Lung Cancer Incidence In China Research Articles

Influence of the atmospheric environment on spatial variation of lung cancer incidence in China.

Conducting this research contributes to a deeper understanding of the correlation between atmospheric environmental quality and lung cancer incidence, and provides the scientific basis for formulating effective environmental protection and lung cancer prevention and control strategies. Lung cancer incidence in China has strong spatial variation. However, few studies have systematically revealed the characteristics of the spatial variation in lung cancer incidence, and have explained the causes of this spatial variation in lung cancer incidence from the perspectives of multiple components of the atmospheric environment to explain this spatial variation in lung cancer incidence. To address research limitations, we first analyze the spatial variation and spatial correlation characteristics of lung cancer incidence in China. Then, we build a spatial regression model using GeoDa software with lung cancer incidence as the dependent variable, five atmospheric environment factors-particulate matter 2.5 (PM2.5) concentration, temperature, atmospheric pressure, and elevation as explanatory variables, and four socio-economic characteristics as control variables to systematically analyze the influence and intensity of these factors on lung cancer incidence. The results show that lung cancer incidence in China has apparent changes in geographical and spatial unevenness, and spatial autocorrelation characteristics. In China, the lung cancer incidence is relatively high in Northeast China, while some areas of high lung cancer incidence still exist in Central China, Southwest China and South China, although the overall lung cancer incidence is relatively low. The atmospheric environment significantly affects lung cancer incidence. Different elements of the atmospheric environment vary in the direction and extent of their influence on the development of lung cancer. A 1% increase in PM2.5 concentration is associated with a level of 0.002975 increase in lung cancer incidence. Atmospheric pressure positively affects lung cancer incidence, and an increase in atmospheric pressure by 1% increases lung cancer incidence by a level of 0.026061. Conversely, a 1% increase in temperature is linked to a level of 0.006443 decreases in lung cancer incidence, and a negative correlation exists between elevation and lung cancer incidence, where an increase in elevation by 1% correlates with a decrease in lung cancer incidence by a level of 0.000934. The core influencing factors of lung cancer incidence in the seven geographical divisions of China exhibit variations. This study facilitates our understanding of the spatial variation characteristics of lung cancer incidence in China on a finer scale, while also offering a more diverse perspective on the impact of the atmospheric environment on lung cancer incidence.

Application of multidisciplinary treatment comprehensive management model for early-stage lung cancer

Objective: To explore the application of multidisciplinary treatment (MDT) and comprehensive management model in the diagnosis and treatment of early-stage lung cancer, and analyze its clinical value and the feasibility and significance of promotion. Methods: A retrospective study of 470 patients in Xijing Hospital who underwent surgery after MDT from January 8, 2018 to December 31, 2019. There were 172 males and 298 females, aged from 23 to 79 (54.46±11.08) years. Basic diagnosis and treatment information as well as postoperative pathology were analyzed, of which 441 cases were recommended for surgery by MDT and 29 cases were subjectively requested for surgery. The patients' general condition, preoperative diagnosis and pathological results were compared, and the specific content of the MDT and comprehensive management model were summarized. We also explored the value of MDT integrated management model in early stage lung cancer treatment in the context of the current lung cancer incidence in China. Results: Among 470 surgical patients, the majority of males had solid nodules (69/172,40.1%), and the majority of females had ground glass nodules (135/298,45.3%). The distribution of nodules showed a trend of more upper lobe(277/470)than lower lobe(161/470) and more right lung(276/470) than left lung(194/470). Among the 441 patients recommended for surgery, 98.11% of males (156/159) and 97.87% of females (276/282) showed malignant pathology after surgery. Adenocarcinoma was the main pathological type (93.59% of males, 146/156; 97.46% of females, 269/276). Among the malignant pathological results, carcinoma in situ (42.31% of males, 66/156; 47.10% of females, 130/276) and stage I lung cancer (50.64% of males, 79/156; 47.46% of females, 131/276) were the most common. In all patients, 1.89% of the males (3/159) and 2.13% of the females (6/282) recommended for surgery showed benign postoperative pathology, of which tuberculosis and fungal infection were the main pathological types (66.67% for each gender, males 2/3, females, 4/6). The postoperative pathology of 29 patients who subjectively requested surgery was also tuberculosis and fungal infection as the main pathological types (69.23% of males, 9/13; 68.75% of females, 11/16). The MDT comprehensive management model made full use of a variety of auxiliary diagnostic technologies and combined the experience advantages of multidisciplinary participation to make up for the limitations of single-diagnosis. The overall diagnosis coincidence rate reached 98.09%, with strong consistency (Kappa>0.81). The positive predictive value (PPV) was 97.96%, the negative predictive value (NPV) was 100%, and the average patient diagnosis and treatment cycle was 24.28-26.51 days. Conclusions: The MDT comprehensive management model meets the consensus requirements. It has great advantages in diagnostic efficiency and diagnosis and treatment cycle, and has a high promotion and application value for the diagnosis and treatment of early-stage lung cancer. At the same time, tuberculosis and fungal infection should be regarded as an important differential diagnosis item.

