Tuberculosis,smoking and risk for lung cancer incidence and mortality

Among the exposures associated with risk for lung cancer, a history of tuberculosis (TB) is one potentially important factor, given the high prevalence of TB worldwide. A prospective cohort study was conducted to evaluate the associations of preexisting pulmonary TB with lung cancer incidence and mortality. The cohort consisted of 1,607,710 Korean adults covered by the National Health Insurance System who had a biennial national medical examination during 1997–2000. During up to 16 years of follow‐up, there were 12,819 incident cases of lung cancer and 9,562 lung cancer deaths. Using Cox proportional hazards models and controlling for age, cigarette smoking and other covariates, the presence of underlying TB was significantly associated with increased risk for lung cancer incidence (HR 1.37 in men with 95% CI 1.29–1.45; HR 1.49 in women with 95% CI 1.28–1.74) and mortality (HR 1.43 in men with 95% CI 1.34–1.52; HR 1.53 in women with 95% CI 1.28–1.83). We also observed a dose‐response relationship between number of cigarettes smoked daily and lung cancer risk. There was no evidence for synergism between a history of TB and smoking. The elevation in risk is relatively modest, particularly in comparison to that from smoking, and a prior history of TB is not likely to be useful risk indicator for clinical purposes. In populations with high prevalence of TB, it can be considered for incorporation into models for lung cancer risk prediction.     

Trends in head and neck cancer incidence in relation to smoking prevalence

The trends in head and neck cancer incidence and smoking prevalence are reviewed, discussing where such trends parallel but also how and why they may not. In the U.S., public health efforts at tobacco control and education have successfully reduced the prevalence of cigarette smoking, resulting in a lower incidence of head and neck cancer. Vigilance at preventing tobacco use and encouraging cessation should continue, and expanded efforts should target particular ethnic and socioeconomic groups. However, an unfortunate stagnation has been observed in oropharyngeal cancer incidence and likely reflects a rising attribution of this disease to oncogenic human papillomavirus, in particular type 16 (HPV-16). For the foreseeable future, this trend in oropharyngeal cancer incidence may continue, but with time the effects of vaccination of the adolescent and young adult female population should result in a lower viral prevalence and hopefully a reduced incidence of oropharyngeal cancer. To hasten the reduction of HPV-16 prevalence in the population, widespread vaccination of adolescent and young adult males should also be considered.     

Reducing inequalities in lung cancer incidence through smoking policies

Introduction

Lower social class has higher lung cancer incidence, largely attributable to higher smoking prevalence among the lower social classes. We assessed the magnitude and time dimension of potential impact of targeted interventions on smoking on socioeconomic inequalities in lung cancer.

Methods

Using population dynamic modelling, we projected lung cancer incidence up to 2050 in lowest and highest socioeconomic groups under two intervention scenarios (annual 10% increase in cigarette prices and health advertisement) and compared this to a scenario of no intervention. For the analysis we retrieved smoking prevalence data from the General Household Survey of England and Wales between 1980 and 2006 and cancer incidence data from the national cancer registry.

Results

By 2050, the model projected that lung cancer incidence inequality would almost double (Incidence Rate Ratio (IRR) = 4.2 in 2050 vs. 2.5 in 2005) in men and slightly decrease (IRR = 2.4 in 2050 vs. 2.7 in 2005) in women compared to what was observed in 2005. If annual increase in cigarette price targeting the lowest socioeconomic group was implemented, socioeconomic inequality in lung cancer incidence in 2050 might be largely reduced (IRR = 1.5 and 1.4 among men and women, respectively). If in addition to annual price increase (targeted to the lowest socioeconomic group) health advertisement was implemented and successfully reduced smoking prevalence in the highest socioeconomic group, the lung cancer gap between the socioeconomic groups would be reduced by 78% and 58% in men and women by 2050.

Conclusion

Even under the best scenarios, inequality in lung cancer was not fully eliminated within 45 years period. Though the process is lengthy, rigorous interventions may reduce the expected widening of the future inequalities in lung cancer. Modelling exercise such as ours relies heavily on the quality of the input data and the assumptions, thus caution is needed in interpretation of our findings and should consider all the assumptions taken in the analysis.     

Trends in testicular cancer incidence in Vaud, Switzerland.

