Journal of Preventive Medicine and Public Health

Original Articles

Lung Cancer Screening With Low-dose Chest Computed Tomography: Experience From Radon-contaminated Regions in Kazakhstan: Alexandra Panina, Dilyara Kaidarova, Zhamilya Zholdybay, Akmaral Ainakulova, Jandos Amankulov, Dias Toleshbayev, Zhanar Zhakenova, Arman Khozhayev; J Prev Med Public Health. 2022;55(3):273-279. Published online April 14, 2022; DOI: https://doi.org/10.3961/jpmph.21.600

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Objectives
The aim of this study was to present the baseline results of a pilot project conducted to evaluate the effectiveness of lung cancer screening using low-dose chest computed tomography (CT) in regions with excessive radon levels in the Republic of Kazakhstan.
Methods
In total, 3671 participants were screened by low-dose chest CT. Current, former, and never-smokers who resided in regions with elevated levels of radon in drinking water sources and indoor air, aged between 40 and 75 with no history of any cancer, and weighing less than 140 kg were included in the study. All lung nodules were categorized according to the American College of Radiology Lung Imaging Reporting and Data System (Lung-RADS 1.0).
Results
Overall, 614 (16.7%) participants had positive baseline CT findings (Lung-RADS categories 3 and 4). Seventy-four cancers were detected, yielding an overall cancer detection rate of 2.0%, with 10.8% (8/74) stage I and a predominance of stage III (59.4%; 44/74). Women never-smokers and men current smokers had the highest cancer detection rates, at 2.9% (12/412) and 6.1% (12/196), respectively. Compared to never-smokers, higher odds ratios (ORs) of lung cancer detection were found in smokers (OR,2.48; 95% confidence interval [CI], 1.52 to 4.05, p<0.001) and former smokers (OR, 2.32; 95% CI, 1.06 to 5.06, p=0.003). The most common histologic type of cancer was adenocarcinoma (58.1%).
Conclusions
Implementation of low-dose CT screening for lung cancer in regions with elevated radon levels is an effective method for both smokers and never-smokers.

Summary

Citations

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Lung cancer screening for never smokers: current evidence and future directions
Kay Choong See
Singapore Medical Journal.2024;[Epub] CrossRef
Secondary prevention and treatment innovation of early stage non-small cell lung cancer: Impact on diagnostic-therapeutic pathway from a multidisciplinary perspective
Giulia Pasello, Daniela Scattolin, Laura Bonanno, Francesca Caumo, Andrea Dell'Amore, Elena Scagliori, Mariaenrica Tinè, Fiorella Calabrese, Gaetano Benati, Matteo Sepulcri, Cristina Baiocchi, Michele Milella, Federico Rea, Valentina Guarneri
Cancer Treatment Reviews.2023; 116: 102544. CrossRef
Performance of Lung-RADS in different target populations: a systematic review and meta-analysis
Yifei Mao, Jiali Cai, Marjolein A. Heuvelmans, Rozemarijn Vliegenthart, Harry J. M. Groen, Matthijs Oudkerk, Marleen Vonder, Monique D. Dorrius, Geertruida H. de Bock
European Radiology.2023; 34(3): 1877. CrossRef

Association Between Angiotensin II Receptor Blockers and the Risk of Lung Cancer Among Patients With Hypertension From the Korean National Health Insurance Service-National Health Screening Cohort: Sungji Moon, Hae-Young Lee, Jieun Jang, Sue K. Park; J Prev Med Public Health. 2020;53(6):476-486. Published online November 3, 2020; DOI: https://doi.org/10.3961/jpmph.20.405

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Abstract PDF Supplementary Material

Objectives
The objective of this study was to estimate the risk of lung cancer in relation to angiotensin II receptor blocker (ARB) use among patients with hypertension from the Korean National Health Insurance Service-National Health Screening Cohort. Methods: We conducted a retrospective cohort study of patients with hypertension who started to take antihypertensive medications and had a treatment period of at least 6 months. We calculated the weighted hazard ratios (HRs) and their 95% confidence intervals (CIs) of lung cancer associated with ARB use compared with calcium channel blocker (CCB) use using inverse probability treatment weighting. Results: Among a total of 60 469 subjects with a median follow-up time of 7.8 years, 476 cases of lung cancer were identified. ARB use had a protective effect on lung cancer compared with CCB use (HR, 0.75; 95% CI, 0.59 to 0.96). Consistent findings were found in analyses considering patients who changed or discontinued their medication (HR, 0.50; 95% CI, 0.32 to 0.77), as well as for women (HR, 0.56; 95% CI, 0.34 to 0.93), patients without chronic obstructive pulmonary disease (HR, 0.75; 95% CI, 0.56 to 1.00), never-smokers (HR, 0.64; 95% CI, 0.42 to 0.99), and non-drinkers (HR, 0.69; 95% CI, 0.49 to 0.97). In analyses with different comparison antihypertensive medications, the overall protective effects of ARBs on lung cancer risk remained consistent. Conclusions: The results of the present study suggest that ARBs could decrease the risk of lung cancer. More evidence is needed to establish the causal effect of ARBs on the incidence of lung cancer.

