Lower Incidence Of Lung Cancer Research Articles

Impact of oseltamivir on the risk of cancer.

Mounting evidence has revealed the anti-cancer activity of various anti-viral drugs. Oseltamivir phosphate (OP), namely Tamiflu®, is routinely used to combat influenza infections. Although evidence has indicated the anti-cancer effects of OP in vitro and in vivo, little information is known about the effect of OP use on cancers in humans. A nationwide population-based cohort study involving 13,977,101 cases with 284,733 receiving OP was performed to examine the association between OP use and cancers using the National Health Insurance Research Database in Taiwan between 2009 and 2018. The cohort study found that OP users showed a significantly lower incidence of lung cancer, colon cancer, liver, and intrahepatic bile duct cancer, oral cancer, pancreas cancer, esophagus cancer, stomach cancer, and prostate cancer. Additionally, OP users exhibited a lower risk of cancer-related mortality (adjusted HR=0.779; 95% confidence interval [CI] 0.743-0.817; p<0.001) and a reduced risk of developing liver cancer (adjusted HR=0.895; 95% CI 0.824-0.972; p=0.008), esophagus cancer (adjusted HR=0.646; 95% CI 0.522-0.799; p<0.001) and oral cancer (adjusted HR=0.587; 95% CI 0.346-0.995; p=0.048). Notably, OP users had a significant reduction in liver cancer occurrence over a 10-year period follow-up and a lower cancer stage at liver cancer diagnosis. These findings first suggest the beneficial effects and therapeutic potential of OP use for certain cancers, especially liver cancer.

Beneficial biological effects of Flavokawain A, a chalcone constituent from kava, on surgically induced endometriosis rat model

Ethnopharmacological relevanceShrub kava has long been grown and utilized, primarily in the South Pacific region, for ceremonial, religious, and social occasions. It has been used as a pain reliever and muscle relaxant in medicinal practices from the eighteenth century. Interestingly, relatively low incidence of lung cancer may attribute to the high consumption of kava products in this region. Aim of the studyKava extracts were used to produce the kava chalcones Flavokawain A, B and C, which have a variety of bioactivities. In the present study, we show that Flavokawain A has positive effects on endometriosis. Materials and methodsThe endometriosis rat model was surgically induced by the autologous transplantation of endometrial tissue. Rats were evaluated for clinical ratings and lesion volume following a 6-week Flavokawain A therapy. Peritoneal fluid and blood samples were taken and ELISA assay was used to measure the cytokines and chemokines levels. Transcriptional and expression levels of Akt, PI3K, NF-kB, iNOS, Bcl-2, Bax and caspase-3 were evaluated by Western blotting and RT-qPCR. Implanted tissue sections of the rats were also analyzed by immunofluorescent and histopathological staining. ResultsLesion volumes and adhesion scores were successfully decreased. Blood and peritoneal fluid levels of associated cytokines and chemokines were markedly down-regulated. Besides, Flavokawain A also mediated cell apoptosis of endometrial implants. Additionally, VEGF expression was reduced, which inhibited the angiogenesis process. As for the expression of Akt, p-Akt, PI3K, p-PI3K, and NF-kB in endometriosis lesions, Flavokawain A significantly reduced them. ConclusionFlavokawain A has beneficial effects on the surgically induced endometriosis rat model, by reducing inflammation, promoting apoptosis, and decreasing angiogenesis. Our findings suggest that these effects may be mediated through the regulation of PI3K/Akt and NF-κB signaling pathways.

Voluntary exercise does not always suppress lung cancer progression

Physical exercise can lower lung cancer incidence. However, its effect on lung cancer progression is less understood. Studies on exercising mice have shown decreased ectopic lung cancer growth through the secretion of interleukin-6 from muscles and the recruitment of natural killer (NK) cells to tumors. We asked if exercise suppresses lung cancer in an orthotopic model also. Single-housed C57Bl/6 male mice in cages with running wheels were tail vein-injected with LLC1.1 lung cancer cells, and lung tumor nodules were analyzed. Exercise did not affect lung cancer. Therefore, we also tested the effect of exercise on a subcutaneous LLC1 tumor and a tail vein-injected B16F10 melanoma model. Except for one case of excessive exercise, tumor progression was not influenced. Moderately exercising mice did not increase IL-6 or recruit NK cells to the tumor. Our data suggest that the exercise dose may dictate how efficiently the immune system is stimulated and controls tumor progression.

Obesity and lung cancer-a narrative review.

