Lower Lung Cancer Research Articles

Epigenetically silenced apoptosis-associated tyrosine kinase (AATK) facilitates a decreased expression of Cyclin D1 and WEE1, phosphorylates TP53 and reduces cell proliferation in a kinase-dependent manner

Silencing of the Apoptosis associated Tyrosine Kinase gene (AATK) has been described in cancer. In our study, we specifically investigated the epigenetic inactivation of AATK in pancreatic adenocarcinoma, lower grade glioma, lung, breast, head, and neck cancer. The resulting loss of AATK correlates with impaired patient survival. Inhibition of DNA methyltransferases (DNMTs) reactivated AATK in glioblastoma and pancreatic cancer. In contrast, epigenetic targeting via the CRISPR/dCas9 system with either EZH2 or DNMT3A inhibited the expression of AATK. Via large-scale kinomic profiling and kinase assays, we demonstrate that AATK acts a Ser/Thr kinase that phosphorylates TP53 at Ser366. Furthermore, whole transcriptome analyses and mass spectrometry associate AATK expression with the GO term ‘regulation of cell proliferation’. The kinase activity of AATK in comparison to the kinase-dead mutant mediates a decreased expression of the key cell cycle regulators Cyclin D1 and WEE1. Moreover, growth suppression through AATK relies on its kinase activity. In conclusion, the Ser/Thr kinase AATK represses growth and phosphorylates TP53. Furthermore, expression of AATK was correlated with a better patient survival for different cancer entities. This data suggests that AATK acts as an epigenetically inactivated tumor suppressor gene.

Adapting Community Educational Programs During the COVID-19 Pandemic: Comparing the Feasibility and Efficacy of a Lung Cancer Screening Educational Intervention by Mode of Delivery.

Few eligible patients receive lung cancer screening. We developed the Lung AIR (awareness, information, and resources) intervention to increase community education regarding lung cancer screening. The intervention was designed as an in-person group intervention; however, the COVID-19 pandemic necessitated adapting the mode of delivery. In this study we examined intervention feasibility and efficacy overall and by mode of delivery (in-person group vs. one-on-one phone) to understand the impact of adapting community outreach and engagement strategies. Feasibility was examined through participant demographics. Efficacy was measured through pre/post knowledge, attitudes, and beliefs about lung cancer screening, and intention to complete screening. We reached N = 292 participants. Forty percent had a household income below $35,000, 58% had a high school degree or less, 40% were Hispanic, 57% were Black, and 84% reported current or past smoking. One-on-one phone sessions reached participants who were older, had lower incomes, more current smoking, smoked for more years, more cigarettes per day, lower pre-intervention lung cancer screening knowledge, and higher pre-intervention fear and worry. Overall pre/post test scores show significant increases in knowledge, salience, and coherence, and reduced fear and worry. Participants in the one-on-one phone sessions had significantly higher increases in salience and coherence and intention to complete screening compared to participants in the in-person group sessions. The Lung AIR intervention is a feasible and effective community-based educational intervention for lung cancer screening. Findings point to differences in reach and efficacy of the community-based intervention by mode of delivery.

Nanotechnology-Assisted Metered-Dose Inhalers (MDIs) for High-Performance Pulmonary Drug Delivery Applications.

PurposeRespiratory disorders pose a major threat to the morbidity and mortality to public health. Here we reviewed the nanotechnology based pulmonary drug delivery using metered dose inhalers.MethodsMajor respiratory diseases such as chronic obstructive pulmonary diseases (COPD), asthma, acute lower respiratory tract infections, tuberculosis (TB) and lung cancer. At present, common treatments for respiratory disorders include surgery, radiation, immunotherapy, and chemotherapy or a combination. The major challenge is development of systemic delivery of the chemotherapeutic agents to the respiratory system. Conventional delivery of chemotherapy has various limitation and adverse side effected. Hence, targeted, and systemic delivery need to be developed. Towards this direction nanotechnology, based controlled, targeted, and systemic drug delivery systems are potential candidate to enhance therapeutic efficacy with minimum side effect. Among different route of administration, pulmonary delivery has unique benefits such as circumvents first pass hepatic metabolism and reduces dose and side effects.ResultsRespiratory disorders pose a major threat to the morbidity and mortality to public health globally. Pulmonary delivery can be achieved through various drug delivery devices such as nebulizers, dry powder inhalers, and metered dose inhalers. Among them, metered dose inhalers are the most interesting and first choice of clinician over others. This review focused on nanotechnology based pulmonary drug delivery using metered dose inhalers. This report focused on delivery of various types of therapeutics using nanocarriers such as polymeric nanoparticles and micelles, dendrimers, lipid nanocarriers such as liposomes, solid lipid nanostructures and nanostructured lipid carriers, and other using metered dose inhalers discussed comprehensively. This report provides insight about the effect of parameters of MDI such as co-solvent, propellants, actuators shape, nozzle diameters, and jet lengths, and respiratory flow rate, and particle size of co-suspension of drug on aerodynamics and lung deposition of formulation. This review also provided the insight about various metered dose inhalers market scenario and digital metered dose inhalers.ConclusionThis report concluded the clinical potential of metered dose inhalers, summary of current progress and future perspectives towards the smart digital metered dose inhalers development.