Climatic modification effects on the association between PM1 and lung cancer incidence in China

BackgroundNationwide studies that examine climatic modification effects on the association between air pollution and health outcome are limited in developing countries. Moreover, few studies focus on PM1 pollution despite its greater health effect.ObjectivesThis study aims to determine the modification effects of climatic factors on the associations between PM1 and the incidence rates of lung cancer for males and females in China.MethodsWe conducted a nationwide analysis in 345 Chinese counties (districts) from 2014 to 2015. Mean air temperature and relative humidity over the study period were used as the proxies of climatic conditions. In terms of the multivariable linear regression model, we examined climatic modification effects in the stratified and combined datasets according to the three-category and binary divisions of climatic factors. Moreover, we performed three sensitivity analyses to test the robustness of climatic modification effects.ResultsWe found a stronger association between PM1 and the incidence rate of male lung cancer in counties with high levels of air temperature or relative humidity. If there is a 10 μg/m3 shift in PM1, then the change in male incidence rate relative to its mean was higher by 4.39% (95% CI: 2.19, 6.58%) and 8.37% (95% CI: 5.18, 11.56%) in the middle and high temperature groups than in the low temperature group, respectively. The findings of climatic modification effects were robust in the three sensitivity analyses. No significant modification effect was discovered for female incidence rate.ConclusionsMale residents in high temperature or humidity counties suffer from a larger effect of PM1 on the incidence rate of lung cancer in China. Future research on air pollution-related health impact assessment should consider the differential air pollution effects across different climatic conditions.

36P Cost-effectiveness of lung cancer screening with low-dose computed tomography in China: A modeling study

Background: Smoking is considered not the only major risk factor that contributing to the lung cancer incidence in China, due to the fact that about half of patients with lung cancers are never-smokers. Considering the potential of the implementation of lung cancer screening in the general Chinese population, this study aimed to assess the potential cost-effectiveness of lung cancer screening with low-dose CT in a general population in China.

Do socioeconomic factors modify the effects of PM1 and SO2 on lung cancer incidence in China?

BackgroundIt remains uncertain whether socioeconomic factors modify the effect of air pollution on human health. Moreover, studies investigating socioeconomic modifying roles on the effect of PM1 are quite limited, especially in developing countries. ObjectivesThe present study aims to investigate socioeconomic modification effects on the associations of the incidence rate of male lung cancer with ambient PM1 and SO2 in China. MethodsWe conducted a nationwide analysis in 345 Chinese counties (districts) between 2014 and 2015. In terms of multivariable linear regression models, we examined the modification effects of urban-rural division, education level and proportion of construction workers in the stratified and combined datasets according to the tertile and binary divisions of the three factors. Moreover, we performed three sensitivity analyses to test the robustness of socioeconomic modification effects. ResultsWe found a larger effect of PM1 on the incidence rate of male lung cancer in urban areas than in rural areas. The association between PM1 (or SO2) and the incidence rate of male lung cancer was stronger in counties with low education levels than in those with high education levels. The findings of the significant modification effects of urban-rural division and education level were robust in the three sensitivity analyses. No significant modification effect was observed for the proportion of construction workers. ConclusionsMale residents in urban areas have a high risk of lung cancer incidence associated with ambient PM1. Male residents with low education levels suffer from larger effects of PM1 and SO2 on the incidence rate of lung cancer. Area- and population-specific strategies should be developed to reduce the urban-rural and educational disparities in air pollution effects, which thereby alleviates air pollution-associated health disparities in China.