A highly nuanced relationship exists between obesity and lung cancer. The association between obesity and lung cancer risk/prognosis varies depending on age, gender, race, and the metric used to quantify adiposity. Increased body mass index (BMI) is counterintuitively associated with decreased lung cancer incidence and mortality, giving rise to the term 'obesity paradox'. Potential explanations for this paradox are BMI being a poor measure of obesity, confounding by smoking and reverse causation. A literature search of this topic yields conflicting conclusions from various authors. We aim to clarify the relationship between various measures of obesity, lung cancer risk, and lung cancer prognosis. The PubMed database was searched on 10 August 2022 to identify published research studies. Literature published in English between 2018 and 2022 were included. Sixty-nine publications were considered relevant, and their full text studied to collate information for this review. Lower lung cancer incidence and better prognosis was associated with increased BMI even after accounting for smoking and pre-clinical weight loss. Individuals with high BMI also responded better to treatment modalities such as immunotherapy compared to individuals with a normal BMI. However, these associations varied highly depending on age, gender, and race. Inability of BMI to measure body habitus is the main driver behind this variability. The use of anthropometric indicators and image-based techniques to quantify central obesity easily and accurately is on the rise. Increase in central adiposity is associated with increased incidence and poorer prognosis of lung cancer, contrasting BMI. The obesity paradox may arise due to the improper use of BMI as a measure of body composition. Measures of central obesity better portray the deleterious effects of obesity and are more appropriate to be discussed when talking about lung cancer. The use of obesity metrics based on anthropometric measurements and imaging modalities has been shown to be feasible and practical. However, a lack of standardization makes it difficult to interpret the results of studies using these metrics. Further research must be done to understand the association between these obesity metrics and lung cancer.

Dietary fibre intake is associated with reduced risk of lung cancer: a Japan public health centre-based prospective study (JPHC).

Several epidemiological studies have been conducted to draw consistent conclusions regarding the effect of dietary fibre on lung diseases and lung cancer. However, the effect of dietary fibre on the incidence of lung cancer remains unclear in an Asian population. We investigated the association between the intake of total dietary fibre and dietary fibre from different food sources and lung cancer incidence in a Japan public health centre-based prospective study (JPHC). A total of 73 405 participants (33 012 men and 40 393 women) aged 45-74 years were eligible for our study. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). During a median follow-up of 18.0 years, 1546 (1042 men and 504 women) newly diagnosed cases of lung cancer were ascertained. In the multivariable models, total dietary fibre intake was inversely associated with lung cancer risk in men, the HRs Q5 vs Q1 (95% CI) were 0.77 (0.62 to 0.94), P-trend = 0.020. Dietary fibre intake from vegetables was protectively associated with lung cancer risk in men [HR Q5 vs Q1 (95% CI): 0.80 (0.64 to 0.99), P-trend = 0.053]. However, no such association was observed in women. In men, a high intake of total dietary fibre may have preventive benefits for lung cancer incidence: dietary fibre intake from vegetables was associated with a lower incidence of lung cancer. However, similar associations did not appear in women. Further investigations are required to confirm the association between dietary fibre and lung cancer risk in women.

TRUST YOUR INSTINCTS: DIAGNOSTIC DIFFICULITIES OF ADVANVED LUNG CANCER IN A YOUNG MALE

TOPIC: Lung Cancer TYPE: Fellow Case Reports INTRODUCTION: Lung cancer remains the leading cause of cancer-related death in the United States, occurring at the highest rate in those aged over 70yrs(1). It is exceedingly rare for those under the age of 40 to be diagnosed with primary lung cancer, with an incidence of 0.6-4.6%(2). The low incidence of lung cancer in this age group can lead to diagnostic delay. We present a case of a 28 yr old male who was diagnosed with stage 4 lung adenocarcinoma after multiple ED and hospital visits. CASE PRESENTATION: A 28 yr old previously healthy male presented to our facility for evaluation of an 8wk history of shortness of breath and non-productive cough. Denied fevers, chills, malaise or myalgias. He stopped working for a car repossession company due to being too dyspneic to walk short distances. Social history is notable for social smoking and vaping but none in the 3 months prior to symptom onset. Denied recent travel or exposures. No relevant family history. He was previously seen at two outside facilities and thought to have an atypical pneumonia. No improvement after two courses of antibiotics, prednisone and trilogy inhaler. After an abnormal chest CT he was seen by an outside pulmonologist and cardiothoracic surgeon for biopsy but it was felt to not be indicated. He sought another opinion at our facility because he felt like something was being missed. A chest CT revealed an extensive central infiltrative masslike consolidation encasing the right main pulmonary artery with extensive interstitial thickening and diffuse nodular pattern throughout the right lung with mediastinal adenopathy. Left lung appeared normal. The outside facility chest CT from a few weeks prior was obtained for comparison. This showed similar findings but the central masslike consolidation was now more extensive and confluent. Biopsy confirmed metastatic lung adenocarcinoma. DISCUSSION: A recent review of lung cancer in those 35yrs and younger found that nearly half of these patients had metastatic disease at presentation(3). The reason for advanced stage at diagnosis in this age group has yet to be delineated. In this case, it is likely that at least one cognitive bias contributed to his diagnosis being delayed. Both ascertainment bias, where a physician's thinking is shaped by prior expectation and representativeness restraint which drives the diagnostician toward looking for prototypical manifestations of disease(4), likely contributed. When age is removed from the equation, his imaging alone would have prompted a biopsy during his earlier encounters. CONCLUSIONS: Illness scripts are an important part of diagnostic reasoning, but it is imperative that clinicians remain wary of potential cognitive biases which may put them at risk for diagnostic error. Relying too heavily on pattern recognition as in representativeness restraint, we risk missing atypical variants of disease such as lung cancer in young man. REFERENCE #1: U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on 2019 submission data (1999-2017): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; www.cdc.gov/cancer/dataviz, released in June 2020. REFERENCE #2: Pan, X., Lv, T., Zhang, F. et al. Frequent genomic alterations and better prognosis among young patients with non-small-cell lung cancer aged 40 years or younger. Clin Transl Oncol 20, 1168–1174 (2018). https://doi.org/10.1007/s12094-018-1838-z REFERENCE #3: Liu B, Quan X, Xu C, et al. Lung cancer in young adults aged 35 years or younger: A full-scale analysis and review. J Cancer. 2019;10(15):3553-3559. Published 2019 Jun 9. doi:10.7150/jca.27490 DISCLOSURES: No relevant relationships by Katie Baxter, source=Web Response

