial and ethnic differences in lung cancer screening (LCS) completion and follow-up may be associated with lung cancer incidence and mortality rates among high-risk populations. Aggregation of Asian American, Native Hawaiian, and Pacific Islander racial and ethnic groups may mask the true underlying disparities in screening uptake and diagnostic follow-up, creating barriers for targeted, preventive health care. To examine racial and ethnic differences in LCS completion and follow-up rates in a multiethnic population. This population-based cohort study was conducted at a health maintenance organization in Hawaii. LCS program participants were identified using electronic medical records from January 1, 2015, to December 31, 2019. Study eligibility requirements included being aged 55 to 79 years, a 30 pack-year smoking history, a current smoker or having quit within the past 15 years, at least 5 years past any lung cancer diagnosis and treatment, and cancer free. Data analysis was performed from June 2019 to October 2020. Eligible for LCS. Screening rates were analyzed by self-reported race and ethnicity and completion of a low-dose computed tomography (LDCT) test. Diagnostic follow-up results were based on the Lung Imaging Reporting and Data System (Lung-RADS) staging system. A total of 1030 eligible LCS program members had an order placed; their mean (SD) age was 65.5 (5.8) years, and 633 (61%) were men. The largest racial and ethnic groups were non-Hispanic White (381 participants [37.0%]), Native Hawaiian or part Native Hawaiian (186 participants [18.1%]), and Japanese (146 participants [14.2%]). Men and Filipino, Chinese, Japanese, and non-Hispanic White individuals had a higher proportion of screen orders for LDCT compared with women and individuals of the other racial and ethnic groups. The overall LCS completion rate was 81% (838 participants). There was a 14% to 15% screening completion rate gap among groups. Asian individuals had the highest screening completion rate (266 participants [86%]) followed by Native Hawaiian (149 participants [80%]) and non-Hispanic White individuals (305 participants [80%]), Pacific Islander (50 participants [79%]) individuals, and individuals of other racial and ethnic groups (68 participants [77%]). Within Asian subgroups, Korean (31 participants [94%]) and Japanese (129 participants [88%]) individuals had the highest completion rates followed by Chinese individuals (28 participants [82%]) and Filipino individuals (78 participants [79%]). Of the 54 participants with Lung-RADS stage 3 disease, 93% (50 participants) completed a 6-month surveillance LDCT test; of 37 individuals with Lung-RADS stage 4 disease, 35 (97%) were followed-up for additional procedures. This cohort study found racial and ethnic disparities in LCS completion rates after disaggregation of Native Hawaiian, Pacific Islander, and Asian individuals and their subgroups. These findings suggest that future research is needed to understand factors that may be associated with LCS completion and follow-up behaviors among these racial and ethnic groups.

The evolving landscape of sex-based differences in lung cancer: a distinct disease in women.

In stark contrast to a few decades ago when lung cancer was predominantly a disease of men who smoke, incidence rates of lung cancer in women are now comparable to or higher than those in men and are rising alarmingly in many parts of the world. Women face a unique set of risk factors for lung cancer compared to men. These include exogenous exposures including radon, prior radiation, and fumes from indoor cooking materials such as coal, in addition to endogenous exposures such as oestrogen and distinct genetic polymorphisms. Current screening guidelines only address tobacco use and likely underrepresent lung cancer risk in women. Women were also not well represented in some of the landmark prospective studies that led to the development of current screening guidelines. Women diagnosed with lung cancer have a clear mortality benefit compared to men even when other clinical and demographic characteristics are accounted for. However, there may be sex-based differences in outcomes and side effects of systemic therapy, particularly with chemotherapy and immunotherapy. Ongoing research is needed to better investigate these differences to address the rapidly changing demographics of lung cancer worldwide.