Endogenous sex hormones, aromatase activity and lung cancer risk in postmenopausal never-smoking women.

Although reproductive factors have been repeatedly associated with lung cancer risk, no study to date has directly evaluated the relationship with endogenous sex hormones nor with aromatase activity in postmenopausal never-smoking women. A case-control study of 397 incident lung cancer cases and their individually matched controls, nested within the Shanghai Women's Health Study, was conducted among postmenopausal women who were lifetime never smokers. Prediagnostic concentrations of sex hormones was quantitated using LC-MS/MS assays in plasma. The product-substrate molar ratio of estrone to androstenedione was used as an index of aromatase activity (IAA). Multivariable conditional logistic regression models were used to calculate odds ratios (ORs) for lung cancer. Baseline concentrations of estradiol, free testosterone and IAA were inversely associated with subsequent risk of lung cancer in multivariable-adjusted models. When further adjusted for body mass index, the inverse association with estradiol was attenuated and no longer statistically significant, but the association with free testosterone and IAA remained. In analyses confined to participants having never used menopausal hormone therapy in 376 case-control pairs, the inverse association with free testosterone and IAA was slightly strengthened. OR for the highest vs the lowest quartile of free testosterone was 0.55 (95% CI=0.34-0.90; Ptrend =.03), and the corresponding OR for IAA was 0.57 (95% CI=0.34-0.96; Ptrend =.04). Our study, for the first time, suggests that higher levels of circulating free testosterone and estimated aromatase activity may be associated with lower lung cancer risk in postmenopausal never-smoking women.

One-off low-dose CT for lung cancer screening in China: a multicentre, population-based, prospective cohort study

Lung cancer is the leading cause of cancer death worldwide. Data on the effectiveness of one-off low-dose CT (LDCT) in reducing lung cancer mortality and all-cause mortality are needed to inform screening programmes in countries with limited medical resources. We aimed to evaluate the effectiveness of one-off LDCT screening in the early detection of lung cancer in China. A multicentre, population-based, prospective cohort study was done in 12 cities of eight provinces across China, recruiting individuals aged 40-74 years who were asymptomatic for lung cancer with no lung cancer history. Participants were classified as at high risk or low risk of lung cancer using a sex-specific risk score that incorporated cigarette smoking, level of physical activity, occupational exposures, history of chronic respiratory diseases, family history of lung cancer, diet, and passive smoking (women only). Participants at high risk were invited for a one-off LDCT scan and were classified into screened and non-screened groups on the basis of whether or not they had the scan. Lung cancer incidence density, lung cancer mortality, and all-cause mortality were calculated for the screened and non-screened groups. The effectiveness of a one-off LDCT scan was evaluated by a comparison of the screened and non-screened groups in terms of lung cancer mortality and all-cause mortality in the period from cohort entry until administrative censoring (June 20, 2020). Inverse probability weighting was adopted to account for potential imbalanced factors between the two groups and Cox proportional hazards model was used to estimate the weighted associations between mortality and one-off LDCT scans. Between Feb 19, 2013, and Oct 31, 2018, 1 032 639 individuals were assessed for eligibility. 1 016 740 participants were enrolled in the study, of whom 3581 had a lung cancer diagnosis after a median follow-up of 3·6 years (IQR 2·8-5·1). Among the 223 302 participants at high risk, 79 581 (35·6%) had an LDCT scan (screened group) and 143 721 (64·4%) did not (non-screened group). After inverse probability weighting, lung cancer incidence density was 47·0% higher (hazard ratio 1·47 [95% CI 1·27-1·70]; p<0·0001), lung cancer mortality was 31·0% lower (0·69 [95% CI 0·53-0·92]; p=0·010) and all-cause mortality was 32·0% lower (0·68 [0·57-0·82]; p<0·0001) for participants in the screened group compared with those in the non-screened group. One-off LDCT screening was associated with significantly lower lung cancer mortality and all-cause mortality in a large population in China. Our results point to the promise of one-off LDCT screening in countries with limited medical resources. Further studies are needed to explore interactions by subgroup-including sex, age, smoking status, and economic status-to develop population-specific screening strategies. Ministry of Finance and National Health Commission of the People's Republic of China. For the Chinese translation of the abstract see Supplementary Materials section.

