Vol 17, No 5 (2021)
Review paper
Published online: 2021-06-10

open access

Page views 6155
Article views/downloads 481
Get Citation

Connect on Social Media

Connect on Social Media

Lung cancer among women — identifying risk factors

Anna Trojnar1, Joanna Domagała-Kulawik1
Oncol Clin Pract 2021;17(5):222-228.

Abstract

The number of lung cancer cases estimates globally 2 million according to WHO, which represents approximately 11.6% of all cancers. The problem of lung diseases among women and women’s lung cancer is relatively not often discussed in the literature. There is evidence that there is a different distribution of histological types between sexes. The prevalence of adenocarcinoma (ADC) among women is observed for many years with an increasing tendency. This review focuses on the lung cancer risk factors such as tobacco smoking, second-hand smoke exposure, genetic and environmental factors, comorbidities and infectious agents. The declining tendency in smoking points to the necessity of focusing on other risk factors. Analysis of them within the context of morbidity and mortality can help to develop more effective screening programs.

Article available in PDF format

View PDF Download PDF file

References

  1. World Cancer Research Fund, Lung cancer statistics. https://www.wcrf.org/dietandcancer/cancer-trends/lung-cancer-statistics.
  2. WHO, International Agency for Research on Cancer (Globocan 2018) . https://gco.iarc.fr/today/data/factsheets/cancers/15-Lung-fact-sheet.pdf.
  3. Ditkowska J, Wojciechowska U, Olasek P. Cancer in Poland in 2017. Krajowy Rejestr Nowotworów 2017.
  4. Krzakowski M, Jassem J, Antczak A, et al. Cancer of the lung, pleura and mediastinum. Oncol Clin Pract. 2019; 15(1): 20–50.
  5. Wong MCS, Lao XQ, Ho KF, et al. Incidence and mortality of lung cancer: global trends and association with socioeconomic status. Sci Rep. 2017; 7(1): 14300.
  6. Lortet-Tieulent J, Soerjomataram I, Ferlay J, et al. International trends in lung cancer incidence by histological subtype: Adenocarcinoma stabilizing in men but still increasing in women. Lung Cancer. 2014; 84(1): 13–22.
  7. Sachs E, Sartipy U, Jackson V. Sex and Survival After Surgery for Lung Cancer: A Swedish Nationwide Cohort. Chest. 2021; 159(5): 2029–2039.
  8. Howlader N, Forjaz G, Mooradian MJ, et al. The Effect of Advances in Lung-Cancer Treatment on Population Mortality. N Engl J Med. 2020; 383(7): 640–649.
  9. Domagala-Kulawik J, Trojnar A. Lung cancer in women in 21th century. J Thorac Dis. 2020; 12(8): 4398–4410.
  10. Doll R, Hill AB. Smoking and carcinoma of the lung. Preliminary report. 1950. Bull World Health Organ. 1999; 77(1): 84–93.
  11. Akhtar N, Bansal JG. Risk factors of Lung Cancer in nonsmoker. Curr Probl Cancer. 2017; 41(5): 328–339.
  12. Wakelee HA, Chang ET, Gomez SL, et al. Lung cancer incidence in never smokers. J Clin Oncol. 2007; 25(5): 472–478.
  13. O'Keeffe LM, Taylor G, Huxley RR, et al. Smoking as a risk factor for lung cancer in women and men: a systematic review and meta-analysis. BMJ Open. 2018; 8(10): e021611.
  14. Thun MJ, Henley SJ, Burns D, et al. Lung cancer death rates in lifelong nonsmokers. J Natl Cancer Inst. 2006; 98(10): 691–699.
  15. WHO global report on trends in prevalence of tobacco use 2000-2025, Third edition. https://www.who.int/publications/i/item/who-global-report-on-trends-in-prevalence-of-tobacco-use-2000-2025-third-edition.