Abstract IA-21: Applying a data integrative and convergence epidemiology approach to study multilevel risk factors for cancer in distinct AANHPI populations

Abstract Background: For Asian American, Native Hawaiian and Pacific Islander (AANHPI) females, lung cancer is one of the most common cancers and the leading cause of cancer death. More than half of lung cancers among AANHPI females occur among never-smokers, but incidence rates of lung cancer according to smoking status have not been available. Purpose: With a large, integrated dataset of electronic health record data from two healthcare systems—Sutter Health in Northern California and Kaiser Permanente Hawai'i—linked to state cancer registry data on incident lung cancer diagnoses 2000-2013, we describe incidence of lung cancer according to smoking status among females across detailed race and ethnicity. Methods: We calculated age-adjusted incidence rates for lung cancer according to smoking status and detailed race and ethnicity among females, focusing on AANHPI ethnic groups, and assessed relative incidence across racial and ethnic groups. The study population included N=1,222,694 females (n=244,147 AANHPI), n=3,297 (n=535) of whom were diagnosed with lung cancer. We examined relative incidence across group defined by detailed race and ethnicity. We also provided incidence of lung cancer among AANHPI males who never smoked in a supplement. Results: Among AANHPI female groups, proportions of lung cancers among never-smokers ranged from 25% among Native Hawaiian to 80% among Chinese females. Incidence of lung cancer among never-smoking AANHPI females as an aggregate was 17.1 per 100,000 (95% CI: 14.9, 19.4), but rates varied widely across ethnic groups. Never-smoking Chinese females had the highest rate (22.8; 95% CI: 17.3, 29.1). Except for Japanese females, incidence among every never-smoking AANHPI female ethnic group was higher than that of all never-smoking females combined. Never-smoking AANHPI males also have higher incidence of lung cancer compared to other groups defined by race and ethnicity. Conclusions: The integrative data analysis approach offers great advantages over traditional cancer cohorts, but it does require substantial time and effort to assure data confidentiality, integrity, and transparency to provide robust results. However, with convergence epidemiology—in this case leveraging needed expertise in data science and analysis to answer an epidemiology question—it is also a valuable approach to study disparate cancer outcomes among small populations. Illustrating this, our study is the first to document high rates of lung cancer among never-smoking AANHPI ethnic groups, dispels the myth that AANHPI females are at overall reduced risk of lung cancer, and demonstrates the need to disaggregate this highly diverse population. Results should inform lung cancer prevention strategies among AANHPI populations. Citation Format: MIndy C. DeRouen, Alison J. Canchola, Caroline A. Thompson, Anqi Jin, Sixiang Nie, Carmen Wong, Daphne Lichtensztajn, Laura Allen, Manali I. Patel, Yihe G. Daida, Harold S. Luft, Salma Shariff-Marco, Peggy Reynolds, Heather A. Wakelee, Su-Ying Liang, Beth E. Waitzfelder, Iona Cheng, Scarlett L. Gomez. Applying a data integrative and convergence epidemiology approach to study multilevel risk factors for cancer in distinct AANHPI populations [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-21.

Abstract IA-48: A brief overview of lung and colorectal cancer disparities in American Indian and Alaska Native populations

Abstract Lung cancer and colorectal cancer (CRC) are leading causes of cancer morbidity and mortality among US American Indian and Alaska Native (AI/AN) men and women. For most AI/AN communities, disparities in these cancers occur compared to their non-Hispanic White (NHW) counterparts. This presentation provides a brief overview of the epidemiology of lung and colorectal cancers among AI/AN, and serves as background for talks regarding the impact of revised eligibility criteria for implementing screening programs among AI/AN. In recent years, lung cancer incidence rates among AI/AN persons were 12% higher than rates among NHW in counties with relatively high proportions of AI/AN residents. By region, rates were 17% to 3 times higher in AI/AN than NHW in Pacific Coast, Alaska, and Northern and Southern Plains, in contrast to the Southwest and Eastern US where AI/AN rates were 35% lower. While lung cancer incidence is decreasing overall in both populations, the rate of decrease is slower for AI/AN. Generally, lung cancer occurs at younger ages and at more advanced stages for AI/AN compared with NHW, and AI/AN persons with lung cancer have worse survival. Little is known about the experience of lung cancer screening (LCS) in health care systems that serve AI/AN communities. LCS has not been a mandatory reporting measure for the Indian Health Service. Models of expanded eligibility for LCS suggest that AI/AN will have a higher relative increase in eligible persons compared with NHW, but information on implementation is scarce. Disparities in CRC are also notable among AI/AN. In recent years, incidence rates among AI/AN were 41% higher than among NHW in counties with relatively high proportions of AI/AN residents. CRC incidence rates also vary regionally, but AI/AN in general had higher CRC incidence rates than did NHW. CRC incidence rates have been decreasing overall among both AI/AN and NHW populations, but at a slower pace for AI/AN. Notably, CRC incidence increased among AI/AN in the Southwest. CRC incidence rates have also increased among persons younger than 50 years for both AI/AN and NHW, but more than 1 in 7 CRC cases among AI/AN were diagnosed at ages younger than 50 years, compared with less than 1 in 10 among NHW. AI/AN were more likely to have late-stage diagnoses than were NHW, and AI/AN men had the worst survival than men in other racial groups. Factors encountered in implementing programs to improve lung and CRC screening among AI/AN health care systems will be discussed follow this presentation. Citation Format: Dorothy A. Rhoades. A brief overview of lung and colorectal cancer disparities in American Indian and Alaska Native populations [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-48.