Occupational Exposures and Lung Cancer Risk-An Analysis of the CARTaGENE Study.

To determine the associations between prevalent occupational agents and lung cancer risk. A case-cohort design (ncases= 147; nsub-cohort= 1,032) was nested within the CARTaGENE prospective cohort study. The Canadian Job Exposure Matrix was used to determine the probability of exposure to 27 agents in participants' longest-held jobs. Multivariable logistic regression with robust variance estimators was used to determine the associations between each agent and lung cancer risk while adjusting for established lung cancer risk factors. Increased lung cancer risk was observed among those exposed to ashes, calcium sulfate, formaldehyde, cooking fumes, alkanes, aliphatic aldehydes, and cleaning agents. Lower lung cancer risk was found among participants exposed to carbon monoxide and polycyclic aromatic hydrocarbons from petroleum. Our findings support the role of several occupational agents, for which we have limited knowledge, in contributing to lung cancer risk.

Valuing burden of premature mortality attributable to air pollution in major million-plus non-attainment cities of India

Accelerating growth due to industrialization and urbanization has improved the Indian economy but simultaneously has deteriorated human health, environment, and ecosystem. In the present study, the associated health risk mortality (age > 25) and welfare loss for the year 2017 due to excess PM2.5 concentration in ambient air for 31 major million-plus non-attainment cities (NACs) in India is assessed. The cities for the assessment are prioritised based on population and are classified as ‘X’ (> 5 million population) and ‘Y’ (1–5 million population) class cities. Ground-level PM2.5 concentration retrieved from air quality monitoring stations for the NACs ranged from 33 to 194 µg/m3. Total PM2.5 attributable premature mortality cases estimated using global exposure mortality model was 80,447 [95% CI 70,094–89,581]. Ischemic health disease was the leading cause of death accounting for 47% of total mortality, followed by chronic obstructive pulmonary disease (COPD-17%), stroke (14.7%), lower respiratory infection (LRI-9.9%) and lung cancer (LC-1.9%). 9.3% of total mortality is due to other non-communicable diseases (NCD-others). 7.3–18.4% of total premature mortality for the NACs is attributed to excess PM2.5 exposure. The total economic loss of 90,185.6 [95% CI 88,016.4–92,411] million US$ (as of 2017) was assessed due to PM2.5 mortality using the value of statistical life approach. The highest mortality (economic burden) share of 61.3% (72.7%) and 30.1% (42.7%) was reported for ‘X’ class cities and North India zone respectively. Compared to the base year 2017, an improvement of 1.01% and 0.7% is observed in premature mortality and economic loss respectively for the year 2024 as a result of policy intervention through National Clean Air Action Programme. The improvement among 31 NACs was found inconsistent, which may be due to a uniform targeted policy, which neglects other socio-economic factors such as population, the standard of living, etc. The study highlights the need for these parameters to be incorporated in the action plans to bring in a tailored solution for each NACs for better applicability and improved results of the programme facilitating solutions for the complex problem of air pollution in India.

Association between previous lung diseases and lung cancer risk: a systematic review and meta-analysis.