Upward trends in testicular cancer incidence have been reported in Europe and North America, particularly for seminomas. We considered incidence data between 1974 and 1999 from the Swiss cancer registry of Vaud, i.e. one of the highest incidence areas on a worldwide scale, including a total of 731 cases. Testicular cancer incidence was around 8.5/100 000 between the mid-1970s and the late 1980s, and increased to around 10/100 000 in the 1990s. Corresponding figures at age 15-44 were around 16/100 000 between the mid-1970s and the late 1980s, and about 19/100 000 thereafter. No evidence of persisting upward trends was evident over the last few years. The rise in testicular cancer incidence in the 1990s was apparently restricted to seminomas, whose rates increased from about 4 to 5.7/100 000 at all ages, and from 7 to over 11/100 000 at age 15-44. No consistent pattern of trends was observed for malignant teratomas and for other and unspecified histotypes. Testicular cancer in Vaud has shown no tendency to further rising over the last decade, thus re-opening the issue of a probable asymptote of testicular cancer incidence in this population.     

Trends in lip cancer incidence in Vaud, Switzerland.

Recent trends in lip cancer incidence in the Swiss Canton of Vaud (approximately 600,000 inhabitants in 1990) were analysed over the period 1975-1990, when a total of 87 cases were registered. A steady and substantial decline was observed in both sexes, since age-standardised (world) rates declined from 1.8 to 0.6/100,000 males and from 0.14 to 0.02/100,000 females. These downward trends were evident across subsequent age groups. These trends were apparently not due to changes in registration or classification criteria in the study period and are discussed in terms of decreased occupational exposure to ultraviolet light, and reduced pipe and cigar smoking.     

Bidi smoking and lung cancer incidence among males in Karunagappally cohort in Kerala, India

The association of lung cancer incidence with bidi smoking was examined using a cohort study data in Karunagappally, Kerala, India. We sought interview of all the residents in Karunagappally with the population of 385,103 in 1991 census, and established a cohort of 359,619 (93% of the population in 1991) in the 1990s. There were 65,829 men aged 30-84 at interview after excluding those diagnosed as cancer or died of any cause before 1997. Among them, 212 newly diagnosed lung cancer cases were ascertained during the 8-year period between 1997 and 2004 through Karunagappally Cancer Registry. The relative risk (RR) of lung cancer was obtained from Poisson regression analysis of grouped data. Lung cancer incidence was relatively high among Moslem people and those with lower educational history. When taking into account attained age, religion and education, the RR between current bidi smokers and those who had never smoked bidis was 3.9 (95%CI = 2.6-6.0, p < 0.001). The lung cancer risk did not return to the level of non-smokers within 10 years after cessation. In further analyses using only those never smoked cigarettes to examine the effect of bidi smoking alone on lung cancer risk, current smokers of bidis had the RR of 4.6 (95%CI = 2.5-8.5, p < 0.001). Lung cancer incidence increased with larger amounts of bidi smoked a day (p < 0.001), with longer durations of smoking bidis (p < 0.001), and with younger ages starting smoking bidis (p < 0.001). Immediate measures should be taken to stop bidi smoking, which is common in south Asia.     

Passive smoking and lung cancer in Chandigarh, India.

The aim of this study is to assess the relationship between exposure to environmental tobacco smoke (ETS) and lung cancer in non-smokers, a case-control study among lifetime non-smokers was conducted in Chandigarh, India. Cases consisted of 58 non-smoking histologically confirmed lung cancer patients; two controls for each case were selected, one among other patients admitted to the wards and one among the visitors to hospital patients. Subjects were asked about ETS exposure from different tobacco products in childhood and in adulthood at home, at the work place and in vehicles. Multivariate logistic regression analysis was used to assess the effects of the ETS exposure variables on lung cancer. Exposure to ETS during childhood was strongly associated with lung cancer (odds ratio (OR) = 3.9; 95% confidence interval (CI) = 1.9-8.2), the effect mostly arising from exposure to cigarettes smoke. The excess risk was observed with either a smoking father or mother. An increasing risk was found with increasing number of smokers and duration of exposure. Restricting the analysis to women produced higher estimates of the risk. No increased risk was found with exposure to a smoking spouse, except for those exposed only to cigarette smoke (OR = 5.1; 95% CI = 1.5-17). A weak association was seen between lung cancer and ETS exposure at the workplace, which increased with the number of years of exposure. Exposure in vehicles also was detected as a risk factor for lung cancer in non-smokers. This study suggests that ETS exposure may be a strong risk factor for lung cancer also in India, a country with low prevalence of smoking and, therefore, low rates of lung cancer. Other studies need to be conducted in similar settings to confirm the role played by ETS exposure early in life in the causation of lung cancer.     