Association of Rurality With Annual Repeat Lung Cancer Screening in the Veterans Health Administration.

Lung cancer causes the largest number of cancer-related deaths in the United States. Lung cancer incidence rates, mortality rates, and rates of advanced stage disease are higher among those who live in rural areas. Known disparities in lung cancer outcomes between rural and nonrural populations may be in part because of barriers faced by rural populations. The authors tested the hypothesis that among Veterans who receive initial lung cancer screening, rural Veterans would be less likely to complete annual repeat screening than nonrural Veterans. A retrospective cohort study was conducted of 10 Veterans Affairs medical centers from 2015 to 2019. Rural and nonrural Veterans undergoing lung cancer screening were identified. Rural status was defined using the rural-urban commuting area codes. The primary outcome was annual repeat lung cancer screening in the 9- to 15-month window (primary analysis) and 31-day to 18-month window (sensitivity analysis) after the first documented lung cancer screening. To examine rurality as a predictor of annual repeat lung cancer screening, multivariable logistic regression models were used. In the final analytic sample of 11,402 Veterans, annual repeat lung cancer screening occurred in 27.7% of rural Veterans (641 of 2,316) and 31.8% of nonrural Veterans (2,891 of 9,086) (adjusted odds ratio: 0.86; 95% confidence interval: 0.73-1.03). Similar results were seen in the sensitivity analysis, with 41.6% of rural Veterans (963 of 2,316) versus 45.2% of nonrural Veterans (4,110 of 9,086) (adjusted odds ratio: 0.88; 95% confidence interval: 0.73-1.04) having annual repeat screening in the expanded 31-day to 18-month window. Among a national cohort of Veterans, rural residence was associated with numerically lower odds of annual repeat lung cancer screening than nonrural residence. Continued, intentional outreach efforts to increase annual repeat lung cancer screening among rural Veterans may offer an opportunity to decrease deaths from lung cancer.

Progress in Immunotherapy for Non-small Cell Lung Cancer

The incidence rate and mortality of non-small cell lung cancer are increasing year by year. Some patients are not sensitive to traditional treatment. Today, with the arrival of the era of immunotherapy, the immunotherapy of non-small cell lung cancer is also progressing and developing. This paper mainly reviews the progress of immunotherapy of non-small cell lung cancer in recent years.

Incidence and Mortality by the Main Types of Cancer in the City of Cuiabá, Mato Grosso, Between the Years of 2008 and 2016.

To analyze the temporal trend of the incidence and mortality rate for prostate, breast, colorectal, lung, cervical, stomach and laryngeal cancer among residents in the city of Cuiabá between 2008 and 2016. Time series study with data from the Mortality Information System and the Population-Based Cancer Registry. Stratified by sex, the proportional distribution of new cases and deaths by age group and the cancer incidence and mortality rates standardized by the world population were calculated. Linear regression was used and the annual percentage change (APC) was estimated. In males, most new cases and deaths, for the main types of cancer, occurred among those aged 50 years or older, and the incidence rate of prostate cancer showed a tendency to decrease in the period (APC=-4.33%). For females, the proportion of new cases and deaths, due to breast and cervical cancer, were more frequent among women aged 50 years or younger, and lung, stomach and colorectal cancer among women aged 50 years or older. The incidence rate of breast cancer showed an increasing trend (APC=3.60%). For both sexes, the mortality rate remained stable. The incidence rate trend varied between sexes, an increase was observed for breast cancer among women and a reduction for prostate cancer among men. The mortality rate for the main types of cancer was stable.