Previous lung diseases (PLD) are known risk factors for lung cancer. However, it remains unclear how the association varies by lung cancer subtype and socio-demographic characteristics. We conducted a systematic literature search in three electronic databases from the inception of each database up until 13 January 2021. A total of 73 studies (18 cohort and 55 case-control studies) consisting of 97 322 cases and 7 761 702 controls were included. Heterogeneity was assessed using the I2 statistic. Based on the heterogeneity, either the fixed-effects or random-effects model was used to estimate the pooled summary estimate (PSE) and 95% confidence interval (CI) for the association between PLD and lung cancer risk. A history of asthma, chronic bronchitis, emphysema, pneumonia, tuberculosis, and chronic obstructive pulmonary disease (COPD) was associated with higher lung cancer risk, with a history of COPD and emphysema having at least twofold relative risk. A history of hay fever was associated with lower lung cancer risk (PSE= 0.66, 95% CI= 0.54-0.81), particularly among ever-smokers (PSE= 0.55, 95% CI= 0.41-0.73). Individuals with a diagnosis of asthma, emphysema, or pneumonia within 1-10 years prior to lung cancer diagnosis were observed to have a higher lung cancer risk as compared to those who were diagnosed more than 10 years prior to lung cancer diagnosis. Ever-smokers with a history of COPD or emphysema were observed to have at least twofold relative risk of lung cancer compared to those without this history. Due to the observed association between PLD with higher risk of lung cancer, it is advisable that individuals with PLD should be closely monitored and prioritised for lung cancer screening.

Explaining spatial patterns of lung cancer mortality in Russia

ABSTRACT Socialization theory assumes that socialization agents, such as family, school, and church, inculcate human values and behaviors. The current study proposes that socialization has affected social acceptability of tobacco use. The analysis identifies socio-demographic risk factors, as measured in two postwar Soviet censuses, for age-adjusted lung cancer mortality in Russia in 2014−2018, using findings from the micro-level. Based on the 1959 and 1970 National Census results, three pairs of principal components were extracted corresponding to three socialization agents. A general-to-specific strategy was used to specify a spatial model and resulted in a spatial autoregressive model with autoregressive disturbances. Four spatial models show consistently that the strength of informal institutions in the postwar societies (i.e. at the socialization stage) was spatially related to a lower age-adjusted lung cancer mortality in men and women. Also, urban style of living and low education in the postwar societies were spatially related to an elevated age-adjusted lung cancer mortality in men. It is concluded that socialization theory can explain spatial variation in age-adjusted lung cancer mortality. The observed latitudinal spatial clustering of age-adjusted lung cancer mortality in the European part of the country remains consistent with the previous research on the spatial variation in violent mortality and suicide mortality.

Lung cancer with partial anomalous pulmonary venous connection in a different lobe: a case report

BackgroundAnomalous pulmonary venous connection (APVC) is a congenital malformation in which the pulmonary veins connect to the systemic venous system but not to the left atrium. APVC can be classified as total or partial (PAPVC). PAPVC is rare among surgical patients with lung cancer, and most cases are detected incidentally during surgery. We herein report a patient with lung cancer in whom PAPVC was diagnosed before surgery, which made it difficult to determine the surgical procedure.Case presentationA 71-year-old man was followed-up as an outpatient after surgery for renal cell carcinoma. Chest computed tomography showed a 22-mm nodule in the right lower lobe and PAPVC in the right upper lobe. He was diagnosed with lung adenocarcinoma (cT1cN0M0 stage IA3) and scheduled for surgery. Preoperative catheterization showed a pulmonary to systemic flow ratio (Qp/Qs) of 1.64 and mean pulmonary artery pressure (MPAP) of 16 mmHg. Surgical repair of PAPVC is indicated when a patient is symptomatic and has a Qp/Qs ≥1.5–2.0. The patient was scheduled for right lower lobectomy, but postoperative worsening of right heart strain was considered. Concomitant PAPVC repair was therefore considered, but he had no atrial septal defect and was asymptomatic; therefore, PAPVC treatment was considered unnecessary. However, we planned to perform concomitant PAPVC repair if his circulatory dynamics worsened during surgery or if his MPAP exceeded 25 mmHg. His MPAP was 20 mmHg and his circulatory dynamics remained stable, and right lower lobectomy was therefore completed. His postoperative course was favorable. Follow-up catheterization at 6 months showed a Qp/Qs of 1.19 and MPAP of 18 mmHg, with no evidence of increased right heart strain. There was no evidence of right heart failure or recurrence of lung cancer at last follow-up at 18 months after surgery.ConclusionsWe present a case of right lower lung cancer complicated by PAPVC in the right upper lobe. This case suggests that concomitant repair of PAPVC in the right upper lobe may not be necessary when performing right lower lobectomy, although the patient’s Qp/Qs and MPAP should be considered.

