Changing trends in incidence of lung cancer by histologic type in Scotland

Lung cancer is a major public health concern worldwide. Our study aims to examine trends in incidence of lung cancer in Scotland during 1959-97 and by histologic type for 1975-97. In Scotland, lung cancer is the most commonly diagnosed cancer in men and is the second most commonly diagnosed cancer in women. Due to poor survival rates, trends in incidence and mortality display similar patterns. Within the United States and many parts of Europe, falls in the incidence of squamous cell carcinoma have occurred whilst the incidence of adenocarcinoma has increased. Data were extracted from the Scottish Cancer Registry. Trends in incidence were examined by standardising rates to the World Standard Population. Age-specific rates were examined by year of diagnosis and mid year of birth. In Scotland the incidence of lung cancer in men has fallen since the late 1970s, whereas incidence in women has continued to increase. Incidence rates of adenocarcinoma have increased over time but squamous cell carcinoma remains the predominant type of lung cancer in Scotland. The quality of lung cancer registration data has improved over time, although a large proportion of lung cancers (>20%) are not microscopically verified. Changes in histologic types are unlikely to be solely due to diagnostic advances. Rates of adenocarcinoma have increased steadily over time, and this may be due to changes in cigarette design during the 1950s.     

Changing trends in histologic types of lung cancer during the last decade (1981–1990) in Korea: a hospital-based study

A review of the histopathology and past history of 2229 patients with primary lung cancer diagnosed at the Yonsei University Medical Center from 1981 to 1990 was performed to investigate the changes in histologic types and the relationship to smoking history. The most frequent histologic type of lung cancer was squamous cell carcinoma (956 patients, 54.0%) followed by adenocarcinoma (311 patients, 17.6%) in males (1772 patients), and adenocarcinoma (206 patients, 45.1%) followed by squamous cell carcinoma (126 patients, 27.6%) in females (457 patients). In both sexes, the predominant type was adenocarcinoma under the age of 40, whereas squamous cell carcinoma was the most frequent type above the age of 40. While squamous cell carcinoma decreased over 10 years (54.3% in 1981, 44.3% in 1990), adenocarcinoma showed a gradually increased incidence (17.0% in 1981, 28.3% in 1990) in both sexes, and the proportion of small cell carcinoma and large cell carcinoma remained unchanged. These changes in histologic type were more prominent in non-smokers. In conclusion, the increasing incidence of adenocarcinoma in both sexes, especially in non-smokers, suggests the possible presence of etiologic factors other than smoking, such as environmental pollution.     

Significant changes in the distribution of histologic types of lung cancer. A review of 4928 cases

The histopathologic data for lung carcinoma were reviewed in 4928 patients between 1964 and 1985. The analysis of this data indicates that lung cancer is increasing in our region. Squamous carcinoma remains the most frequent type in men, followed by adenocarcinoma. Small cell carcinoma is the second most frequent type in women, after adenocarcinoma. Small cell carcinoma has increased over the past years and may become the most common type of lung cancer in women, a development that might result in increased numbers of deaths. Lung cancer data must be carefully analyzed in view of the impact on selection of therapy, patient management, and education.     

469例经支气管镜检查确诊40岁以下肺癌患者的临床分析

背景与目的近年来,青年肺癌在临床上已不少见,发病率呈逐年上升趋势,临床上易误诊,预后较差。现将我科诊治的469例40岁以下肺癌患者支气管镜及临床特点回顾性分析如下,探讨40岁以下肺癌患者的肿瘤病理分型与性别、生长部位等的关系。方法对经支气管镜检查取材确诊的469例40岁以下肺癌进行回顾性分析。结果469例40岁以下患者肺癌患者中,男性332例,女性137例,男女性别比为2.42:1,病理分型,鳞状细胞癌155例(33.0%),其次是腺癌122例(26.0%),小细胞癌96例(20.5%),男性鳞癌的比例40.7%,明显高于女性14.6%,腺癌比例19.0%明显低于女性43.1%,男性和女性的肿瘤病理类型分布构成有显著差异(P<0.05)。病变部位以双上叶居多,右侧多于左侧。镜下改变新生物及黏膜浸润等直接征象占81.4%。结论40岁以下肺癌患者中,男性以鳞癌为主,女性以腺癌居多。青年人肺癌易漏诊和误诊,支气管镜检查是其诊断的重要手段,应该提高对青年肺癌的警惕和认识,及早进行支气管镜检查。     