Abstract 5761: Trends and regional distribution pattern of female lung cancer in China from 1992 to 2016

Abstract Background: The risk factors of female lung cancer in China are still unclear. The growing trend of lung cancer in Chinese women has become a global concern of public health. This study aims to explore the secular trends and regional distribution of female lung cancer in China. Method: The results of global burden of disease (GBD 2016) and the world standard population database (WHO 2000-2025) were used to extract age- sex- and province-specific incidence, mortality, and years of life lost due to premature death (YLL) for this report. The Joinpoint regression analysis was applied to fit the secular female lung cancer trends of age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and YLL rate for China and its 33 provincial administrative regions in 1992-2016. Result: From 1992 to 2016, the secular trend of female lung cancer incidence in China rose upward and the trend of mortality or rate of YLL fell down. The average annual percent change (AAPC) of the ASIR, ASMR, and YLL rate were 0.7 (95%CI: 0.6,0.8%), -0.3% (95%CI: -0.5, -0.2%), and -0.7 (95%CI: -0.8, -0.6%) respectively. However, the secular trends among 33 provincial units are inconsistent. There were 5 regional patterns of joint trends in ASIR, ASMR, and YLL rate among 33 provinces, autonomous regions, and municipalities. Conclusion: The regional pattern of the trends of female lung cancer in China suggested that the prevention and control of female lung cancer should be taken with targeted regional interventions. Citation Format: Xue Ni, Bei Zhang, Ning Xu, Xinying Zeng, Qiang Wang. Trends and regional distribution pattern of female lung cancer in China from 1992 to 2016 [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5761.

Case study of an autoantibody panel for early detection of lung cancer and ground-glass nodules

PurposeIncreasing lung cancer incidence in China with a high death rate due to late diagnosis highlights the need for biomarkers, such as panels of autoantibodies (AAbs), for prediction and early lung cancer diagnosis. We conducted a study to further evaluate the clinical performance of an AAb diagnostic kit.MethodsUsing enzyme-linked immunosorbent assay, levels of seven AAbs in serum samples from 121 patients with newly diagnosed lung cancer, 84 controls (34 healthy individuals and 50 patients with benign lung disease), and 100 indeterminate solid nodules, were measured. Participants were followed up until 6 months after a positive test result to confirm lung cancer diagnosis.ResultsThe seven AAb concentration was significantly higher in lung cancer patients than in controls (P < 0.05). The seven AAb sensitivity and specificity for newly diagnosed lung cancer were 45.5% and 85.3%, respectively, while the seven AAb combined area under the curve (in lung cancer patients versus controls) was 0.660. Of the 28 patients with solid nodules with positive test results, 8 and 3 were diagnosed with lung cancer and benign lung disease, respectively, during follow-up. The positive predictive value of the experiment was 72.7%.ConclusionPositive AAb test results were associated with a high risk of lung cancer. The seven-AAb panel also had a high predictive value for detecting lung cancer in patients with solid nodules. Our seven lung cancer autoantibody types can provide an important early warning sign in the clinical setting.

Ambient PM2.5 and Annual Lung Cancer Incidence: A Nationwide Study in 295 Chinese Counties.

Most studies have examined PM2.5 effects on lung cancer mortalities, while few nationwide studies have been conducted in developing countries to estimate the effects of PM2.5 on lung cancer incidences. To fill this gap, this work aims to examine the effects of PM2.5 exposure on annual incidence rates of lung cancer for males and females in China. We performed a nationwide analysis in 295 counties (districts) from 2006 to 2014. Two regression models were employed to analyse data controlling for time, location and socioeconomic characteristics. We also examined whether the estimates of PM2.5 effects are sensitive to the adjustment of health and behaviour covariates, and the issue of the changing cancer registries each year. We further investigated the modification effects of region, temperature and precipitation. Generally, we found significantly positive associations between PM2.5 and incidence rates of lung cancer for males and females. If concurrent PM2.5 changes by 10 μg/m3, then the incidence rate relative to its baseline significantly changes by 4.20% (95% CI: 2.73%, 5.88%) and 2.48% (95% CI: 1.24%, 4.14%) for males and females, respectively. The effects of exposure to PM2.5 were still significant when further controlling for health and behaviour factors or using 5 year consecutive data from 91 counties. We found the evidence of long-term lag effects of PM2.5. We also found that temperature appeared to positively modify the effects of PM2.5 on the incidence rates of lung cancer for males. In conclusion, there were significantly adverse effects of PM2.5 on the incidence rates of lung cancer for both males and females in China. The estimated effect sizes might be considerably lower than those reported in developed countries. There were long-term lag effects of PM2.5 on lung cancer incidence in China.