Age and Gender Specific Lung Cancer Incidence and Mortality in Hungary: Trends from 2011 Through 2016.

Objective: No assessment was conducted describing the age and gender specific epidemiology of lung cancer (LC) prior to 2018 in Hungary, thus the objective of this study was to appraise the detailed epidemiology of lung cancer (ICD-10 C34) in Hungary based on a retrospective analysis of the National Health Insurance Fund database. Methods: This longitudinal study included patients aged ≥20 years with LC diagnosis (ICD-10 C34) between January 1, 2011 and December 31, 2016. Patients with different cancer-related codes 6 months before or 12 months after LC diagnosis or having any cancer treatment other than lung cancer protocols were excluded. Results: Lung cancer incidence and mortality increased with age, peaking in the 70–79 age group (375.0/100,000 person-years) among males, while at 60–69 age group for females (148.1/100,000 person-years). The male-to-female incidence rate ratio reached 2.46–3.01 (p < 0.0001) among the 70–79 age group. We found 2–11% decrease in male incidence rate at most age groups, while a significant 1–3% increase was observed in older females (>60) annually during the study period. Conclusion: This nationwide epidemiology study demonstrated that LC incidence and mortality in Hungary decreased in younger male and female population, however we found significant increase of incidence in older female population, similar to international trends. Incidence rates peaked in younger age-groups compared to Western countries, most likely due to higher smoking prevalence in these cohorts, while lower age LC incidence could be attributed to higher competing cardiovascular risk resulting in earlier mortality in smoking population.

Reduction of heart and lung normal tissue complication probability using automatic beam angle optimization and more generic optimization objectives for breast radiotherapy.

During breast cancer radiotherapy, sparing of healthy tissue is desired. The effect of automatic beam angle optimization and generic dose fall-off objectives on dose and normal tissue complication probabilities was studied. In all patients, dose to lungs and heart showed a mean reduction of 0.4 Gy (range 0.1–1.3 Gy) and 0.2 Gy (range −0.2–0.7 Gy), respectively. These lower doses led to a statistically significant lower cumulative cardiac and lung cancer mortality risk. For smoking patients 40–45 years of age who continue to smoke, it would lead to a reduction from 3.2% ± 0.7% to 2.7% ± 0.6% (p < 0.001).

Lung cancer incidence differences in migrant men in Belgium, 2004\u20132013: histology-specific analyses

BackgroundImmigrants make up an important share of European populations which has led to a growing interest in research on migrants’ health. Many studies have assessed migrants’ cancer mortality patterns, yet few have studied incidence differences. This paper will probe into histology-specific lung cancer incidence by migrant origin aiming to enhance the knowledge on lung cancer aetiology and different risk patterns among population groups.MethodsWe used data on all lung cancer diagnoses during 2004–2013 delivered by the Belgian Cancer Registry individually linked with the 2001 Belgian Census and the Crossroads Bank for Social Security. Absolute and relative inequalities in overall and histology-specific lung cancer incidence have been calculated for first-generation Italian, Turkish and Moroccan migrant men aged 50–74 years compared to native Belgian men.ResultsMoroccan men seemed to be the most advantaged group. Both in absolute and relative terms they consistently had lower overall and histology-specific lung cancer incidence rates compared with native Belgian men, albeit less clear for adenocarcinoma. Turkish men only showed lower overall lung cancer incidence when adjusting for education. On the contrary, Italian men had higher incidence for overall lung cancer and squamous cell carcinoma, which was explained by adjusting for education.ConclusionsSmoking habits are likely to explain the results for Moroccan men who had lower incidence for smoking-related histologies. The full aetiology for adenocarcinoma is still unknown, yet the higher incidence among Italian men could point to differences in occupational exposures, e.g. to carcinogenic radon while working in the mines.