Trends in oral cavity cancer incidence,mortality, survival and treatment in the Netherlands

Information on epidemiology is essential to evaluate care for the growing group of oral cancer patients. We investigated trends in incidence, mortality and relative survival rates for oral cavity cancer (OCC) and its subsites in the Netherlands from 1991 to 2010, and relate these to changes in stage and treatment. Patient (age, sex), tumour (subsite, stage) and treatment characteristics of patients diagnosed with OCC (ICD‐O‐3: C02‐C06) in 1991–2010 were extracted from the Netherlands Cancer Registry. Incidence, mortality and 5‐year relative survival rates over time are presented, as well as trends in type of treatment. The incidence of OCC increased with +1.2% (95%CI: +0.9%;+1.6%) per year: more strongly in women, stage I and IV disease, and in cancers of the tongue and gum. The mortality rate slightly rose (+0.8%, 95%CI: +0.3%;+1.3% per year), but differed by subsite. The 5‐year relative survival improved from 57% in 1991–1995 to 62% in 2006–2010. The 5‐year relative survival was better for women compared with men (64% and 55%, respectively), decreased with increasing stage, was the best for tongue cancer (63%) and the worst for cancer of the gum (56%) and floor of mouth cancer (55%). The relative excess risk of dying was higher for non‐surgery‐based treatments. Surgery was the main treatment option and the proportion of “surgery only” rose in stage I and III disease. The incidence and, to a lesser extent, mortality of OCC are increasing and therefore, even with slightly improving survival rates, OCC is an increasingly important health problem.     

Trends in skin cancer incidence in Neuchatel, 1976-98.

AIMS AND BACKGROUND: Limited data are available on trends in skin cancer incidence. This paper examines trends of the three major histotypes of skin cancer in an environment favorable for skin cancer registration. METHODS: Trends of skin cancer incidence by histotype in the Swiss Canton of Neuchatel (165,000 inhabitants) were analyzed on the basis of 4,455 incident cases of basal cell, squamous cell carcinoma, and malignant melanoma registered over the period 1976-1998. RESULTS: Trends over the last decade considered tended to be downwards for squamous cell carcinoma in both sexes, were still on the rise for basal cell carcinoma, and leveled off for malignant melanoma in both sexes. CONCLUSIONS: Different trends were confirmed in this population between skin cancer histotypes related to cumulative intense sun exposure (squamous cell carcinoma) and those mainly related to more complex patterns of exposure to sunlight (basal cell carcinoma and malignant melanoma).     

Mortality and incidence of second cancers following treatment for testicular cancer

We studied 5555 seminoma patients and 3733 patients with nonseminomatous testicular cancers diagnosed in Southeast England between 1960 and 2004. For both groups survival improved over time: 10-year relative survival increased from 78% in 1960-1969 to 99% in 1990-2004 for seminomas, and from 55 to 95% for nonseminomas. In the early period mortality was still significantly increased more than 15 years after diagnosis in both groups, whereas in more recent periods the excess deaths mainly occurred in the first 5 years after diagnosis. For seminomas, there was a significant excess of cancers of the colon (standardised incidence ratio (SIR) 2.36; 95% confidence interval (CI) 1.13-4.35), soft tissue (SIR 13.64; CI 1.65-49.28) and bladder (SIR 4.28; CI 2.28-7.31) in the long term (20+ years after diagnosis), of pancreatic cancer in both the medium (10-19 years) (SIR 2.91; CI 1.26-5.73) and long term (SIR 5.48; CI 2.37-10.80), of leukaemia in both the short (0-9 years) (SIR 3.01; CI 1.44-5.54) and long term (SIR 4.48; CI 1.64-9.75), and of testis cancer in both the short (SIR 6.69; CI 4.28-9.95) and medium term (SIR 3.96; CI 1.08-10.14). For nonseminomas, significant excesses were found in the long term for cancers of the stomach (SIR 5.13; CI 1.40-13.13), rectum (SIR 4.49; CI 1.22-11.51) and pancreas (SIR 10.17: CI 3.73-22.13), and for testis cancer in the medium term (SIR 5.94; CI 2.18-12.93). Leukaemia was significantly increased in the short term (SIR 6.78; CI 2.93-13.36). The better survival observed is largely attributable to improved treatment, and the trend in reducing the toxicity of therapy should continue to reduce future health risks in testicular cancer survivors.     

Trends in the prostate cancer incidence in India.

Trends in prostate cancer in five population-based cancer Registries (Mumbai, Chennai, Bangalore, Delhi & Bhopal) in India were studied over a period of two decades using a model that fitting the data as the logarithm of Y=ABx which represents a Linear Regression model. This approach showed increasing trends in the age adjusted incidence rates throughout the entire period of observation for most of the registries, especially in Chennai and Bhopal and to the least extent in Mumbai. Particularly in Asia we face a future major increase in the rates of prostate cancer. Collaborative action now is a high priority to allow the preparations necessary for effective control of prostate cancer.