7843例原发肺恶性肿瘤流行病学特征分析

目的:分析首都医科大学附属北京胸科医院2014-2018年期间住院患者中初次病理诊断为原发肺恶性肿瘤患者的年龄、性别、病理类型特点,以初步了解近5年肺恶性肿瘤患者的流行病学特征。方法:对2014-2018年5年期间首次经病理诊断为肺恶性肿瘤病例的年龄、性别、病理类型等流行病学特征进行统计分析。结果:本研究共纳入病例7 843例,年龄中位发病年龄为63岁（最小年龄7岁,最大年龄90岁）,病例数呈逐年增加趋势。男性患者共5 094例,女性患者共2 749例,男女性别比例为1.85∶1（5 094/2 749）,女性病例构成比呈上升趋势,由31.79%（439/1 381）增加至38.99%(680/1 744)。主要病理类型为腺癌,其构成比呈逐年上升趋势,由51.19%(707/1 381)增加至59.75%(1 042/1 744)。发病年龄段愈年轻,腺癌构成比越高。结论:北京胸科医院近5年收治住院原发性肺恶性肿瘤患者病例数呈逐年增长趋势,女性构成比呈上升趋势,腺癌构成比呈上升趋势。发病年龄越轻,腺癌构成比越高。     

The changing epidemiology of lung cancer in Europe

BACKGROUND: Since the incidence and mortality of the histological subtypes of lung cancer in Europe has changed dramatically during the 20th century, we described the variation and changes in incidence, treatment modalities and survival of lung cancer. METHODS: For geographical variation and changes in incidence, data of the European cancer incidence and mortality (EUROCIM) database were used, and data on survival were derived from the EUROCARE database. For trends in treatment modalities and survival, according to histology and stage, data of the Eindhoven Cancer registry were used. RESULTS: Although the incidence of lung cancer among men in Denmark, Finland, Germany (Saarland), Italy (Varese), the Netherlands, Switzerland and the United Kingdom has been decreasing since the 1980s, the age-adjusted rate for men in other European countries increased at least until the 1990s. Among women the peak in incidence had not been reached in the 1990s. The proportion of adenocarcinoma has been increasing over time; the most likely explanation is the shift to low-tar filter cigarettes. In the 1990s more patients with localised non-small cell lung cancer received surgery than in the 1970s. Among patients with non-localised non-small cell lung cancer and among those with small cell lung cancer there was a trend towards more chemotherapy. There was fairly large variation in survival within Europe. Despite improvement in both the diagnosis and treatment, the overall prognosis for patients with non-small-cell lung cancer hardly improved over time. In contrast, the introduction and improvement of chemotherapy since the 1970s gave rise to an improvement in survival for patients with small-cell lung cancer. CONCLUSION: The epidemic of lung cancer is not over yet, especially in southern and eastern Europe. Prevention remains the best policy, but improvement in the management of lung cancer also remains very important.     

Secular trends in histologic types of lung cancer

The histology pattern of lung cancer in Los Angeles County was reviewed for a 10-year period, 1972-81. In men, the total lung cancer incidence has been fairly constant, but there has been a shift in the histology pattern with an increase in adenocarcinoma and a decrease in "other" cell type (i.e., carcinoma not otherwise specified, large-cell and undifferentiated tumors). This changing histology pattern may be partly due to changes in diagnostic standards and practices. With the assumption that these changes are comparable in men and women, the "true" annual rate of change was estimated for each lung cancer cell type in women. All lung cancer types have increased in women; of the cell types squamous cell carcinoma, small-cell carcinoma, and adenocarcinoma, small-cell carcinoma showed the largest rate of annual increase and adenocarcinoma, the smallest.     

729例女性肺癌支气管镜下特征分析

背景与目的近年来,女性肺癌的发生率逐渐升高,该文通过分析湘雅医院1994年1月-2007年6月经支气管镜诊断的女性肺癌病例,探讨其支气管镜下特征。方法对729例女性肺癌患者支气管镜检查资料进行回顾性分析。结果中年组检出数最多(57.0%),其次是老年组(28.5%),青年组较少(14.0%);主要的病理类型分别为腺癌(42.8%)、鳞癌(23.9%)和小细胞癌(19.2%),随着年份的增加三大主要病理类型的检出例数均逐渐增多;好发于右肺(P<0.05),上叶多于下叶(P<0.05);支气管镜下表现以直接征象为主(92.0%),腺癌患者支气管镜下表现以浸润性改变为多(P<0.05),鳞癌和小细胞癌镜下表现均以增生性改变为多(P<0.05);肺不张对应的镜下表现以增生性改变为主(P<0.05),胸腔积液对应的镜下表现以浸润性改变为主(P<0.05)。结论支气管镜检查是诊断女性肺癌的重要手段,借助其可以提高对女性肺癌的认识和警惕,也有助于早期明确诊断。     

Global perspective of tobacco habits and lung cancer: a lesson for third world countries.