Ambient particulate matter burden of disease in the Kingdom of Saudi Arabia

BackgroundAir pollution is one of the top 10 global health risk factors and has been associated with premature mortality, cardiovascular, cerebrovascular, respiratory, and metabolic disease. Currently, there is a lack of health assessments on the public health impacts of air pollution in the Kingdom of Saudi Arabia. AimThis study aims to assess the ambient particulate matter burden of disease in the Kingdom of Saudi Arabia. MethodsA comparative risk assessment (CRA) using the 2017 Global Burden of Disease was performed to estimate ambient particulate matter exposure, mortality, and lost years of a healthy life. Saudi Arabia population-weighted mean concentrations of particle mass with an aerodynamic diameter less than 2·5 μm (PM2.5), at an approximate 11 km × 11 km resolution was estimated using satellite-based estimates, chemical transport models, and ground-level measurements. The CRA for PM2.5 was based on relative risks originated from epidemiological studies using integrated exposure-response functions for ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, lung cancer, lower respiratory infections, and type 2 diabetes. Mortality, years of life lost (YLL), years lived with disability (YLD) and disability-adjusted life years (DALYs) attributable to PM2.5 were estimated at the national level for all ages and both sexes from 1990 to 2017. ResultsIn 2017, the annual exposure to ambient particulate matter in the population-weighted mean PM2.5 in Saudi Arabia was 87.9 μg/m3 (95% UI 29.6–197.9). The PM2.5 population-weighted mean has increased by 24% since 1990. Annual deaths attributable to PM2.5 were estimated at 8536 (95% UI 6046–11,080), representing 9% of the total annual deaths in Saudi Arabia. In 2017, 315,200 (95% UI 231,608–401,926) DALYs were attributable to PM2.5. Males contributed to 67% (209,822 (95% UI 151,322–277,503)) of DALYs, and females contributed to 33% (105,378 (95% UI 76,014–135,269) of DALYs. Ischemic heart disease represented 44% of the PM2.5 attributable DALYs, followed by type 2 diabetes (20%), lower respiratory infections (13%), stroke (11%), COPD (10%), and tracheal, bronchus, and lung cancer (3%). In 2017, 240,966 (95% UI 168,833–319,178) years of life lost (YLL) and 74,234 (95% UI 50,229–100,410) years lived with disability (YLD) were attributed to PM2.5. ConclusionAmbient particulate matter is the fifth health risk factor in Saudi Arabia, contributing 9% of total mortality. Over the past 27 years, estimated exposure levels of PM2.5 in Saudi Arabia have been above WHO's air quality guidelines. Although since 2011 mortality and DALY rates attributable to PM2.5 have decreased, air pollution concentrations continue to increase. National and local authorities in Saudi Arabia should consider policies to reduce industrial and traffic-related air pollution in combination with the strengthening of current investments and improvements in health care and prevention services.

Role of dietary carbohydrates on risk of lung cancer

ObjectivesInconsistent findings have been reported on the link between dietary carbohydrates and lung cancer. This study aims to comprehensively evaluate the role of dietary carbohydrates on lung cancer risk. Materials and methodsThe prospective study is based on the PLCO trial, which recruited 113,096 eligible participants across the United States. Participants had to have completed baseline and diet history questionnaires. The incidence of lung cancer was acquired through self-report and medical record follow-up. A multivariable logistic model adjusted for confounders was used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) of dietary carbohydrates, fiber, whole grains, glycemic index (GI) and glycemic load (GL) for lung cancer. Similar methods were applied in analyzing the carbohydrates and fiber from different food sources. Multinomial logistic models were used for sensitivity analysis with lung cancer subtypes as outcomes. ResultsDietary carbohydrates and GL were inversely associated with lung cancer incidence in the PLCO population. Among various carbohydrates, 30-g daily consumption of dietary fiber was related to a lower risk of lung cancer (fourth vs first quartile OR: 0.62, 95 % CI: 0.54−0.72) compared with 8.8-g. Furthermore, consuming whole grains 2.3 servings per day as opposed to 0.3 servings per day was associated with a lower risk of lung cancer (OR: 0.73, 95 % CI: 0.64−0.83). A higher risk of lung cancer was seen for the consumption of high-GI food (OR: 1.19, 95 % CI: 1.05–1.35) and refined carbohydrates from soft drinks (OR: 1.23, 95 % CI: 1.04–1.46). ConclusionCarbohydrates and fiber from fruits, vegetables and whole grains are associated with lower lung cancer risk. Refined carbohydrates from processed food, such as soft drinks, appear to increase risk.