Abstract IA-49: Facilitators and barriers to implementing low-dose CT screening for lung cancer in a tribal health system

Abstract Lung cancer is the leading cause of cancer mortality among American Indians and Alaska Natives (AI/AN), and many AI/AN communities have worse lung cancer incidence rates, survival, and death compared to the general population. Although lung cancer screening (LCS) with low-dose computed tomography is a grade-B USPSTF recommendation, uptake of LCS has been slow in most healthcare systems. LCS implementation among AI/AN has not been studied before in detail. To address this knowledge and implementation gap, a multi-phase, 5-year “Tribally Engaged Approaches to Lung Screening" (TEALS) study was launched in 2019 in partnership with the Choctaw Nation of Oklahoma. The overarching goal of this project is to co-design and test an LCS implementation program. This presentation will discuss what is being learned about potential facilitators and barriers to implementing LCS in a tribal health care setting. Findings may be pertinent to other health systems serving tribal, rural or underserved populations. Citation Format: Zsolt J. Nagykáldi. Facilitators and barriers to implementing low-dose CT screening for lung cancer in a tribal health system [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-49.

Role and Significance of Bioactive Substances in Sputum in the Diagnosis of Lung Cancer

肺癌是我国目前发病率最高的恶性肿瘤之一，其诊断的金标准需要进行组织活检的病理学检查或脱落细胞学检查，二者的有创性和敏感性限制了他们的使用。痰液中含有大量核酸、蛋白质，是肺功能的良好反映物，肺癌组织也会影响痰液中的生物成分，检测其中的生物活性物质可有助于肺癌的诊断。本文综合目前国内外的研究结果，对痰液中可用于肺癌诊断的生物活性物质做一综述。

Impact of the National Lung Screening Trial (NLST) publication and Medicare Lung cancer screening payment on lung cancer incidence rates: An interrupted time series analysis

IntroductionExplore the impact of the Lung Cancer Screening Trial (NLST-September-2011) and the Medicare approval for CT-screening (CT-LCS-AP-February-2015) on lung cancer incidence rates, mortality, and the percentage of early-stage lung cancer diagnosis (ESLCD-T1-T2N0M0). MethodsRetrospective interrupted time series analysis using SEER-18 database. All individuals with lung cancer (LC) diagnosis from 2006 to 2016 were included. The effect of NLST and CT-AP-2015 on the monthly percentage of early-stage ESLCD was the primary outcome, additionally LC incidence and mortality rates were calculated. The analysis was performed by age, sex, race, marital status, insurance status, and household income. Bivariate and multivariate models were used to identify predictors of ESLCD. ResultsThe study cohort was composed by 388,207 individuals, 69 years old in average, 46.6 % female, and 81.1 % white. LC incidence and mortality rates declined from 2006 to 2016 without association with NLST-September-2011 and CT-LCS-AP-February-2015. The percentage of ESLCD increased over time for all groups. Overall rates of ESLCD started at 18 % in January-2006 and increased to 25 % by December-2016. The intervention NLST-2011 did not show an impact in the ESLCD while the CT-AP-2015 showed a significant impact in the ESLCD trend (p < 0.001). ESLCD was associated with female, white, insurance, and household incomes above median. Medicare expansion was a significant factor for insured group, married patients and those from households under the median income level. ConclusionMedicare approval for CT screening was found to have a statistically significant effect on the diagnosis of early-stage lung cancer and neither NLST-September-2011 nor CT-AP-2015-February-2015 impacted the incidence nor mortality rates. Policy summaryTo improve early-stage lung cancer diagnosis, it is vital to invest in health policies to increase Lung Cancer Screening implementation and to reduce disparities in access to diagnosis. Furthermore, policies that facilitate access to diagnosis and treatment are crucial to reduce lung cancer mortality.

Does air pollution contribute to urban-rural disparity in male lung cancer diseases in China?