Cancer incidence among musicians: 45 years of follow-up in four Nordic countries

Background There are studies suggesting that participation in musical activities may protect from cancer. On the other hand, some musicians have a lifestyle that might increase the risk of cancer. The objective of this study was to assess the cancer pattern of musicians in four Nordic countries. Material and methods This study combines census and cancer registry data from 1961 to 2005 for 13 million people from Finland, Iceland, Norway, and Sweden. Standardized incidence ratio (SIR) analyses were conducted with the cancer incidence rates for entire national populations used as reference rates. Results There were 11,401 male and 3105 female musicians with 2039 cancer cases. The SIR for all sites combined was 1.02 (95% confidence interval 0.97–1.07) in men and 1.04 (0.94–1.15) in women. In male musicians, there were statistically significant excesses in oropharyngeal cancer (4.36, 2.73–6.60), esophageal cancer (2.08, 1.51–2.81), liver cancer (1.81, 1.26–2.52), and skin melanoma (1.40, 1.10–1.75). The risk was decreased in lip cancer (0.13, 0.02–0.48), stomach cancer (0.66, 0.50–0.82), and lung cancer (0.77, 0.65–0.90). In female musicians, there were no statistically significant SIRs in any of the cancer types studied, but the risk of breast cancer was significantly elevated in the age category of 70+ (1.52, 1.04–2.15). The overall SIR was stable over the 45 year period of observation, but strong decreases were observed in the SIRs of esophageal cancer, liver cancer, laryngeal cancer, and skin melanoma. Conclusion Musicians have characteristics of indoor workers such as low incidence of lip cancer and high incidence of skin melanoma. The low incidence of lung cancer suggests that the prevalence of smoking among musicians is lower than in the general population while the elevated risk of alcohol-related cancer types suggest that drinking is likely more common among musicians. The cancer risk for all sites combined is still similar to that of the general population in the four countries studied.

The Expression of Three Negative Co-Stimulatory B7 Family Molecules in Small Cell Lung Cancer and Their Effect on Prognosis

BackgroundIn recent years, immune checkpoint inhibitors have shown significant effects in a variety of solid tumors. However, due to the low incidence of small cell lung cancer (SCLC) and its unclear mechanism, immune checkpoints in SCLC have not been fully studied.MethodsWe evaluated the expression of PD-L1, B7-H3, and B7-H4 in 115 SCLC tissue specimens using immunohistochemistry. The clinical data of patients with SCLC were retrospectively reviewed to investigate three negative co-stimulatory B7 family molecules’ ability to affect the prognosis of SCLC.ResultsAmong the SCLC patients with complete follow-up data (n = 107), sixty-nine (64.49%) expressed moderate to high B7-H3 levels, which correlated positively with tumor sizes (P < 0.001). Eighty (74.77%) patients expressed moderate to high B7-H4 levels, which correlated positively with metastases (P = 0.049). The positive expression of B7-H3 and B7-H4 correlated significantly with shortened overall survival (OS) (B7-H3, P = 0.006; B7-H4, P = 0.019). PD-L1 was positively expressed only in 13.08% of cancer tissues, and there was no significant correlation with prognosis. The Cox proportional hazards regression showed that B7-H3 was an independent prognostic indicator of OS (P = 0.028; HR = 2.125 [95% CI = 0.985-4.462]).ConclusionsOur results suggest that B7-H3 has a negative predictive effect on SCLC. This outcome provides a theoretical basis for the subsequent research on immune checkpoint inhibitors targeting B7-H3.

