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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