It remains unknown whether exposure to ambient air pollution can be a mediator linking socioeconomic indicator to health outcome. The present study aims to examine the mediation effect of PM2.5 air pollution on the association between urban-rural division and the incidence (mortality) rate of male lung cancer. We performed a nationwide analysis in 353 counties (districts) of China between 2006 and 2015. A structural equation model was developed to determine the mediation effect of exposure to PM2.5. We also tested whether the findings of the mediation effect of exposure to PM2.5 are sensitive to the controls of smoking factors and additional air pollutant, and PM2.5 exposures with different lag structures. According to the results,we found that exposure to PM2.5 significantly mediated the association between urban-rural division and the incidence rate of male lung cancer. Specifically, there were significant associations between urban-rural division, exposure to PM2.5, and the incidence rate of male lung cancer, with PM2.5 exposure accounting for 29.80% of total urban-rural difference in incidence rates of male lung cancer. A similar pattern of results was observed for the mortality rate of male lung cancer. That is, there was a significant mediation effect by PM2.5 on the association of the mortality rate with urban-rural division. The findings of exposure to PM2.5 as a mediator were robust in the three sensitivity analyses. In conclusion,urban-rural difference in exposures to PM2.5 may be a potential factor that contributes to urban-rural disparity in male lung cancer diseases in China. The findings inform that air pollution management and control may be effective measures to alleviate the great difference in male lung cancer diseases between urban and rural areas in China.

Ambient Ozone, PM1 and Female Lung Cancer Incidence in 436 Chinese Counties.

Ozone air pollution has been increasingly severe and has become another major air pollutant in Chinese cities, while PM1 is more harmful to human health than coarser PMs. However, nationwide studies estimating the effects of ozone and PM1 are quite limited in China. This study aims to assess the spatial associations between ozone (and PM1) and the incidence rate of female lung cancer in 436 Chinese cancer registries (counties/districts). The effects of ozone and PM1 were estimated, respectively, using statistical models controlling for time, location and socioeconomic covariates. Then, three sensitivity analyses including the adjustments of smoking covariates and co-pollutant (SO2) and the estimates of ozone, PM1 and SO2 effects in the same model, were conducted to test the robustness of the effects of the two air pollutants. Further still, we investigated the modifying role of urban–rural division on the effects of ozone and PM1. According to the results, a 10 μg/m3 increase in ozone and PM1 was associated with a 4.57% (95% CI: 4.32%, 16.16%) and 4.89% (95% CI: 4.37%, 17.56%) increase in the incidence rate of female lung cancer relative to its mean, respectively. Such ozone and PM1 effects were still significant in three sensitivity analyses. Regarding the modifying role of urban–rural division, the effect of PM1 was greater by 2.98% (95% CI: 1.01%, 4.96%) in urban than in rural areas when PM1 changed by 10 μg/m3. However, there was no modification effect of urban–rural division for ozone. In conclusion, there were positive associations between ozone (and PM1) and the incidence rate of female lung cancer in China. Urban-rural division may modify the effect of PM1 on the incidence rate of female lung cancer, which is seldom reported. Continuous and further prevention and control measures should be developed to alleviate the situation of the two air pollutants.

PL01.02 Disparities in Lung Cancer Care Across the Population

Health disparities: ‘differences in the incidence, prevalence, mortality, and burden of disease, and other adverse health conditions that exist among specific population groups….’ (NIH, 2014).1 Lung cancer, the oncologic scourge of our age, with 2.2 million cases and 1.8 million deaths estimated worldwide in 2020, is the leading cause of cancer death among men in 93 countries, and women in 25 countries. Global aggregate 5 year survival is only 10% to 20% in most countries.2 In the United States (US), aggregate lung cancer incidence rates have been sequentially decreasing, in men since the mid-1980s and in women since the mid-2000s, at a rate of -2.2%/year.

Significant Regional Differences in Lung Cancer Incidence in Hungary: Epidemiological Study Between 2011 and 2016.