Uncommon EGFR Mutations in Non-Small Cell Lung Cancer and Their Impact on the Treatment.

Epidermal growth factor receptor (EGFR) mutations play an important role in the pathogenesis of non-small cell lung cancer. Because these alterations are so-called targetable mutations, their identification is important in daily clinical practice. The diagnostic standard of EGFR mutations is currently based on polymerase chain reaction methods, particularly the quantitative real-time polymerase chain reaction. In recent years, new generation sequencing has become increasingly important. In patients with EGFR mutations, a significant improvement in therapeutic outcomes was achieved with the administration of targeted therapy using tyrosine kinase inhibitors. EGFR is composed of four domains: extracellular with a ligand binding site, a transmembrane domain, a cytoplasmic tyrosine kinase catalytic domain, and a C-terminal domain. The key structures of the tyrosine kinase domain responsible for signal activation and transmission are encoded within exons 18-21 on chromosome7. EGFR mutations are highly heterogeneous. About 90% of EGFR mutations are deletions of exon 19 and point mutation L858R in exon 21. These are referred to as classic mutations. Approximately 10% of the total number of EGFR mutations is attributable to less frequent alterations in the EGFR gene. Due to the low incidence of non-small cell lung cancer with less frequent EGFR mutations, information on their predictive significance is still incomplete. Most of the data for the treatment of cases with uncommon mutations were gathered from retrospective analyses and evaluations of small cohorts. The aim of this review is to summarise the current options for diagnosing and treating non-small cell lung cancer patients with uncommon EGFR mutations. This work was supported by the MEYS - NPS I - LO1413 and MH CR - DRO (MMCI, 00209805). The authors declare they have no potential conflicts of interest concerning drugs, products, or&#8239;services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 2. 6. 2019 Accepted: 26. 8. 2019.

Loss of parkin reduces lung tumor development by blocking p21 degradation.

Several epidemiological studies have demonstrated the reciprocal relationship between the development of cancer and Parkinson’s disease (PD). However, the possible mechanisms underlying this relationship remain unclear. To identify this relationship, we first compared lung tumor growth in parkin knockout (KO) mice and wild-type (WT) mice. Parkin KO mice showed decreased lung tumor growth and increased expression of p21, a cell cycle arrester, as compared with WT mice. We also found that parkin interacts with p21, resulting in its degradation; however, parkin KO, knockdown, as well as mutation (R275W or G430D) reduced the degradation of p21. We investigated whether parkin KO increases the association of p21 with proliferating cell nuclear antigen (PCNA) or CDK2 by reducing p21 degradation, and, thus, arresting the cell cycle. The interaction between p21 and PCNA or CDK2 was also enhanced by parkin knockdown, and this increased interaction induced sub G0/G1 arrest, leading to cell death. Therefore, our data indicate that parkin KO reduces the development of lung tumors via cell cycle arrest by blocking the degradation of p21. These findings suggest that PD could be associated with lower lung cancer incidence.

LUNG cancer in Lleida: An epidemiologic study.

e20003 Background: According to GLOBOCAN, in 2018 lung cancer was associated with the greatest incidence and mortality attributable to cancer worldwide: 27.9 cases/100,000 habitants and 23.5 cases/100,000 habitants, respectively. In Spain, lung cancer is the fourth most frequent cancer but the first cause of cancer mortality in the country. We have undertaken this study to compare the epidemiologic data for lung cancer in our Spanish provincial population with those worldwide and nationwide. Methods: This was an observational, retrospective study. It included all patients with lung cancer in the Lleida province of Catalonia, Spain in a period of 6 years, from January 2011 to December 2016. Data taken from electronic medical records included variables such as sex, age of diagnosis, smoking history, histology, stage, and oncologic treatments, among others. Incidence, prevalence, survival and mortality rates were determined, as well as the main clinical characteristics of the cohort. Results: Seven hundred eighty-two patients with a diagnosis of lung cancer between January 2011 and December 2016 were included. Median follow-up was 11.7 months. Men comprised 78.6% of the cohort. The median age at diagnosis was 66.6 years. More than half of the patients (53.2%) smoked at the time of diagnosis. The majority were adenocarcinomas (44.1%), with 33.2% squamous cell carcinomas, and 12.1% small cell carcinomas. EGFR testing was performed in 300 patients. 18.7% were positive for a mutation, of which 69.7% were exon 19 insertions. At diagnosis, 52.3% of cases were stage IV, 25.3% stage III, 7.3% stage II, and 14.5% stage I. The average annual incidence rate was 37 cases/100,000 habitants. The median overall survival (OS) was 12.3 months (95% CI: 10.7-13.8). The OS at 1 year was 50.8% (95% CI: 47.3-54.3) and at 5 years was 13.7% (95% CI: 10.2-17.2). The estimated mortality rates were 49.2% in the first year and 86.3% at 5 years. Conclusions: In the Lleida province of Spain, the incidence and mortality associated with lung cancer are greater than global rates but lower than those of Spain as a whole (incidence: 37 vs 58 cases/100.000 hab). Lung cancer survival at 5 years is greater than countrywide statistics (12,3% vs 9.9 %). The heathier lifestyle and rural geography may favor the lower incidence of lung cancer in Lleida compared with the rest of Spain.

