Highlights
- •Never-smokers with lung cancer often present late as there are no established aetiological risk factors.
- •The annual frequency of developing lung cancer in never-smokers increased from 13% to 28%.
- •This is attributable to an absolute increase in numbers and not simply a change in the ratio of never-smokers to smokers.
- •Presenting features were non-specific and majority were detected on incidental imaging.
- •We observed more than a double the annual frequency of lung cancer in never-smokers in the last 7 years.
Abstract
Background
Never-smokers with lung cancer often present late as there are no established aetiological
risk factors. The aim of the study is to define the frequency over time and characterise
clinical features of never-smokers presenting sufficiently early to determine if it
is possible to identify patients at risk.
Methods
We retrospectively analysed data from a prospectively collected database of patients
who underwent surgery. The frequency was defined as number of never-smokers versus
current and ex-smokers by year. Clinical features at presentation were collated as
frequency.
Results
A total of 2170 patients underwent resection for lung cancer from March 2008 to November
2014. The annual frequency of developing lung cancer in never-smokers increased from
13% to 28%, attributable to an absolute increase in numbers and not simply a change
in the ratio of never-smokers to current and ex-smokers.
A total of 436 (20%) patients were never-smokers. The mean age was 60 (16 SD) years
and 67% were female. Presenting features were non-specific consisting of cough in
34%, chest infections in 18% and haemoptysis in 11%. A total of 14% were detected
on incidental chest film, 30% on computed tomography, 7% on positron-emission tomography/computed
tomography and 1% on MRI.
Conclusions
We observed more than a double of the annual frequency of never-smokers in the last
7 years. Patients present with non-specific symptoms and majority were detected on
incidental imaging, a modality that is likely to play an increasingly important role
for early detection in this cohort that does not have any observable clinical risk
factors.
Keywords
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References
- Increasing incidence of never smokers in non small cell lung cancer (NSCLC) patients.in: World conference on lung cancer. Denver, CO. 2015
- Lung cancer in never smokers- a different disease.Nature publishing group, 2007
- Human non-small cell lung tumors and cells derived from normal lung express both estrogen receptor α and β and show biological responses to estrogen.Cancer Res. 2002; 62: 2141-2150
- Expression of estrogen receptors alpha and beta in human lung tissue and cell lines.Lung Cancer. 2002; 37: 153-159
- Gender- dependent expression of alpha and β estrogen receptors in human nontumor and tumor lung tissue.Mol Cell Endocrinol. 2002; 188: 125-140
- Dose-response relationship between cooking fumes exposures and lung cancer among Chinese nonsmoking women.Cancer Res. 2006; 66: 4961-4967
- Lung cancer among Chinese women.Int J cancer. 1987; 40: 604-609
- Lung cancer in nonsmoking Chinese women: a case-control study.Lung Cancer. 1996; 14: S93-S98
- Tobacco smoke and involuntary smoking.IARC Monogr Eval Carcinog Risks Hum. 2004; 83 (1–1438)
- Beyard S. Jinot J. Koppikar A.M. Respiratory health effects of passive smoking: lung cancer and other disorders. Environmental Protection Agency, Washington DC, USA1992: 1-29 (Chpt 6)
- Shopland D. Zeise L. Dunn A. Health effects of exposure to environmental tobacco smoke. National Cancer Institute, Bethesda, USA1999: 282-308
- No impact of passive smoke on the somatic profile of lung cancers in never-smokers.Eur Respir J. 2015; 5 (ERJ-00973)
- Never-smokers with lung cancer: epidemiologic evidence of a distinct disease entity.J Clin Oncol. 2006; 24: 2245-2251
- Lung cancer in never-smokers.J Clin Pathol. 2007; 60 (Apr 1): 337-340
- Natural history of non-small cell lung cancer in non-smokers.J Clin Oncol. 2005; 23: 7252
- Variation in cancer risk among tissues can be explained by the number of stem cell divisions.Science. 2015; 347: 78-81
- Genetic variants and risk of lung cancer in never smokers: a genome-wide association study.Lancet Oncol. 2010; 11: 321-330
Article Info
Publication History
Published online: August 04, 2017
Accepted:
June 24,
2017
Received in revised form:
June 19,
2017
Received:
April 5,
2017
Footnotes
☆This work was presented at the IASLC 16th World Conference on Lung Cancer September 6–9 2015, Denver, Colorado.
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
