Update in Lung Cancer and Mesothelioma 2012

Abstract

Lung cancer remains the number one cause of cancer-related death in the United States among both men and women. It is estimated that in 2013, there will be more than 200,000 new diagnoses of lung cancer and nearly 160,000 deaths (1). Despite the discovery and application of targeted therapies, the overall survival (OS) remains poor, with an overall 5-year survival approximating 16%. In addition, there are a growing number of cases among former smokers and never smokers. However, based on research advances in 2012, there is enthusiasm that improvements in early detection, coupled with tobacco cessation and the application of novel genetic and genomics technologies, will lead to improved outcomes. EPIDEMIOLOGYAlthough more than 85% of patients diagnosed with lung cancer will have smoked at some point in their lives, only 15 to 20% of smokers will develop lung cancer, thus suggesting the involvement of additional risk factors. Studies examining the roles of various exposures, including asbestos, welding, arsenic, and concomitant lung diseases, such as chronic obstructive pulmonary disease (COPD), tuberculosis, and pneumonia, as risk factors independent of tobacco consumption are ongoing (2, 3). A recent large epidemiological study in more than 2,000 incident cases of lung cancer cases and control subjects identified a 36% increase in lung cancer risk among welders and flame cutters. Interestingly, welding fumes were an independent risk factor for lung cancer (4). DisparitiesA recent examination of multiple registries confirmed that African Americans have the highest incidence of lung cancer (73/100,000) (5) and have a decreased OS and lower rates of surgical resection. Factors contributing to the disparities in lung cancer include inequities in access to health care, differing perceptions regarding early detection, smoking cessation and treatment, and variation in susceptibilities to the effects of cigarette smoke (6, 7). Conversely, the incidence rates for lung cancer among Hispanic men are much lower, and OS is better than in non-Hispanic whites. The explanations for these differences include a combination of decreased smoking rates among Hispanics, potential genetic variants (8), and histological distribution. Saeed and colleagues conducted a systematic analysis of the SEER database and determined that Hispanics had a higher rate of less aggressive histological subtypes of lung cancer (adenocarcinoma in situ and lepidic predominant adenocarcinoma) (9). Investigation of these areas should help to narrow the lung cancer outcomes gap that exists between ethnic groups.

An Official American Thoracic Society/European Respiratory Society Statement: The Role of the Pulmonologist in the Diagnosis and Management of Lung Cancer

“…Pulmonologists see patients at risk for developing lung cancer that may benefit from an effective screening program. The increased use of detailed CT imaging has led to the increased identification of lung nodules, and this prevalence will increase in the era of CT-based screening (9,10). Advances in the evaluation of lung nodules include the use of guided bronchoscopy procedures performed by the pulmonologist, such as electromagnetic navigation, endobronchial ultrasound, and virtual bronchoscopic navigation.…”

Immunohistochemical Expression and Serum Levels of CD44 as Prognostic Indicators in Patients with Non-Small Cell Lung Cancer

“…Despite the discovery and application of advanced therapies, the overall 5-year survival rate with lung cancer is only 16% [1,2] . It is often diagnosed as advanced disease because of its rapid growth and early tendency to spread to distant organs [3] .…”

Survival in surgical non-small cell lung cancer in a French Hospital

“…This study, including 1 562 patients undergoing thoracic surgery, shows that over last 25 years, adenocarcinoma became the most frequent lung cancer histological type, that the proportion of women and non-smokers diagnosed with lung cancer increased, and that more early stages (stage I) were treated by surgery [14][15][16][17][18][19]. We observed that, as a whole, patients undergoing surgery for lung cancer diagnosed since 2003, when PET, and AT began to be adopted in daily practice, had a better 1 year and 2 years survival than those diagnosed before.…”