Vitamin D levels and cancer incidence in 217,244 individuals from primary health care in Denmark.

Vitamin D has been linked to cancer development in both pre-clinical and epidemiological studies. Our study examines the association between serum levels of vitamin D and cancer incidence in the Capital Region of Denmark. Individuals who had vitamin D analyzed at The Copenhagen General Practitioners Laboratory between April 2004 and January 2010 were linked to Danish registries with end of follow-up date at Dec 31st 2014, excluding individuals with pre-existing cancer. Cox regression models adjusted for age in one-year intervals, sex, month of sampling, and Charlson Comorbidity Index were applied. The study population of 217,244 individuals had a median vitamin D level of 46 nmol/L (IQR 27-67 nmol/L). Non-melanoma skin cancer was the most frequent form of cancer, followed by breast-, lung-, and prostate cancers. No associations were found between increments of 10 nmol/L vitamin D and incidence of breast, colorectal, urinary, ovary or corpus uteri cancer. However, higher levels of vitamin D were associated with higher incidence of non-melanoma (HR 1.09 [1.09-1.1]) and melanoma skin cancer (HR 1.1 [1.08-1.13]) as well as prostate (HR 1.05 [1.03-1.07]) and hematological cancers (HR 1.03 [1.01-1.06]), but with lower incidence of lung cancer (HR 0.95 [0.93-0.97]). In our study, vitamin D levels are not associated with the incidence of several major cancer types, but higher levels are significantly associated with a higher incidence of skin, prostate, and hematological cancers as well as a lower incidence of lung cancer. These results do not support an overall protective effect against cancer by vitamin D.

Cardiorespiratory fitness, incidence and mortality of lung cancer in men: A prospective cohort study

ObjectivesTo evaluate the association between cardiorespiratory fitness (CRF), lung cancer incidence and cancer mortality in men. DesignProspective cohort study. MethodsMaximal exercise testing was performed in 4920 men (59.2±11.4years) free from malignancy at baseline. Multivariate Cox hazard models adjusted for established cancer risk factors including smoking were analyzed for lung cancer incidence and cancer mortality among those who were diagnosed with lung cancer. Population attributable risks (PAR) of low CRF (<5 METs) were determined. ResultsDuring 12.7±7.5years follow-up, 105 (2.1%) participants were diagnosed with lung cancer and 83 (79%) of those died from cancer after 3.6±4.6 years from diagnosis. CRF was inversely and independently associated with cancer outcomes. A 1-MET increase and categories of moderate and high CRF were associated with 10%, 47% and 65% reduction in lung cancer incidence (p=0.002), and 13%, 58% and 76% reduction in cancer mortality (p=0.002), respectively. Also, individuals who were diagnosed with lung cancer and were at moderate or high CRF categories at baseline exhibited longer survival time (p<0.001). The PARs% for lung cancer incidence and cancer mortality were 8.7% and 18.5%, respectively. ConclusionsHigher CRF is associated with lower lung cancer incidence in men. Among individuals who were diagnosed with lung cancer, higher CRF was associated with reduced cancer mortality and longer survival time. These results support the protective benefits of higher CRF in the prevention of lung cancer outcomes. Eliminating low CRF as a risk factor would potentially prevent considerable lung cancer morbidity and mortality.