Spatial association between outdoor air pollution and lung cancer incidence in China

BackgroundLung cancer is the most common cancer in China. Previous studies have indicated that lung cancer incidence exhibits remarkable spatial heterogeneity, and lung cancer is related to outdoor air pollution. However, the non-linear spatial association between outdoor air pollution and lung cancer incidence in China remains unclear.MethodsIn this study, the relationships between the lung cancer incidence of males and females from 207 counties in China in 2013 with annual concentrations of PM2.5, PM10, SO2, NO2, CO and O3 were analysed. GeoDetector q statistic was used for examining the non-linear spatial association between outdoor air pollution and incidence of lung cancer.ResultsAn apparent spatial and population gender heterogeneity was found in the spatial association between outdoor air pollution and lung cancer incidence. Among the six selected pollutants, SO2 has the greatest influence on lung cancer (q = 0.154 in females) in north China. In the south, each selected pollutant has a significant impact on males or females, and the mean q value in the south is 0.181, which is bigger than that in the north (q = 0.154). In addition, the pollutants have evident non-linear interaction effects on lung cancer. In north China, the interaction between SO2 and PM2.5 is the dominant interaction, with q values of 0.207 in males and 0.334 in females. In the south, the dominant interactive factors are between SO2 and O3 in males and between SO2 and CO in females, with q values of 0.45, 0.232 respectively. Smoking is a substantial contributor to lung cancer among men, either in South or North China, with q value of 0.143 and 0.129 respectively, and the interaction between smoking and air pollutants increases this risk.ConclusionsThis study implies that the influence of SO2 and PM2.5 on lung cancer should be focused on in north China, and in the south, the impact of O3 and CO as well as their interaction with SO2 need to be paid more attention. Smoking, particularly in men, remains a significant risk factor for lung cancer in both North and South China.

Air pollution and lung cancer incidence in China: Who are faced with a greater effect?

BackgroundWhether socioeconomic indicators modify the relationship between air pollution exposure and health outcomes remains uncertain, especially in developing countries. ObjectiveThis work aims to examine modification effects of socioeconomic indicators on the association between PM2.5 and annual incidence rate of lung cancer for males in China. MethodsWe performed a nationwide analysis in 295 counties (districts) from 2006 to 2014. Using multivariable linear regression models controlling for weather conditions and socioeconomic indicators, we examined modification effects in the stratified and combined datasets according to the tertile and binary divisions of socioeconomic indicators. We also extensively investigated whether the roles of socioeconomic modifications were sensitive to the further adjustment of demographic factors, health and behaviour covariates, household solid fuel consumption, the different operationalization of socioeconomic indicators and PM2.5 exposure with single and moving average lags. ResultsWe found a stronger relationship between PM2.5 and incidence rate of male lung cancer in urban areas, in the lower economic or lower education counties (districts). If PM2.5 changes by 10 μg/m3, then the shift in incidence rate relative to its mean was significantly higher by 3.97% (95% CI: 2.18%, 4.96%, p = 0.000) in urban than in rural areas. With regard to economic status, if PM2.5 changes by 10 μg/m3, then the change in incidence rate relative to its mean was significantly lower by 0.99% (95% CI: −2.18%, 0.20%, p = 0.071) and 1.39% (95% CI: −2.78%, 0.00%, p = 0.037) in the middle and high economic groups than in the low economic group, respectively. The change in incidence rate relative to its mean was significantly lower by 1.98% (95% CI: −3.18%, −0.79%, p = 0.001) and 2.78% (95% CI: −4.17%, −1.39%, p = 0.000) in the middle and high education groups compared with the low education group, respectively, if PM2.5 changes by 10 μg/m3. We found no robust modification effects of employment rate and urbanisation growth rate. ConclusionMale residents in urban areas, in the lower economic or lower education counties are faced with a greater effect of PM2.5 on the incidence rate of lung cancer in China. The findings emphasize the need for public health intervention and urban planning initiatives targeting the urban–rural, educational or economic disparities in health associated with air pollution exposure. Future prediction on air pollution-induced health effects should consider such socioeconomic disparities, especially for the dominant urban–rural disparity in China.