Estimating disease burden attributable to household air pollution: new methods within the Global Burden of Disease Study

BackgroundDespite a substantial reduction in the use of solid fuels worldwide, exposure to household air pollution (HAP) from use of these fuels for cooking remains a leading risk factor for global disease burden. Among environmental risk factors, the contribution of HAP to disease burden is second only to ambient particulate matter pollution. We present updates to our modeling methodology as well as our latest findings on attributable burden estimates. MethodsWe estimated HAP-attributable burden for cataract, chronic obstructive pulmonary disease, ischaemic heart disease, lower respiratory infections, lung cancer, neonatal disorders, stroke, and type 2 diabetes for 204 countries and territories from 1990 to 2019. We used spatio-temporal Gaussian Process Regression to model data from observational surveys and censuses reporting primary cooking fuel to estimate the proportion of individuals using a specific solid-fuel type (wood, coal/charcoal, agricultural residues, or dung) by location. We converted the fuel exposure estimates to year, location, and sex/age-specific PM2·5 exposures with a regression mapping function using household air pollution measurements. Using a Bayesian meta-regression tool, we estimated relative risk as a function of PM2·5 exposure for each disease based upon a systematic review of the epidemiological literature on indoor and ambient air pollution. We then combined our exposure estimates and relative risks to estimate population attributable fractions and attributable burden for each cause. FindingsIn 2019, 91·5 million global disability-adjusted life years (DALYs) (95% uncertainty interval 67·0–119) were attributable to HAP, a decline of more than 50% from 1990. We estimated 2·31 million (1·63–3·12) global deaths were attributable to HAP and accounted for over 4% of all deaths in 2019. HAP-attributable burden remains highest in sub-Saharan Africa and south Asia, with 3770·3 (2876·4–4720·2) and 2068·0 (1412·5–2799·7) age-standardised DALYs per 100 000 population, respectively. InterpretationAlthough the disease burden attributable to HAP decreased considerably between 1990 and 2019, it remains a significant risk factor. Our internally consistent methodology and comprehensive approach to estimation of HAP-attributable burden provides a robust resource for global health interventions. Efforts to transition to cleaner household energy sources should be accelerated. FundingBill & Melinda Gates Foundation.

Lung Cancer Risk Perception Among Older Smokers; a Cross-sectional Study

Background: Lung cancer is one of the deadliest cancers around the world. Also, scientific evidence proves the considerably lower lung cancer risk perceptions of smokers compared to non-smokers. Objectives: This study aimed at assessing the risk perception of smokers about their risk to contract lung cancer and their perceptions about lung cancer survival. Methods: In this cross-sectional study, the data were collected from 215 smokers in Tabriz, Iran, between April 2019 and July 2019. The data collection tool was designed, using validated questionnaires and contained questions on the perceived risk of smokers to develop lung cancer and their perception of lung cancer survival. A general linear model was conducted to model the relationship of risk perception with underlying predictors considering a significance level of 0.1. Results: The results of modeling indicated that perceived susceptibility (P-Sus) was negatively related to “years smoked” in simple regression (B = -0.035, P = 0.069) and multiple regression (B = -0.069, P = 0.007). P-Sus was also negatively related to the variable “age” in the age category of 45 to 50 years (B = -1.981, P = 0.046). Moreover, perceived severity (P-Sev) was negatively related to the variable “sex” (B = -1.037, P = 0.068). The results of the Spearman correlation indicated significant and direct correlations between “quitting intention” and P-Sus (r = 0.296, P &lt; 0.001), P-Sev (r = 0.162, P = 0.009). Conclusions: Lung cancer risk perception of participants was moderately above the average and significant correlations were observed between “quitting intention” and “P-Sus” and “P-Sev” and “Risk Perception score”. This could be utilized in developing educational programs to promote awareness about lung cancer, especially for smokers.

Lung cancer screening: intention to participate and acceptability among Belgian smokers.

Next to the obvious benefits of tobacco-use cessation, lung cancer screening using low-dose computed tomography (LDCT) scans has been proposed as a means to lower lung cancer burden. Achieving an impact of any cancer screening program on cancer-specific mortality largely depends on the uptake. The aim of this study was to estimate the acceptability and intention to participate in a lung cancer screening program among Belgian current or former smokers. A cross-sectional online survey was carried out among adults from the Belgian population. Sampling took place within an existing online panel. In total, 83.6% of all respondents (n = 2727), including current or former smokers and never smokers, believed that offering lung cancer screening to current or former smokers is a good idea. 84.3% of all current or former smokers (n = 1534) answered that they would likely or very likely participate in a screening program for lung cancer. The majority of current smokers that were willing to be screened said they would also want to receive tobacco-use cessation counseling in parallel with screening (71.8%; n = 486), whereas 9% (n = 61) would decline. These findings suggest that a Belgian lung cancer screening program would be acceptable and could be well-attended by current or former smokers. Further research should focus on how smokers can be best reached to propose screening, and how tobacco-use cessation counseling can be successfully integrated in a lung cancer screening program.