A RARE CASE OF PARANEOPLASTIC NEUROLOGICAL SYNDROME ASSOCIATED WITH ADENOCARCINOMA OF THE LUNG

SESSION TITLE: Lung Cancer 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Paraneoplastic neurologic syndromes (PNS) are rare but clinically important complications of malignancy. These syndromes occur in approximately 0.01% of cancer patients, although more frequently in those with lung cancer, specifically small cell carcinoma. The neurologic syndromes are extensive and may present as encephalomyelitis, cerebellar cortical degeneration, peripheral neuropathy, neuopsoclonus-myoclonus, and retinopathy[1]. CASE PRESENTATION: A 76-year old woman with a recent diagnosis of well differentiated adenocarcinoma, mixed acinar and micropapillary, KRAS p.Gly12Val tumor marker positive, type lung cancer, presented with shortness of breath and altered mental status. According to family she was becoming progressively confused for the prior six weeks, displaying “hyper-somnolence” and speaking “with her eyes closed”. Neurological exam was significant for lethargy, confusion, and incoherent speech. Admission labs showed elevated WBC count 15.7; lactate 0.8. Chest X-ray showed patchy opacities bilaterally, and mild pulmonary congestion. CT scan of her brain was negative for acute pathology. Brain MRI was negative for metastatic disease. Empiric treatment for pneumonia was initiated based on x-ray findings. During her hospital stay, patient remained minimally communicative and unable to follow commands. VEEG was unremarkable. CSF analysis showed 5 WBC, no RBC, with 48% lymphocytes, and 48% monocytes. CSF cytology was negative for malignant cells. Elevated protein was measured at 81 mg/dL. CSF PCR was negative for VZV, HSV, and West Nile Virus. Paraneoplastic encephalitis was suspected due to lack of alternative etiologies for the patient’s symptoms. Treatment with IVIG and high-dose solumedrol was initiated. Ultimately, the paraneoplastic antibody panel resulted with type I anti-neuronal nuclear antibody (ANNA-1) titer of 1:512, Anti-Hu AB titer of 1:32, and anti-recoverin titer of 1:1. DISCUSSION: Paraneoplastic neurologic syndromes are rare clinical syndromes, resulting from the remote effect of a tumor on the nervous system, associated 95% of the time with small cell lung cancer [2]. Our patient’s manifestation of PNS with lung adenocarcinoma is extremely rare. Due to the very low incidence of non-small cell lung cancer associated with PNS, her diagnosis of lung adenocarcinoma was not believed to be contributory to her change in mental status. However, discovery of well characterized onconeural proteins such anti-Hu antibodies in the CSF, made a diagnosis of a PNS highly likely. CONCLUSIONS: Our case demonstrates that lung adenocarcinoma can play a role in the development of paraneoplastic neurologic syndrome and should be considered in the setting of a patient with altered mental status without other cause. Reference #1: Miyamoto, K., et al., A case of paraneoplastic syndrome accompanied by two types of cancer. J Neurol Neurosurg Psychiatry, 2002. 72(3): p. 408-9. Reference #2: Kanaji, N., et al., Paraneoplastic syndromes associated with lung cancer. World J Clin Oncol, 2014. 5(3): p. 197-223. DISCLOSURES: No relevant relationships by Scott Ferrara, source=Web Response No relevant relationships by eman rashed, source=Web Response No relevant relationships by Peter Rattner, source=Web Response No relevant relationships by Michael Silverberg, source=Web Response

Abstract 1200: 25OH vitamin D concentrations are associated with both higher and lower incidence of specific cancers

Abstract This study examined the association between concentrations of 25OH vitamin D and cancer incidence in individuals from the Capital Region of Denmark who had 25OH vitamin D analyzed in serum via their general practitioner between April 2004 and January 2010 (CopD). CopD data were linked to the Danish Cancer Registry, the National Patient Registry and the Danish Civil Registration System as of December 2014. CopD consists of 246,858 individuals with 25OH vitamin D analyses. Individuals diagnosed with cancer prior to their 25OH vitamin D analysis (N=29,614) were excluded. The population analyzed in the study (217,244 individuals) had a mean level of 25OH vitamin D of 50.2 nmol/L, a mean age of 49.1 years (SD 20.1), female predominance (65.3%), and low comorbidity burden (Charlson Comorbidity index (CCI) ≥1 in 20.5%). Cox regression models with time since blood sampling as the underlying time scale adjusted for age in one year intervals, sex, month of sampling, and CCI as strata variables were performed in SAS 9.4 (SAS Institute, Cary, USA). P-values less than 0.05 were considered statistically significant. The study population experienced a total of 18,359 incident cancers during the follow-up period. Non-melanoma skin cancer was the most frequent form of cancer, followed by breast-, lung-, and prostate cancer (Table). In the adjusted analysis higher levels of 25OH vitamin D in increments of 10 nmol/L were associated with higher incidence of non-melanoma- and melanoma skin cancer, as well as prostate- and hematological cancers, but lower incidence of lung cancer. Excluding those diagnosed with cancer within 5 years of blood sampling, revealed similar results (Table). In conclusion, higher concentrations of 25OH vitamin D are associated with both higher and lower incidence of cancer depending on cancer type in CopD. Thus, in a population from general practice we find higher 25OH vitamin D concentrations are associated with the incidence of skin-, prostate and hematological cancers. Hazard ratios (HR) per 10nmol/L increase in 25OH vitamin D.Adjusted HR for allHR for cancer after 5+ yearsN casesHR95% ClpN casesHR95% ClpSkin cancerNon-melanoma50451.091.09-1.10&amp;lt;0.000110621.111.09-1.13&amp;lt;0.0001Melanoma6841.101.08-1.13&amp;lt;0.00011301.141.08-1.20&amp;lt;0.0001Sex specific cancersBreast21671.000.99-1.020.644551.020.99-1.050.21Ovary2540.990.94-1.030.58530.980.89-1.080.68C. Uteri3470.990.96-1.030.71900.990.92-1.060.71Prostate14701.051.03-1.07&amp;lt;0.00012211.091.04-1.150.0002Tobacco related cancersLung17070.950.93-0.97&amp;lt;0.00013180.930.89-0.980.003Colon11080.980.96-1.000.102220.970.93-1.030.32Rectum4610.980.94-1.010.18880.980.91-1.060.67Urinary10160.990.96-1.010.342130.980.93-1.040.50Other cancersHematological9681.031.01-1.060.0041811.081.03-1.130.002Central Nervous System incl. eye6891.000.98-1.030.871441.000.95-1.060.94 Citation Format: Fie J. Vojdeman, Christian M. Madsen, Darshana Durup, Kirsten Frederiksen, Anja Olsen, Louise Hansen, Anne-Marie Heegaard, Bent S. Lind, Anne Tjønneland, Henrik L. Jørgensen, Peter Schwarz. 25OH vitamin D concentrations are associated with both higher and lower incidence of specific cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1200.