Abstract CT114: Nivolumab versus docetaxel in a predominantly Chinese patient population with previously treated advanced non-small cell lung cancer (NSCLC): results of the phase 3 CheckMate 078 study

Abstract Introduction: Lung cancer incidence in China has increased and it remains the leading cause of cancer death, highlighting a need for new treatments. We report results from CheckMate 078, the first phase 3 study of an anti-programmed death (ligand) 1 (PD-[L]1) agent in predominantly Chinese patients with NSCLC and disease progression after platinum (Pt)-based chemotherapy. Methods: Patients who had disease progression during or after Pt-based doublet chemotherapy were randomized 2:1 to receive nivolumab (3 mg/kg Q2W) or docetaxel (75 mg/m2 Q3W). Patients were included regardless of tumor histology or PD-L1 expression, and randomization was stratified according to both of these factors (≥1% vs &amp;lt;1%/unevaluable tumor PD-L1; squamous vs non-squamous histology). Patients with epidermal growth factor receptor mutation-positive tumors were excluded. The primary endpoint was overall survival (OS); other endpoints included progression-free survival (PFS) and objective response rate (ORR). Results: 639 patients were enrolled from December 2015 to December 2016; 504 were randomized. Of all randomized patients, ~90% were from China, 60% had non-squamous tumor histology; tumor PD-L1 expression was &amp;lt;1% in 41% of patients and ≥1% in 50% of patients (9% unevaluable). Minimum follow-up was 8.8 months. OS was significantly improved with nivolumab (n=338) vs docetaxel (n=166); median OS was 12.0 vs 9.6 months, respectively (hazard ratio [HR; 97.7% CI]: 0.68 [0.52, 0.90]; P&amp;lt;0.001). The HR (95% CI) for OS was 0.61 (0.42, 0.89) in patients with squamous NSCLC and 0.76 (0.56, 1.04) in patients with non-squamous NSCLC. In patients with tumor PD-L1 expression &amp;lt;1% and ≥1%, the HR (95% CI) was 0.75 (0.52, 1.09) and 0.62 (0.45, 0.87), respectively. Median PFS was 2.8 months in both treatment arms; PFS curves began to separate at 3 months, resulting in a PFS advantage with nivolumab (HR [95% CI]: 0.77 [0.62, 0.95]; P=0.0147). ORR was 17% with nivolumab vs 4% with docetaxel; median duration of response was not reached with nivolumab (95% CI: 11.1 months, not available [NA]) and 5.3 (95% CI: 3.58, NA) months with docetaxel. Rates of grade ≥3 treatment-related adverse events were lower among patients treated with nivolumab (10%) vs docetaxel (48%). Conclusions: In this population of patients with advanced NSCLC previously treated with Pt-based chemotherapy, nivolumab demonstrated superior OS, PFS, and ORR compared with docetaxel. Efficacy and safety of nivolumab in this first randomized controlled trial of nivolumab in NSCLC in a predominantly Chinese patient population were consistent with the results of the pivotal global CheckMate 017/057 studies. Citation Format: Yi-Long Wu, Shun Lu, Ying Cheng, Caicun Zhou, Jie Wang, Tony Mok, Li Zhang, Haiyan Tu, Lin Wu, Jifeng Feng, Yiping Zhang, Alexander Valeriercich Luft, Jianying Zhou, Zhiyong Ma, You Lu, Chengping Hu, Yuankai Shi, Christine Baudelet, Zoe Li, Jianhua Chang. Nivolumab versus docetaxel in a predominantly Chinese patient population with previously treated advanced non-small cell lung cancer (NSCLC): results of the phase 3 CheckMate 078 study [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 CT114.