Over the past 50 years, a dominant role of tobacco smoking in lung cancer causation has been demonstrated. Almost three-quarters of the lung cancer cases can be attributed to tobacco smoking. The global variation in lung cancer incidence is thought to be directly proportional to the smoking habits prevalent in that part of the world. Lung cancer shows a greater upward trend in incidence in the USA, in central and Eastern Europe than ever before, especially in females. Japan too has recorded a 10-fold increase in incidence in both sexes since 1975. In India the problem is further compounded by absence of authentic data on time trend. The recent trend of available data suggests a more or less linear trend. At present lung cancer ranks among the top three killers in men in almost every metropolis in India. The highest incidence rate has been recorded in Bombay (14.6/ 100,000) and the lowest in Barshi (2.0/100,000). How much of these can be attributed to smoking cannot be commented on as no case-control or cohort studies have ever been undertaken in India. The situation is more alarming in other developing countries, where there is no authentic data on tobacco use or lung cancer incidences. The relationship between tobacco and cancer is both simple and complex. The majority of the cancer patients are smokers, while the cancer incidence is not proportional among smokers. To explain this, various factors such as type of smoke, duration of smoke, amount of carcinogens, presence of activation and metabolism pathways, and lately genetic environment interaction, have been put forward. It appears that the relationship is more complex than at first thought. In developing countries, it is further compounded by lack of data on usage and dependence of the economies of these countries on tobacco. The situation is alarming, with ever-increasing incidence among women and non-smokers exposed to smoke (passive smokers). Tobacco use has already become an epidemic.     

Targeted therapies for esophageal cancer

Esophageal cancer is a highly aggressive neoplasm. In 2005, 14,520 Americans will be diagnosed with esophageal cancer, and more than 90% will die of their disease. On a global basis, cancer of the esophagus is the sixth leading cause of cancer death worldwide. In fact, gastric and esophageal cancers together accounted for nearly 1.3 million new cases and 980,000 deaths worldwide in 2000-more than lung, breast, or colorectal cancer. Although esophageal squamous cell carcinoma cases have steadily declined, the incidence of gastroesophageal junction adenocarcinoma has increased 4%-10% per year among U.S. men since 1976, more rapidly than for any other cancer type, and parallels rises in population trends in obesity and reflux disease.With advances in surgical techniques and treatment, the prognosis of esophageal cancer has slowly improved over the past three decades. However, the 5-year overall survival rate (14%) remains poor, even in comparison with the dismal survival rates (4%) from the 1970s. The underlying reasons for this disappointingly low survival rate are multifold: (a) ineffective screening tools and guidelines; (b) cancer detection at an advanced stage, with over 50% of patients with unresectable disease or distant metastasis at presentation; (c) high risk for recurrent disease after esophagectomy or definitive chemoradiotherapy; (d) unreliable noninvasive tools to measure complete response to chemoradiotherapy; and (e) limited survival achieved with palliative chemotherapy alone for patients with metastatic or unresectable disease. Clearly, additional strategies are needed to detect esophageal cancer earlier and to improve our systemic treatment options. Over the past decade, the field of drug development has been transformed with the identification of and ability to direct treatment at specific molecular targets. This review focuses on novel targeted treatments in development for esophageal squamous cell carcinoma and distal esophageal and gastroesophageal junction adenocarcinoma.     