Summary

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Ayako Maeda-Minami, Masayuki Takagi, Yasunari Mano, Hideki Ishikawa, Yutaka Matsuyama, Michihiro Mutoh
Cancer Prevention Research.2023; 16(1): 37. CrossRef
Angiotensin Receptor Blocker Associated with a Decreased Risk of Lung Cancer: An Updated Meta-Analysis
Zexu Wang, Lingyun Wei, Cheng Yin, Wang Li, Bing Wan
Journal of Personalized Medicine.2023; 13(2): 243. CrossRef
The association between angiotensin receptor blockers and lung, bladder, and colon cancer development: A 10-year multicentric retrospective Lebanese study
Yara G. Dagher, Sandra El Helou, Karen G. Haifa, Issam G. Chalhoub, Rita T. Boulos, Bachir Atallah, Fadi Nasr, Issam Kassab, Mirna N. Chahine
Medicine.2023; 102(36): e34901. CrossRef
Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers and Cancer Risk: An Updated Meta-Analysis of Observational Studies
Kayeong Shin, Jiwoo Yang, Yeuni Yu, Eunjeong Son, Kihun Kim, Yun Hak Kim
SSRN Electronic Journal .2022;[Epub] CrossRef
The Effect of Local Renin Angiotensin System in the Common Types of Cancer
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Frontiers in Endocrinology.2021;[Epub] CrossRef

Brief Report

Estimating the Survival of Patients With Lung Cancer: What Is the Best Statistical Model?: Siavosh Abedi, Ghasem Janbabaei, Mahdi Afshari, Mahmood Moosazadeh, Masoumeh Rashidi Alashti, Akbar Hedayatizadeh-Omran, Reza Alizadeh-Navaei, Ehsan Abedini; J Prev Med Public Health. 2019;52(2):140-144. Published online February 18, 2019; DOI: https://doi.org/10.3961/jpmph.17.090

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Abstract PDF

Objectives
Investigating the survival of patients with cancer is vitally necessary for controlling the disease and for assessing treatment methods. This study aimed to compare various statistical models of survival and to determine the survival rate and its related factors among patients suffering from lung cancer.
Methods
In this retrospective cohort, the cumulative survival rate, median survival time, and factors associated with the survival of lung cancer patients were estimated using Cox, Weibull, exponential, and Gompertz regression models. Kaplan-Meier tables and the log-rank test were also used to analyze the survival of patients in different subgroups.
Results
Of 102 patients with lung cancer, 74.5% were male. During the follow-up period, 80.4% died. The incidence rate of death among patients was estimated as 3.9 (95% confidence [CI], 3.1 to 4.8) per 100 person-months. The 5-year survival rate for all patients, males, females, patients with non-small cell lung carcinoma (NSCLC), and patients with small cell lung carcinoma (SCLC) was 17%, 13%, 29%, 21%, and 0%, respectively. The median survival time for all patients, males, females, those with NSCLC, and those with SCLC was 12.7 months, 12.0 months, 16.0 months, 16.0 months, and 6.0 months, respectively. Multivariate analyses indicated that the hazard ratios (95% CIs) for male sex, age, and SCLC were 0.56 (0.33 to 0.93), 1.03 (1.01 to 1.05), and 2.91 (1.71 to 4.95), respectively.
Conclusions
Our results showed that the exponential model was the most precise. This model identified age, sex, and type of cancer as factors that predicted survival in patients with lung cancer.

Summary

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Marek Tradecki, Jolanta Ziółkowska, Roma Roemer-Ślimak, Grzegorz Mazur, Aleksandra Butrym
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Review

Hormonal Replacement Therapy and the Risk of Lung Cancer in Women: An Adaptive Meta-analysis of Cohort Studies: Jong-Myon Bae, Eun Hee Kim; J Prev Med Public Health. 2015;48(6):280-286. Published online November 9, 2015; DOI: https://doi.org/10.3961/jpmph.15.054