The relationship of indoor coal use and environmental tobacco smoke exposure with lung cancer in China: A meta-analysis.

To assess the association between long-term exposures to smoky coal, environmental tobacco smoke (ETS) and lung cancer incidence in China. A meta-analysis was performed on literature searched through Web of Science, Chinese National Knowledge Infrastructure, Weipu, and Wanfang databases. Odds ratio (OR) with 95% confidence intervals (CIs) was used to assess the strength of association between air pollution and lung cancer in China. Twenty-eight studies were included in the meta-analysis. Stratification by ETS exposure source, amount, and gender found a variation in effect. The pooled OR (95% CI) for exposure to spousal, parents, and work ETS was 1.153 (1.000-1.329), 2.117 (1.626-2.755), and 1.454 (1.307-1.618), respectively. The OR (95% CI) values related to childhood exposure was 1.297 (1.142-1.473), adulthood exposure 1.102 (0.937-1.296), exposure lower than 20 cigarette/day 1.088 (0.809-1.464), higher than 20 cigarette/day 1.776 (1.392-2.267), male 1.555 (1.304-1.855), female 1.487 (1.265-1.748), and coal use 1.490 (1.330-1.669). The meta-analysis provided evidence that indoor coal use and ETS were significantly associated with lung cancer in China.

Long non-coding RNA stabilizes the Y-box-binding protein 1 and regulates the epidermal growth factor receptor to promote lung carcinogenesis.

Indoor and outdoor air pollution has been classified as group I carcinogen in humans, but the underlying tumorigenesis remains unclear. Here, we screened for abnormal long noncoding RNAs (lncRNAs) in lung cancers from patients living in Xuanwei city which has the highest lung cancer incidence in China due to smoky coal combustion-generated air pollution. We reported that Xuanwei patients had much more dysregulated lncRNAs than patients from control regions where smoky coal was not used. The lncRNA CAR intergenic 10 (CAR10) was up-regulated in 39/62 (62.9%) of the Xuanwei patients, which was much higher than in patients from control regions (32/86, 37.2%; p=0.002). A multivariate regression analysis showed an association between CAR10 overexpression and air pollution, and a smoky coal combustion-generated carcinogen dibenz[a,h]anthracene up-regulated CAR10 by increasing transcription factor FoxF2 expression. CAR10 bound and stabilized transcription factor Y-box-binding protein 1 (YB-1), leading to up-regulation of the epidermal growth factor receptor (EGFR) and proliferation of lung cancer cells. Knockdown of CAR10 inhibited cell growth in vitro and tumor growth in vivo. These results demonstrate the role of lncRNAs in environmental lung carcinogenesis, and CAR10-YB-1 represents a potential therapeutic target.

Lung cancer incidence and ambient air pollution in China: a spatial age–period cohort study 1990–2009