南京市1996-2005年1128例肺癌住院病例发病特征的动态变化分析

背景与目的肺癌的流行病学特征是随时间的变化而不断改变的,本研究拟通过分析南京市近10年来肺癌住院病例在性别、年龄、吸烟、病理类型等方面的特征和动态变化,为肺癌病因研究提供临床资料。方法收集整理南京市胸科医院1996年-2005年10年间1128例新发肺癌住院病人的临床资料并进行统计学分析,重点比较前后5年肺癌发病特征动态变化。结果女性肺癌的比例明显逐年增加,总体男女性别比为2.4:1,其中前5年为3.2:1,后5年则下降为1.9:1。10年来肺癌的平均发病年龄呈下降趋势,且后5年小于50岁的病例数占25.6%,显著高于前5年(10.2%)。10年来肺癌病理类型中腺癌的病例数明显上升,由前5年32.4%上升到后5年的45.2%;而鳞癌的病例数有所下降,由40.6%下降到30.8%。无论男性和女性,鳞癌患者的吸烟比例最高。结论10年来肺癌的发病有年轻化的趋势,且女性、腺癌病例有明显增加,值得引起广泛的关注。     

Characteristics of lung cancer in Korea, 1997

The high proportion of smokers and the incidence of advanced, unresectable lung cancer in Korea were examined to aid the development of a national anti-smoking program and the early detection of lung cancer. Koreans are a single racial group with a high smoking rate among men and a contrastingly low smoking rate among women. This report documents a retrospective investigation conducted by The Korean Academy of Tuberculosis and Respiratory Disease into the characteristics of all lung cancers diagnosed between 1 January 1997 and 31 December 1997 in Korea. Among the 3794 patients included in this study, 76.8% were smokers and, in particular, 89.8% of the males were smokers. Squamous cell carcinoma was the most frequent type of lung cancer encountered (44.7%), followed by adenocarcinoma (27.9%). The smoking rate in the case of adenocarcinoma was significantly lower than that found in both squamous cell carcinoma and small cell cancer. The most common symptom was a cough. Only 7.2% of patients were asymptomatic. Bronchoscopic biopsy has a primary role in the diagnosis of squamous cell carcinoma and small cell cancer, but percutaneous needle biopsy has a more important role in the case of adenocarcinoma. Two-thirds of the nonsmall cell lung cancer patients were detected in the unresectable advanced stages (IIIB and IV). In contrast to other countries, squamous cell carcinoma is still the most frequent type of lung cancer in Korea. The high proportion of smokers and the incidence of advanced, unresectable lung cancer at diagnosis have urged development of a national anti-smoking program to promote the cessation of smoking and the early detection of lung cancer.     

煤焦沥青碘油溶液气管注入诱发大鼠肺癌的实验研究

本文报告了应用煤焦沥青碘油溶液气管注入诱发大鼠肺癌的实验研究。Ｗｉｓｔａｒ大鼠气管注入致癌物，于实验结束时，肺癌发生率达９１．６％。碘油对照组未见肺癌发生。所诱发的肺癌大多为多灶性起源。最早出现于实验的第１６天，组织学类型有鳞癌、腺癌及腺鳞癌。结果表明：碘油作为赋形剂进行沥青实验性肺癌研究，可提高肺癌发生率，发癌时间提前，中央型肺癌增多且便于Ｘ线观察。     

Gender-specific incidence trends in lung cancer by histological type in Sweden, 1958-1996.

We used the Swedish Family-Cancer Database to examine the time trends of lung cancer in Sweden by histological type, with special reference to gender. A total of 45,297 lung cancer cases were analysed. The overall age-adjusted incidence rates of squamous cell carcinoma (SCC) in men peaked in the 1980s and then slightly decreased, while corresponding rates in women increased steadily. The incidence of adenocarcinoma increased in both genders. The male-to-female incidence ratio for SCC was 12.4 in the 1960s and 3.6 in the 1990s. For adenocarcinoma the ratio was close to 1.5 throughout the period. Regression analysis indicated that the birth cohort of the 1940s was at the highest risk for adenocarcinoma in men and for all types of lung cancer in women. Lung cancer in parents was a risk factor for offspring. In conclusion, the data, particularly on women, suggest that modern cigarettes induce lung adenocarcinoma and SCC in a proportion of 1:0.6. This proportion was 1:3.7 among men diagnosed in the 1960s. The incidence ratio of 1.3 for adenocarcinoma between men and women in the 1990s is consistent with the smoking prevalence data a few decades ago, suggesting equal sensitivity of both genders to tobacco-induced lung cancer.     

