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The Lung Cancer Epidemic: is there anything we can do? Diana C. Márquez-Garbán University of California, Los Angeles Division of HematologyOncology Acknowledgements National Program Excellent University National Program Excellent University EU/Slovakia EU/Slovakia Dr. Martina Nebohácová UCLA Richard J. Pietras Hermes J. Garbán Hsiao-Wang Chen Olga Weinberg Edward Garon Eugene Tsai Jeison Recinos UCLA Lung Cancer SPORE Program Dr. Steven Dubinett Global Incidence • 1.3 million deaths/year worldwide. • Lung cancer kills more people than any other cancer • Number one killer in men and second in women • 5 year survival still at 14% • Risk factors: radon, asbestos, air pollution Tobacco smoke responsible for 87% of cases of Lung Cancer Smoking and Lung Cancer: History • “Phenomenal increase in the number of deaths attributed to cancer of the lung” (1922-1947) Cigarette smoking is related to Lung Cancer Toxic chemicals in tobacco smoke * Nicotine – the addictive agent in tobacco smoke * Formaldehyde – used in preservation of laboratory specimens * Ammonia – used in toilet cleaner * Hydrogen Cyanide – used in rat poison * Acetone – used in nail polish remover * Carbon monoxide - found in car exhaust * Tar - particulate matter in cigarette smoke * Toluene - found in paint thinners * Phenol – used in fertilisers.1,2 Smoking Damages Virtually Every Part of the Body Smoking Second-hand smoke also does Second-Hand Smoke Normal and Smoker’s lung Normal Smoker’s lung Lung Cancer Tobacco Is a Risk Factor for 6 of the World’s 8 Leading Causes of Death Lung Cancer Facts Myth: Lung cancer is a man’s disease. Fact: The incidence of lung cancer in men has been leveling off in recent years. In women, however, the incidence is rising rapidly. Lung cancer among women at epidemic proportions Age-adjusted death rates for lung cancer and breast cancer among women, US, 1930-1997. 600% increase in death rate in 50 years 1960: First brand specifically manufactured for women Virginia Slims: “You've come a long way, baby" "It's a woman thing” "Find Your Voice” Virginia Slims remembers when a woman carried more weight than a man Marketing campaigns targeted women with the social pressures they face Women who smoke like men, die like men Classification Non-Small Cell (~85%): • Adenocarcinoma: 40% of all cases Most common among women • Squamous • Large Cell Small Cell •Related to Smoking •More Aggressive than NSCLC Lung Cancer Symptoms Persistent cough Hoarseness Change in color (blood) or amount of sputum Recurrent pneumonia, bronchitis Diagnosis Radiology: Chest X-ray, CT scan, MRI scan, PET scan Biopsy: Needle, bronchoscope-directed, open surgical Lung Cancer CT Scan X-ray Staging and Treatment of Lung Cancer Stage I Early Surgery Stage II +/- Radiation Stage III +/- Chemotherapy Stage IV Advanced Chemotherapy Non-small Cell Lung Cancer • Staging: Estimate prognosis Guide treatment decisions • 70% present with advanced locoregional or metastatic involvement Stage IIIA, IIIB, or IV 5 year survival 1-25% Ginsberg RJ, et al. Cancer: Principles and Practices of Oncology. 5th ed. 1997;858-911. Lung Cancer: One Name, Many Diseases •Heterogenous disease: •Smokers vs. non-smokers •Women vs men • Epidemiologic findings suggest women more susceptible than men to the effects of tobacco smoke (Henschke C, JAMA 2006) • Women develop the disease at an earlier age and with less reported tobacco exposure than men •Among non-smokers, women are particularly vulnerable to lung cancer (80% of cases) ? •Women: increasing incidence Do Hormones Influence Lung Cancer Progression? • Estrogen contributes to normal lung development • Association of estrogen levels and lung cancer survival – Serum estrogen elevated in women with lung cancer compared to similar age without lung cancer (Tiuriunova et al, 1986) – Hormone replacement therapy and lung cancer survival • Lung epithelium express ER- and ER- – Receptors are active • Lung epithelium produce estrogen (via aromatase) • Estrogen stimulates proliferation in vitro and in vivo What can we do? Tobacco is the world’s single most avoidable cause of death Most Countries Have Not Implemented Effective Tobacco Control Policies WHO Report on the Global Tobacco Epidemic, 2008 In the 20th century the tobacco epidemic killed 100 million people worldwide During the 21st century, it could kill 1,000 million WHO Report on the Global Tobacco Epidemic, 2008 We must become the change we want to see Mahatma Gandhi (1869-1948) Lung Cancer Facts 90% of new smokers begin as teenagers; one third of these new smokers will eventually die of tobacco related diseases. 1970-today: advertising with so-called “light” and “low-tar” Tobacco companies use lies: cigarettes with “reduced risk” Risks men are not exposed to: 1 Birth Control Pill- Increased risk of heart attack and stroke 2 Mother to be- baby likely to be under weight 3 Smoking reduces fertility 4 Reach menopause earlier than non smokers 5 Higher risk of osteoporosis 6 Increased risk of cervical cancer Stopping: - Improves weight of baby - After 2y risk of HA and stroke decrease Myths about smoking 1 2 3 4 It won't happen to me. It’s not like I am hurting anyone but myself. I'm not hooked. I can stop anytime I want. Sure I smoke, but at least I don't do drugs, have unsafe sex, or get drunk. 5 It’s better to smoke because if I quit, I’m going to get fat. 6 I smoke "light" cigarettes, so I won't get hurt as much. 7 I've tried to quit, but I can't. Second Hand Smoke 1 It causes heart disease and lung cancer 2 Exposed at home or work- Increased risk of lung cancer and heart disease 3 People with heart disease at increased risk of HA 4 Even brief exposure can be dangerous In children: • • Respiratory symptoms in children and slows the growth of their lungs Sudent infant death syndrome, acute respiratory infections, ear problems and worsens asthma