Objective: Hungary has one of the highest incidences and mortality rates of lung cancer (LC), therefore the objective of this study was to analyse and compare LC incidence and mortality rates between the main Hungarian regions.Methods: This nationwide, retrospective study used data from the National Health Insurance Fund and included patients aged ≥20 years who were diagnosed with lung cancer (ICD-10 C34) between Jan 1, 2011 and Dec 31, 2016. Age-standardized incidence and mortality rates were calculated and compared for the main regions.Results: The highest incidence rate in males was recorded in Northern Hungary (146.8/100,000 person-years [PY]), while the lowest rate was found in Western Transdanubia (94.7/100,000 PY in 2011). All rates showed a declining trend between 2011 and 2016, with the largest decrease in the Northern Great Plain (−20.0%; p = 0.008). LC incidence and mortality rates in women both showed a rising tendency in all regions of Hungary, reaching the highest in Central Hungary (59.86/100,000 PY in 2016). Lung cancer incidence and mortality rates in males correlated with the level of education and smoking prevalence (p = 0.006 and p = 0.01, respectively) in the regions. A correlation with GDP per capita and Health Development Index (HDI) index could also be observed in the Hungarian regions, although these associations were not statistically significant. No correlations could be detected between these parameters among females.Conclusion: This analysis revealed considerable differences in the epidemiology of LC between the 7 main Hungarian regions. LC incidence and mortality rates significantly correlated with smoking and certain socioeconomic factors in men, but not in women. Further research is needed to explain the regional differences.

Radon flux estimates, from both gamma radiation and geochemical data, to determine sources, migration pathways, and related health risk: The Campania region (Italy) case study

An empirical method was applied to estimate the 222Rn fluxes distribution across the Campania region (Italy) by using both gamma-rays and U, Th, K concentrations in soils. As a first step, K, Th and U soil concentrations and 4 K, 238U and 232Th activity have been converted into their own specific activity to calculate the Terrestrial Gamma Dose Rate (TGDR). This latter has been then used to determine the 222Rn fluxes across the region. Regardless of the radiometric or geochemical origin, 222Rn fluxes reached, as expected, their maximum values in correspondence with the volcanic centres of Campania (Mt. Somma-Vesuvius, Phlegrean Fields, Mt. Roccamonfina). However, comparing the results obtained from the two different datasets, it was also possible to infer the existence of contributions to surficial 222Rn fluxes proceeding from both some underlying geological bodies and active seismogenic sources.In line with some national regulations, the 222Rn flux esteemed from gamma radiations was also used to assess the possible regional distribution of risk deriving from the indoor environmental exposure to 222Rn; results were compared with standardized incidence rates (SIRs) of lung cancer for an area on the south-western sector of Mt. Somma-Vesuvius showing a potential spatial relationship among flux data and SIRs.

Incidence and survival analyses for occult lung cancer between 2004 and 2015: a population-based study

BackgroundThis study aimed to investigate the incidence and long-term survival outcomes of occult lung cancer between 2004 and 2015.MethodsA total of 2958 patients were diagnosed with occult lung cancer in the 305,054 patients with lung cancer. The entire cohort was used to calculate the crude incidence rate. Eligible 52,472 patients (T1-xN0M0, including 2353 occult lung cancers) were selected from the entire cohort to perform survival analyses after translating T classification according to the 8th TNM staging system. Cancer-specific survival curves for different T classifications were presented.ResultsThe crude incidence rate of occult lung cancer was 1.00 per 100 patients, and it was reduced between 2004 and 2015 [1.4 per 100 persons in 2004; 0.6 per 100 persons in 2015; adjusted risk ratio = 0.437, 95% confidence interval (CI) 0.363–0.527]. In the survival analysis, there were 2206 death events in the 2353 occult lung cancers. The results of the multivariable analysis revealed that the prognoses with occult lung cancer were similar to patients with stage T3N0M0 (adjusted hazard ratio = 1.054, 95% CI 0.986–1.127, p = 0.121). Adjusted survival curves presented the same results. In addition, adjusted for other confounders, female, age ≤ 72 years, surgical treatment, radiotherapy, adenocarcinoma, and non-squamous and non-adenocarcinoma non-small cell carcinoma were independent protective prognostic factors (all p < 0.05).ConclusionsOccult lung cancer was uncommon. However, the cancer-specific survival of occult lung cancer was poor, therefore, we should put the assessment of its prognoses on the agenda. Timely surgical treatment and radiotherapy could improve survival outcomes for those patients. Besides, we still need more research to confirm those findings.

CircPTCH1 Promotes Migration in Lung Cancer by Regulating MYCN Expression Through miR-34c-5p.