A cancer incidence survey in Tianjin: the third largest city in China—between 1981 and 2000

During the past three decades, the social/natural environment and lifestyle of people in China have undergone a marked transformation to westernization. However, age-standardized cancer rates have not been determined to any great extent in China. In this study, we tracked the cancer incidence between 1981 and 2000 in Tianjin, to identify the changes in incidence associated with social and economic changes. Cancer incidence data were collected by the Tianjin Cancer Registry. Sex, age, and organ site-specific incidence trends were analyzed by the "join-point regression" method. Overall crude cancer incidence increased, but the age-standardized incidence slightly decreased during the study period. The incidence of lung cancer increased between 1981 and 1996 but decreased between 1996 and 2000. The incidences of uterine, esophageal, stomach, and liver cancers decreased. However, the incidences of colorectal, pancreatic, breast, ovarian, and prostate cancers all increased during the study period. There was an aging-related increase in the overall crude cancer incidence and an alteration in the distribution of cancer types in Tianjin. The incidences of cancer types that are more prevalent in developed countries appeared to increase in China, whereas the incidences of cancer types that are more prevalent in developing countries appeared to decline.     

Cigarette filter and the incidence of lung adenocarcinoma among Tunisian population

Increasing incidence of lung adenocarcinoma (Ad) is observed for the last two decades in all over the world and may become the most frequent lung cancer subtype in the next years. Its increasing prevalence has been well documented in United States for the last two decades. Geographical differences in the increase of Ad prevalence was also reported in Europe where the Squamous Cell Carcinoma (SCC) still predominates but the increase of Ad incidence was shown in the beginning of 1980s. In Tunisia, the incidence of Ad was relatively low in 1990 when compared to western countries and was shown to continue to increase with a more important rise of Ad incidence over SCC type. In this study the time-dependent increased incidence of Ad is reported between USA, Europe and Tunisia. A lag-time period of 10 years is observed between Tunisia and Europe for this increased incidence in smokers and about 20 years between USA and Tunisia. According to the literature, changes in the types of cigarettes smoked as well as modifications in time and geographical trends seem to explain partly the increased incidence of Ad lung cancer.     

A statistical study of lung cancer in the annual of pathological autopsy cases in Japan, from 1958 to 1997, with reference to time trends of lung cancer in the world.

Lung cancer cases (66650 males and 20890 females) registered in the Annual of Pathological Autopsy Cases in Japan, between 1958 and 1997, were analyzed with regard to sex, age and histology. They were subdivided into decades (periods I to IV), and compared with the Japanese mortality statistics, with which they were in good correspondence. Although the autopsy rate is decreasing, more than 10% of the total lung cancer deaths in Japan were registered by 1990. Among autopsied cases, the incidence of lung cancer cases increased from 6% to 12% in males and from 3% to 6% in females. From period III, lung cancer in males became the most frequent, and was the second most frequent cancer in females after gastric cancer. As for the histological distribution, adenocarcinoma was the most frequent and squamous cell carcinoma was the next most frequent in both sexes. Recently, a significant increase in adenocarcinoma and a significant decrease in squamous cell carcinoma have been observed in both sexes. The peak ages shifted from the 60s to the 70s and a significant rise in the mean ages were observed. The male-to-female ratios and the ratio curves by histological and age group were high for squamous cell carcinoma and small cell carcinoma, while they were low for the total and adenocarcinoma. With the recently acquired data on lung cancer in Asian countries, and from the male-to-female ratios and the status of smoking rates, lung cancer in the world at present was divided into three groups; North America, Europe and Asia. The possibility of one group changing to resemble another and of groups converging in the near future is suggested.     

A population-based study of lung cancer incidence trends by histologic type, 1974-81

All incident cases of microscopically confirmed lung cancer diagnosed between 1974 and 1981 in western Washington State were identified through the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, Bethesda, MD. The incidence of lung cancer by histologic type was studied in relation to time, with age, sex, and stage of disease at diagnosis being taken into account. Overall and within each sex, the incidence of adenocarcinoma has increased significantly since 1974. The rate of increase has been higher among females (86% increase) than among males (54% increase), with most of the increase in both sexes being among those over age 65 years with distant or unstaged disease at diagnosis. Similar patterns were not observed for squamous cell carcinoma. The potential effects of changes in diagnostic and pathology practice during the study period in producing these results were explored, and etiologic implications of the observed increase in adenocarcinoma were discussed.     

Lung cancer in women

Lung cancer is the most common cancer in both men and women; however, there are some clear genderbased differences. As the incidence of lung cancer is declining in men, the incidence of lung cancer is increasing in women. Women are more likely than men to have adenocarcinoma, a histologic subtype that correlates with worsened prognosis, but women have improved survival compared with men. Genetic predisposition and the presence of estrogen receptors in lung cancer cells may predispose women to developing lung cancer. Further studies are needed to understand the mechanism and significance of these findings.