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Abstract PDF

Objectives
Approximately 10% to 15% of lung cancer cases occur in never-smokers. Hormonal factors have been suggested to lead to an elevated risk of lung cancer in women. This systematic review (SR) aimed to investigate the association between hormonal replacement therapy (HRT) and the risk of lung cancer in women using cohort studies.
Methods
We first obtained previous SR articles on this topic. Based on these studies we made a list of refereed, cited, and related articles using the PubMed and Scopus databases. All cohort studies that evaluated the relative risk of HRT exposure on lung cancer occurrence in women were selected. Estimate of summary effect size (sES) with 95% confidence intervals (CIs) were calculated.
Results
A total of 14 cohort studies were finally selected. A random effect model was applied due to heterogeneity (I-squared, 64.3%). The sES of the 14 articles evaluating the impact of HRT exposure on lung cancer occurrence in women indicated no statistically significant increase in lung cancer risk (sES, 0.99; 95% CI, 0.90 to 1.09).
Conclusions
These results showed that HRT history had no effect on the risk of lung cancer in women, even though the sES of case-control studies described in previous SR articles indicated that HRT had a protective effect against lung cancer. It is necessary to conduct a pooled analysis of cohort studies.

Summary

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Multicenter Study

Cigarette Smoking, Alcohol Consumption, Tuberculosis and Risk of Lung Cancer: The Korean Multi-center Cancer Cohort Study.: Jisuk Bae, Jin Gwack, Sue Kyung Park, Hai Rim Shin, Soung Hoon Chang, Keun Young Yoo; J Prev Med Public Health. 2007;40(4):321-328.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.321

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Abstract PDF

OBJECTIVES
The aim of this study was to evaluate the roles of cigarette smoking, alcohol consumption, tuberculosis, and their interactions in the risk of lung cancer in a Korean cohort. METHODS: The study subjects comprised 13,150 males and females aged above 20 years old. During the follow up period from 1993 to 2002, 79 lung cancer cases were identified by the central cancer registry and the national death certificate database. Information on cigarette smoking, alcohol consumption and the history of physiciandiagnosed tuberculosis was obtained by interview. Indirect chest X-ray findings were also evaluated to ascertain tuberculosis cases. Cox proportional hazard models were used to estimate relative risks (RR) and 95% confidence intervals (CI) after adjusting for age and gender. RESULTS: Cigarette smoking was statistically significantly associated with an increased risk of lung cancer [for current smokers, RR = 2.33 (95% CI = 1.23 - 4.42) compared to non-smokers]. After further adjustment for cigarette smoking, both alcohol consumption and tuberculosis showed no statistically significant association with the risk of lung cancer [for current drinkers, RR = 0.80 (95% CI = 0.48 - 1.33) compared to non-drinkers] [for tuberculosis cases, RR = 1.17 (95% CI = 0.58 - 2.36) compared to noncases]. There was no statistically significant interaction between cigarette smoking and alcohol consumption (pinteraction = 0.38), or cigarette smoking and tuberculosis (p-interaction = 0.74). CONCLUSIONS: Although cigarette smoking was confirmed as a risk factor of lung cancer in this cohort study, this study suggests that alcohol consumption and tuberculosis may not be associated with the risk of lung cancer.

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English Abstract

Spatial Analysis of Air Pollution and Lung Cancer Incidence and Mortality in 7 Metropolitan Cities in Korea. .: Seung Sik Hwang, Jin Hee Lee, Gyu Won Jung, Jeong Hun Lim, Ho Jang Kwon; J Prev Med Public Health. 2007;40(3):233-238.; DOI: https://doi.org/10.3961/jpmph.2007.40.3.233

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Abstract PDF

OBJECTIVES
We aimed to assess the relationship between long-term exposure to air pollution and lung cancer in the Republic of Korea. METHODS: Using the Annual Report of Ambient Air Quality in Korea, Annual Report of National Cancer Registration, and Annual Report on the Cause of Death Statistics, we calculated the standardized mortality ratio (SMR) and standardized incidence ratio (SIR) of lung cancer for both sexes in 74 areas from 7 Korean metropolitan cities. We performed random intercept, Poisson regression using empirical Bayes method. RESULTS: Both SMRs and SIRs in the 7 metropolitan cities were higher in women than in men. Mean SIRs were 99.0 for males and 107.0 for females. The association between PM(10) and lung cancer risk differed according to gender. PM(10) was not associated with the risk of lung cancer in males, but both incidence and mortality of lung cancer were positively associated with PM(10) in females. The estimated percentage increases in the rate of female lung cancer mortality and incidence were 27% and 65% at the highest PM(10) category (> or = 70 microgram/m(3)), compared to the referent category (<50 microgram/m(3)). CONCLUSIONS: Long-term exposure to PM(10) was significantly associated with female lung cancer incidence in 7 Korean metropolitan cities. Further study is undergoing to estimate the relative risk of PM(10) using multi-level analysis for controlling individual and regional confounders such as smoking and socioeconomic position.

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