BackgroundThe incidence rate and mortality rate of lung cancer are the highest in the world. Therefore, further studies are needed to reveal the molecular mechanism of lung cancer progression and development. Previous study demonstrated that the deregulation of circRNAs can regulate cell biological functions in tumorigenesis and development. However, the roles of circPTCH1 in lung cancer have not yet been revealed.Materials and MethodsThe expression levels of circPTCH1, miR-34c-5p, and MYCN were measured by RT-PCR in lung cancer tissues and cells; dual-luciferase reporter and RIP assay showed that circRNA served as a sponge for miRNA, and miRNA could target mRNA. In vitro, effects of si-circPTCH1 can regulate lung cancer cells’ migration, invasion were detected by CCK-8 assay, wound healing assay, and transwell assay.ResultsOur research demonstrated that the expression of circPTCH1 was upregulated in lung cancer tissues and cell lines and increased in metastatic tissues compared to that of non-metastatic tissues. circPTCH1 sponging miR-34c-5p to target MYCN was revealed by dual-luciferase reporter and a RIP assay. In addition, the expression level of miR-34c-5p was reduced in lung cancer tumor tissues, and MYCN was significantly increased in lung cancer tumor tissues. Pearson correlation analysis showed that miR-34c-5p with circPTCH1 and MYCN had a moderately negative correlation, and there was a moderately positive correlation between circPTCH1 and MYCN. Further, cytological studies found that circPTCH1 reduced lung cancer cells’ migration and invasion by targeting MYCN via miR-34c-5p.ConclusioncircPTCH1 plays a tumor enhancement role in lung cancer and that can effectively promote migration, invasion and EMT by targeting the miR-34c-5p/MYCN axis. circPTCH1 may be a novel potential treatment and diagnosis biomarker for lung cancer.

LUNG CANCER INCIDENCE AND MORTALITY IN THE KHANTY-MANSI AUTONOMOUS OKRUG – YUGRA

The aim of the study was to assess the lung cancer incidence and mortality in the Khanty-mansi autonomous okrug – Yugra during the period 1999–2019.Material and methods. We have studied the lung cancer incidence and mortality rates in Yugra over the last 21 years (1999–2019).Results. In Yugra, the lung cancer (lc) incidence rates increased by 24.7 % from 1999 to 2019, demonstrating higher rates than those in the Russian Federation (RF), where lc incidence rates decreased by 20.3 %. In 2019, the age-standardized incidence rate was 30.5 per 100,000 (22.7 for RF); the age-standardized mortality rate was 16.4 per 100,000 (18.4 for RF). The mortality rate from lc in Yugra was 9.6 times higher in males than in females (35.5 vs. 3.7 per 100,000). The cross-correlation analysis revealed a correlation between the lc incidence/mortality and air pollution in Yugra. The main carcinogens in Yugra were formaldehyde, phenol, nitrogen dioxide, and benzapyrene. The assessment of the relationship between the age-standardized lc incidence/mortality rates and the amount of pollutants emitted into the atmosphere revealed that their synergistic effects with tobacco smoking can double the risk of lung cancer development. The increase in the number of chest computed tomography (ct) scans performed in the context of the pandemic caused by covid-19 infection led to an 18 % increase in the number of incidentally detected pulmonary nodules, of which 9 % of cases were diagnosed as lc.Conclusion. The lc incidence rates in Yugra tended to increase. The high rate of lc incidence is caused by man-made and natural factors, which requires the implementation of a screening program with the use of low-dose computed tomography in order to improve the early detection and prevention of this disease.