Comparison of cancer incidence in Australian farm residents 45 years and over, compared to rural non-farm and urban residents - a data linkage study

BackgroundIt is not known if the incidence of common cancers in Australian farm residents is different to rural non-farm or urban residents.MethodsData from farm, rural non-farm and urban participants of the 45 and Up Study cohort in New South Wales, Australia, were linked with state cancer registry data for the years 2006–2009. Directly standardised rate ratios for cancer incidence were compared for all-cancer, prostate, breast, colorectal cancer, melanoma and non-Hodgkin Lymphoma (NHL). Proportional hazards regression was used to generate incidence hazard ratios for each cancer type adjusted for relevant confounders.ResultsFarm women had a significantly lower all-cancer hazard ratio than rural non-farm women (1.14, 1.01–1.29). However, the lower all-cancer risk observed in farm men, was not significant when compared to rural non-farm and urban counterparts. The all-cancer adjusted hazard ratio for combined rural non-farm and urban groups compared to farm referents, was significant for men (1.08,1.01–1.17) and women (1.13, 1.04–1.23). Confidence intervals did not exclude unity for differences in risk for prostate, breast, colorectal or lung cancers, NHL or melanoma. Whilst non-significant, farm residents had considerably lower risk of lung cancer than other residents after controlling for smoking and other factors.ConclusionsAll-cancer risk was significantly lower in farm residents compared to combined rural non-farm and urban groups. Farm women had a significantly lower all-cancer adjusted hazard ratio than rural non-farm women. These differences appeared to be mainly due to lower lung cancer incidence in farm residents.

Lung cancer screening: screening frequency and lung cancer risk

Lung cancer is the commonest cause of cancer death worldwide. Along with primary prevention such as tobacco control, screening with low-dose computed tomography (LDCT) has the potential to reduce lung cancer mortality. Screening has already been implemented in some countries but national health authorities in many countries have yet to adopt lung cancer screening as a public health policy. Although there is evidence to support the effectiveness of LDCT screening in high-risk groups there are many challenges to implementing a cost-effective lung cancer screening program and there are still unanswered questions about how to most efficiently select high risk groups for screening, how to optimally manage lung nodules and how frequently to offer screening. A recent retrospective cohort analysis of data from the National Lung Screening Trial (NLST) provides some evidence to support the concept that annual screening might not be necessary for all participants in a lung cancer screening program. Individuals with a negative baseline LDCT result have been shown to have a lower incidence of lung cancer and reduced lung cancer mortality at follow up compared with all participants in baseline screening and the relative costs, benefits and harms of annual screening in this group may differ compared to those with a positive prevalence LDCT. Further research is needed to determine whether risk prediction models incorporating the findings of prevalence LDCT scans can be used to guide the frequency of subsequent screening in order to maximize the efficient use of resources and reduce the harms associated with screening.

Lung cancer screening: screening frequency and lung cancer risk

: Lung cancer is the commonest cause of cancer death worldwide. Along with primary prevention such as tobacco control, screening with low-dose computed tomography (LDCT) has the potential to reduce lung cancer mortality. Screening has already been implemented in some countries but national health authorities in many countries have yet to adopt lung cancer screening as a public health policy. Although there is evidence to support the effectiveness of LDCT screening in high-risk groups there are many challenges to implementing a cost-effective lung cancer screening program and there are still unanswered questions about how to most efficiently select high risk groups for screening, how to optimally manage lung nodules and how frequently to offer screening. A recent retrospective cohort analysis of data from the National Lung Screening Trial (NLST) provides some evidence to support the concept that annual screening might not be necessary for all participants in a lung cancer screening program. Individuals with a negative baseline LDCT result have been shown to have a lower incidence of lung cancer and reduced lung cancer mortality at follow up compared with all participants in baseline screening and the relative costs, benefits and harms of annual screening in this group may differ compared to those with a positive prevalence LDCT. Further research is needed to determine whether risk prediction models incorporating the findings of prevalence LDCT scans can be used to guide the frequency of subsequent screening in order to maximize the efficient use of resources and reduce the harms associated with screening.