Lung Cancer Screening by Low-Dose Computed Tomography - Part 1: Expected Benefits, Possible Harms, and Criteria for Eligibility andPopulation Targeting.

Trials in the USA and Europe have convincingly demonstrated the efficacy of screening by low-dose computed tomography (LDCT) as a means to lower lung cancer mortality, but also document potential harms related to radiation, psychosocial stress, and invasive examinations triggered by false-positive screening tests and overdiagnosis. To ensure that benefits (lung cancer deaths averted; life years gained) outweigh the risk of harm, lung cancer screening should be targeted exclusively to individuals who have an elevated risk of lung cancer, plus sufficient residual life expectancy. Overall, randomized screening trials show an approximate 20 % reduction in lung cancer mortality by LDCT screening. In view of declining residual life expectancy, especially among continuing long-term smokers, risk of being over-diagnosed is likely to increase rapidly above the age of 75. In contrast, before age 50, the incidence of LC may be generally too low for screening to provide a positive balance of benefits to harms and financial costs. Concise criteria as used in the NLST or NELSON trials may provide a basic guideline for screening eligibility. An alternative would be the use of risk prediction models based on smoking history, sex, and age as a continuous risk factor. Compared to concise criteria, such models have been found to identify a 10 % to 20 % larger number of LC patients for an equivalent number of individuals to be screened, and additionally may help provide security that screening participants will all have a high-enough LC risk to balance out harm potentially caused by radiation or false-positive screening tests. · LDCT screening can significantly reduce lung cancer mortality. · Screening until the age of 80 was shown to be efficient in terms of cancer deaths averted; in terms of LYG relative to overdiagnosis, stopping at a younger age (e. g. 75) may have greater efficiency. · Risk models may improve the overall net benefit of lung cancer screening. · Kaaks R, Delorme S. Lung Cancer Screening by Low-Dose Computed Tomography - Part 1: Expected Benefits, Possible Harms, and Criteria for Eligibility and Population Targeting. Fortschr Röntgenstr 2021; 193: 527 - 536.

State Variation in Low-DoseComputed Tomography Scanning for Lung Cancer Screening in the United States.

BackgroundAnnual lung cancer screening (LCS) with low-dose chest computed tomography in older current and former smokers (ie, eligible adults) has been recommended since 2013. Uptake has been slow and variable across the United States. We estimated the LCS rate and growth at the national and state level between 2016 and 2018. MethodsThe American College of Radiology’s Lung Cancer Screening Registry was used to capture screening events. Population-based surveys, the US Census, and cancer registry data were used to estimate the number of eligible adults and lung cancer mortality (ie, burden). Lung cancer screening rates (SRs) in eligible adults and screening rate ratios with 95% confidence intervals (CI) were used to measure changes by state and year.ResultsNationally, the SR was steady between 2016 (3.3%, 95% CI = 3.3% to 3.7%) and 2017 (3.4%, 95% CI = 3.4% to 3.9%), increasing to 5.0% (95% CI = 5.0% to 5.7%) in 2018 (2018 vs 2016 SR ratio = 1.52, 95% CI = 1.51 to 1.62). In 2018, several southern states with a high lung-cancer burden (eg, Mississippi, West Virginia, and Arkansas) had relatively low SRs (<4%) among eligible adults, whereas several northeastern states with lower lung cancer burden (eg, Massachusetts, Vermont, and New Hampshire) had the highest SRs (12.8%-15.2%). The exception was Kentucky, which had the nation’s highest lung cancer mortality rate and one of the highest SRs (13.7%).ConclusionsFewer than 1 in 20 eligible adults received LCS nationally, and uptake varied widely across states. LCS rates were not aligned with lung cancer burden across states, except for Kentucky, which has supported comprehensive efforts to implement LCS.