Regional interaction of lung cancer incidence influenced by PM2.5 in China

PM2.5 is the key pollutant threatening human health and can even cause lung cancer. Pollution is the most serious problem in China with its fast industrialisation, urbanisation and high population density. This pollutant is conveyed through the atmosphere, trade and the embodied emission flow amongst regions. Scientific evaluation of the responsibility for regional lung cancer by considering both internal and external influences seems to be meaningful in addressing regional inequity. This study develops a relatively convenient and practical method to evaluate the regional inequity reflected by lung cancer associated with PM2.5 pollution in China. Results show that PM2.5 emissions and concentrations have similar distribution patterns: high values were predominant in the east and south where has high population density, while the west had low values. The cancer incidence rate showed high values mainly in eastern and central China. At a provincial scale, the lung cancer incidence rate was significantly correlated with PM2.5 concentration levels, and a high correlation was also found between PM2.5 concentration and emissions, indicating that emission reduction is the key to lung cancer prevention. Due to domestic trade, some developed regions more pulled lung cancer in less developed regions, and some less developed regions also have an obvious influence on external regions. Spatially, provinces in northern and central China are always more influenced by external regions. Lung cancer inequity analysis shows that coastline regions are more advantaged, while the reverse applies to inland China. The central government needs to further strengthen regional coordinated development measures, such as economic compensation for medical care and adjustments to industry structure. It should optimise spatial allocation and comprehensively consider regional inequity and character.

Global, regional, and national burden of respiratory tract cancers and associated risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

SummaryBackgroundPrevention, control, and treatment of respiratory tract cancers are important steps towards achieving target 3.4 of the UN Sustainable Development Goals (SDGs)—a one-third reduction in premature mortality due to non-communicable diseases by 2030. We aimed to provide global, regional, and national estimates of the burden of tracheal, bronchus, and lung cancer and larynx cancer and their attributable risks from 1990 to 2019.MethodsBased on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 methodology, we evaluated the incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) of respiratory tract cancers (ie, tracheal, bronchus, and lung cancer and larynx cancer). Deaths from tracheal, bronchus, and lung cancer and larynx cancer attributable to each risk factor were estimated on the basis of risk exposure, relative risks, and the theoretical minimum risk exposure level input from 204 countries and territories, stratified by sex and Socio-demographic Index (SDI). Trends were estimated from 1990 to 2019, with an emphasis on the 2010–19 period.FindingsGlobally, there were 2·26 million (95% uncertainty interval 2·07 to 2·45) new cases of tracheal, bronchus, and lung cancer, and 2·04 million (1·88 to 2·19) deaths and 45·9 million (42·3 to 49·3) DALYs due to tracheal, bronchus, and lung cancer in 2019. There were 209 000 (194 000 to 225 000) new cases of larynx cancer, and 123 000 (115 000 to 133 000) deaths and 3·26 million (3·03 to 3·51) DALYs due to larynx cancer globally in 2019. From 2010 to 2019, the number of new tracheal, bronchus, and lung cancer cases increased by 23·3% (12·9 to 33·6) globally and the number of larynx cancer cases increased by 24·7% (16·0 to 34·1) globally. Global age-standardised incidence rates of tracheal, bronchus, and lung cancer decreased by 7·4% (−16·8 to 1·6) and age-standardised incidence rates of larynx cancer decreased by 3·0% (−10·5 to 5·0) in males over the past decade; however, during the same period, age-standardised incidence rates in females increased by 0·9% (−8·2 to 10·2) for tracheal, bronchus, and lung cancer and decreased by 0·5% (−8·4 to 8·1) for larynx cancer. Furthermore, although age-standardised incidence and death rates declined in both sexes combined from 2010 to 2019 at the global level for tracheal, bronchus, lung and larynx cancers, some locations had rising rates, particularly those on the lower end of the SDI range. Smoking contributed to an estimated 64·2% (61·9–66·4) of all deaths from tracheal, bronchus, and lung cancer and 63·4% (56·3–69·3) of all deaths from larynx cancer in 2019. For males and for both sexes combined, smoking was the leading specific risk factor for age-standardised deaths from tracheal, bronchus, and lung cancer per 100 000 in all SDI quintiles and GBD regions in 2019. However, among females, household air pollution from solid fuels was the leading specific risk factor in the low SDI quintile and in three GBD regions (central, eastern, and western sub-Saharan Africa) in 2019.InterpretationThe numbers of incident cases and deaths from tracheal, bronchus, and lung cancer and larynx cancer increased globally during the past decade. Even more concerning, age-standardised incidence and death rates due to tracheal, bronchus, lung cancer and larynx cancer increased in some populations—namely, in the lower SDI quintiles and among females. Preventive measures such as smoking control interventions, air quality management programmes focused on major air pollution sources, and widespread access to clean energy should be prioritised in these settings.FundingBill & Melinda Gates Foundation.