Physical activity and sedentary behavior in relation to lung cancer incidence and mortality in older women: The Women's Health Initiative.

Physical activity has been associated with lower lung cancer incidence and mortality in several populations. We investigated these relationships in the Women's Health Initiative Observational Study (WHI-OS) and Clinical Trial (WHI-CT) prospective cohort of postmenopausal women. The WHI study enrolled 161,808 women aged 50-79 years between 1993 and 1998 at 40 U.S. clinical centers; 129,401 were eligible for these analyses. Cox proportional hazards models were used to assess the association of baseline physical activity levels [metabolic equivalent (MET)-min/week: none <100 (reference), low 100 to <500, medium 500 to <1,200, high 1,200+] and sedentary behavior with total lung cancer incidence and mortality. Over 11.8 mean follow-up years, 2,148 incident lung cancer cases and 1,365 lung cancer deaths were identified. Compared with no activity, higher physical activity levels at study entry were associated with lower lung cancer incidence [p = 0.009; hazard ratios (95% confidence intervals) for each physical activity category: low, HR: 0.86 (0.76-0.96); medium, HR: 0.82 (0.73-0.93); and high, HR: 0.90 (0.79-1.03)], and mortality [p < 0.0001; low, HR: 0.80 (0.69-0.92); medium, HR: 0.68 (0.59-0.80); and high, HR: 0.78 (0.66-0.93)]. Body mass index (BMI) modified the association with lung cancer incidence (p = 0.01), with a stronger association in women with BMI < 30 kg/m(2) . Significant associations with sedentary behavior were not observed. In analyses by lung cancer subtype, higher total physical activity levels were associated with lower lung cancer mortality for both overall NSCLC and adenocarcinoma. In conclusion, physical activity may be protective for lung cancer incidence and mortality in postmenopausal women, particularly in non-obese women.

Lung cancer incidence and mortality in National Lung Screening Trial participants who underwent low-dose CT prevalence screening: a retrospective cohort analysis of a randomised, multicentre, diagnostic screening trial

Annual low-dose CT screening for lung cancer has been recommended for high-risk individuals, but the necessity of yearly low-dose CT in all eligible individuals is uncertain. This study examined rates of lung cancer in National Lung Screening Trial (NLST) participants who had a negative prevalence (initial) low-dose CT screen to explore whether less frequent screening could be justified in some lower-risk subpopulations. We did a retrospective cohort analysis of data from the NLST, a randomised, multicentre screening trial comparing three annual low-dose CT assessments with three annual chest radiographs for the early detection of lung cancer in high-risk, eligible individuals (aged 55-74 years with at least a 30 pack-year history of cigarette smoking, and, if a former smoker, had quit within the past 15 years), recruited from US medical centres between Aug 5, 2002, and April 26, 2004. Participants were followed up for up to 5 years after their last annual screen. For the purposes of this analysis, our cohort consisted of all NLST participants who had received a low-dose CT prevalence (T0) screen. We determined the frequency, stage, histology, study year of diagnosis, and incidence of lung cancer, as well as overall and lung cancer-specific mortality, and whether lung cancers were detected as a result of screening or within 1 year of a negative screen. We also estimated the effect on mortality if the first annual (T1) screen in participants with a negative T0 screen had not been done. The NLST is registered with ClinicalTrials.gov, number NCT00047385. Our cohort consisted of 26 231 participants assigned to the low-dose CT screening group who had undergone their T0 screen. The 19 066 participants with a negative T0 screen had a lower incidence of lung cancer than did all 26 231 T0-screened participants (371·88 [95% CI 337·97-408·26] per 100 000 person-years vs 661·23 [622·07-702·21]) and had lower lung cancer-related mortality (185·82 [95% CI 162·17-211·93] per 100 000 person-years vs 277·20 [252·28-303·90]). The yield of lung cancer at the T1 screen among participants with a negative T0 screen was 0·34% (62 screen-detected cancers out of 18 121 screened participants), compared with a yield at the T0 screen among all T0-screened participants of 1·0% (267 of 26 231). We estimated that if the T1 screen had not been done in the T0 negative group, at most, an additional 28 participants in the T0 negative group would have died from lung cancer (a rise in mortality from 185·82 [95% CI 162·17-211·93] per 100 000 person-years to 212·14 [186·80-239·96]) over the course of the trial. Participants with a negative low-dose CT prevalence screen had a lower incidence of lung cancer and lung cancer-specific mortality than did all participants who underwent a prevalence screen. Because overly frequent screening has associated harms, increasing the interval between screens in participants with a negative low-dose CT prevalence screen might be warranted. None.