BackgroundThe International Agency for Research on Cancer has concluded that exposure to outdoor fine particles (PM2·5) is a risk factor for lung cancer. China is experiencing unprecedentedly high levels of PM2·5 air pollution and has the highest lung cancer burden in the world. However, until now, no study has assessed the association between ambient PM2·5 and lung cancer incidence in China. MethodsData of lung cancer incidence between 1990 and 2009 were obtained from the National Cancer Registration of China. The annual concentrations of PM2·5 at 0·1°×0·1° spatial resolution between 1990 and 2005 were estimated by combining remote sensing, global chemical transport models, and ground monitoring air pollution data. A spatial age–period cohort model was used to examine the relative risks (RR) and 95% CI for incident lung cancer associated with increments in 2-year mean PM2·5 concentrations after adjusting for age, period, birth cohort, sex, community type (rural and urban), smoking rate at the community level, as well as the spatial variation in lung cancer incidence. This study was approved by the University of Queensland's behaviour and social sciences ethical review committee (2013000739). FindingsDuring study period, there were 368 762 cases of lung cancer, including 247 533 men and 312 678 cases living in urban areas. The mean concentration of PM2·5 was 69·4 ug/m3. Incident lung cancer was positively associated with increments in 2-year mean PM2·5, and the risk was more pronounced in women (RR 1·149, 95% CI 1·120–1·178) than in men (RR 1·055, 95% CI 1·038–1·072; psex interaction <0·0001). The association was smaller in rural areas (RR 1·037, 95% CI 0·998–1·078) than in urban areas (RR 1·060, 95%CI 1·044–1·075; pinteraction=0·03) and stronger in elderly people (>75 years of age; 1·111 95% CI 1·077–1·146) than young people (30–65 years of age; RR 1·074 95% CI 1·052–1·096; pinteraction=0.007). InterpretationIn China, lung cancer incidence is associated with PM2·5 air pollution. Effective control measures to reduce levels of air pollution are likely to reduce the incidence of lung cancer in the Chinese population. Further studies are still needed to examine causality of the association between PM2·5 and lung cancer incidence, as this study is an observational epidemiology investigation. This study used community-level incidence and air pollution exposure, but not individual-level information on exposure and outcome. We only had air pollution data for the years 1990 and 2005, and interpolated the data to 1990–2009. These might underestimate the association between air pollution and lung cancer incidence, because random measurement error in exposure will bias the effect estimates towards the null. FundingHope Run Malathon Fund (Cancer Institute & Hospital, Chinese Academy of Medical Sciences, LC2011Y41), and University of Queensland Research Fellowship (YG).

Dietary exposure estimates of 16 polycyclic aromatic hydrocarbons (PAHs) in Xuanwei and Fuyuan, counties in a high lung cancer incidence area in China

Xuanwei and Fuyuan are located in the southwest of China and have the highest lung cancer incidence in China, possibly even highest in the world. Dietary samples were collected from these two counties and the contamination status of sixteen polycyclic aromatic hydrocarbons (PAHs) were determined. PAH components, food constituents, dietary exposure level, as well as spatial difference, were studied in the different groups. The percentage of dietary intake to total intake of PAHs was calculated and the relationship between the dietary intake of PAHs and the abnormal lung cancer incidence was primarily discussed. The results showed that rice and potatoes were the main foods of the local residents in Xuanwei and Fuyuan. The daily exposure doses of Bap (benzo[a]pyrene), total PAHs, and TEQs (toxic equivalents) based on Bap toxicity in two counties were estimated to be 458 ng d(-1), 14,532 ng d(-1), and 896 ng d(-1), respectively, which were much less than those in other cities reported previously. The lower ingestion amount of food with a relatively higher content of PAHs, such as meat and fish, could account for the lower exposure doses. PAHs with less than 4 rings occupied a high percentage of the total PAHs in food samples. The exposure doses varied significantly among different sites and even different families at the same site. Dietary exposure was not the main exposure route of PAHs at most sites. It appears that there was not a direct relationship between dietary exposure and the lung cancer incidence. However, high ratios of dietary intake to total PAHs intake (1.33%-70.61%) were found in several areas and rational diet suggestions should be given in these areas in the future.

Bayesian age-period-cohort prediction of lung cancer incidence in China.

Lung cancer is one of the most common cancers in China. Estimation of future cancer trends is important for cancer control planning. The aim of this study was to examine the trend of lung cancer incidence from 1998 to 2007 and predict the lung cancer burden up to 2020 in China. Lung cancer incidence data were retrieved from the national cancer registration database from 1998 to 2007. Annual population projection for the same period was obtained from the National Statistics Bureau. The Bayesian Age-Period-Cohort Modeling and Prediction package (Institute of Biomedical Engineering, Imperial College, London, UK) was used to describe the trend of lung cancer incidence and to predict the incidence rate and number of cases until the year 2020. The crude incidence rates of lung cancer increased from 43.39 per 100 000 in 1998 to 51.25 per 100 000 in 2007. After age standardization, the incidence rates remained stable over the 10-year period. The trends were mainly caused by aging, no obvious period effects and cohort effects were observed. Our projection showed that the age-standardized lung cancer incidence rate would remain steady until 2020. The estimated number of new incident cases was predicted to increase to 693 727 in 2020. The burden of lung cancer incidence is likely to continue increasing. Effective policies such as smoking cessation and environmental protection are imperative for lung cancer control and prevention.