Adenocarcinoma of the lung among women: risk associated with smoking, prior lung disease, diet and menstrual and pregnancy history
Introduction
In a number of developed countries, the distribution of lung cancer by gender and cell type has changed over the last few decades. In the US, the age-adjusted lung cancer incidence rates in men levelled off and declined subsequently, contrasting with a continuous rise among women. The number of new lung cancer cases among US women expected in 2003 has been estimated at 12% of the sum of all types of female new cancer cases expected in 2003 [1]. Adenocarcinoma of the lung is now the most common lung cancer type in the US [2], and may also become the major cell type in Australia, New Zealand and Europe in the near future [3].
Significant associations with smoking have been found for all major cell types. However, smoking seems to have the strongest effect on small- and squamous-cell cancers and the weakest on adenocarcinoma [4]. Therefore, it is not surprising that adenocarcinoma has always represented the majority of lung cancers among nonsmokers of both genders, and that adenocarcinoma is the least affected by increasing duration of smoking cessation [5]. The greater proportion of adenocarcinoma among nonsmokers in comparison to other cell types may suggest that factors other than smoking may be involved in the etiology of this cell type of lung cancer [6]. The variation in association between smoking and cell types of lung cancer may be related to increase in use of filter low tar cigarettes [3], [7], tumor location, prevalence of other factors such as genetic profile, occupational or other environmental exposures such as passive smoking [4]. The relative importance and contribution of each factor can vary with geographic area and socioeconomic conditions.
To investigate the role of tobacco and some other known or suspected factors responsible for the risk of developing adenocarcinoma of the lung, and to compare with other cell types (squamous-, small- and large-cell cancers) in Czech women, we conducted a case-control study. This report, based on 145 cases of adenocarcinoma of the lung, 221 lung cancer cases of other cell types, and 1624 controls, describes the risk associated with smoking habits, passive smoking, previous lung disease or cancer, diet, and menstrual and pregnancy history.
Section snippets
Study sample and data collection
A hospital-based case-control study of adenocarcinoma of the lung in women was conducted in the Prague University Hospital Na Bulovce, Departments of Pneumology, thoracic surgery and internal medicine. To be included as a case, a female lung cancer patient had to be admitted between April 1998 and July 2002, suffer from microscopically confirmed adenocarcinoma of the lung, be aged 25–89 years, and reside within the catchment area of the departments covering the north-eastern sectors of Prague
Results
The mean age of adenocarcinoma cases was 62.0 years, of women with squamous-, small- and large-cell cancers 63.3, 63.3 and 63.5, respectively, and of controls 57.0 years (Table 1). The most numerous age-group among cases with adenocarcinoma was 55–64 years, among women with squamous-, small- and large-cell cancers 65–74 years, and among controls 45–54 years.
The smoking habits of lung cancer patients were different by cell types (Table 1). Among adenocarcinoma cases more than one-third (34.5%)
Discussion
The risk of lung cancer can be conceptualized as reflecting the joint consequences of the interrelationship between exposure to etiologic (or protective) agents and the individual susceptibility to these agents [12]. Tobacco is the strongest epidemiologic risk factor for the development of lung cancer. Changes in the cigarette design and smoking behaviour are supposed to be responsible for the most of the changing epidemiologic patterns in lung cancer by histologic types [3], [13]. Recently,
Acknowledgements
This work was supported by the International Association for the Study of Lung Cancer and the Cancer Research Foundation of America.
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