  16. WHO The Global Health Observatory, Age-standardized estimates of current tobacco use, tobacco smoking and cigarette smoking. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/gho-tobacco-control-monitor-current-tobaccouse-tobaccosmoking-cigarrettesmoking-agestd-tobagestdcurr.
  17. Pinkas J, Kaleta D, Zgliczyński WS, et al. The Prevalence of Tobacco and E-Cigarette Use in Poland: A 2019 Nationwide Cross-Sectional Survey. Int J Environ Res Public Health. 2019; 16(23).
  18. Kaisar MA, Prasad S, Liles T, et al. A decade of e-cigarettes: Limited research & unresolved safety concerns. Toxicology. 2016; 365: 67–75.
  19. Samet JM, Avila-Tang E, Boffetta P, et al. Lung cancer in never smokers: clinical epidemiology and environmental risk factors. Clin Cancer Res. 2009; 15(18): 5626–5645.
  20. Oberg M, Jaakkola MS, Woodward A, et al. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. 2011; 377(9760): 139–146.
  21. Toh CK, Gao F, Lim WT, et al. Never-smokers with lung cancer: epidemiologic evidence of a distinct disease entity. J Clin Oncol. 2006; 24(15): 2245–2251.
  22. Subramanian J, Velcheti V, Gao F, et al. Presentation and stage-specific outcomes of lifelong never-smokers with non-small cell lung cancer (NSCLC). J Thorac Oncol. 2007; 2(9): 827–830.
  23. Nordquist LT, Simon GR, Cantor A, et al. Improved survival in never-smokers vs current smokers with primary adenocarcinoma of the lung. Chest. 2004; 126(2): 347–351.
  24. Domagala-Kulawik J. New Frontiers for Molecular Pathology. Front Med (Lausanne). 2019; 6: 284.
  25. Barta JA, Powell CA, Wisnivesky JP. Global Epidemiology of Lung Cancer. Ann Glob Health. 2019; 85(1).
  26. Dearden S, Stevens J, Wu YL, et al. Mutation incidence and coincidence in non small-cell lung cancer: meta-analyses by ethnicity and histology (mutMap). Ann Oncol. 2013; 24(9): 2371–2376.
  27. Dogan S, Shen R, Ang DC, et al. Molecular epidemiology of EGFR and KRAS mutations in 3,026 lung adenocarcinomas: higher susceptibility of women to smoking-related KRAS-mutant cancers. Clin Cancer Res. 2012; 18(22): 6169–6177.
  28. Shi Y, Au JSK, Thongprasert S, et al. A prospective, molecular epidemiology study of EGFR mutations in Asian patients with advanced non-small-cell lung cancer of adenocarcinoma histology (PIONEER). J Thorac Oncol. 2014; 9(2): 154–162.
  29. Levy MA, Lovly CM, Pao W. Translating genomic information into clinical medicine: lung cancer as a paradigm. Genome Res. 2012; 22(11): 2101–2108.
  30. Fang B, Mehran RJ, Heymach JV, et al. Predictive biomarkers in precision medicine and drug development against lung cancer. Chin J Cancer. 2015; 34(7): 295–309.
  31. de Sousa VM, Carvalho L. Heterogeneity in Lung Cancer. Pathobiology. 2018; 85(1-2): 96–107.
  32. Timofeeva MN, Hung RJ, Rafnar T, et al. Transdisciplinary Research in Cancer of the Lung (TRICL) Research Team. Influence of common genetic variation on lung cancer risk: meta-analysis of 14 900 cases and 29 485 controls. Hum Mol Genet. 2012; 21(22): 4980–4995.
  33. Ji X, Mukherjee S, Landi MT, et al. Protein-altering germline mutations implicate novel genes related to lung cancer development. Nat Commun. 2020; 11(1): 2220.
  34. Gu J, Hua F, Zhong D, et al. [Systematic review of the relationship between family history of lung cancer and lung cancer risk]. Zhongguo Fei Ai Za Zhi. 2010; 13(3): 224–229.
  35. Gaughan EM, Cryer SK, Yeap BY, et al. Family history of lung cancer in never smokers with non-small-cell lung cancer and its association with tumors harboring EGFR mutations. Lung Cancer. 2013; 79(3): 193–197.
  36. Arakawa A, Ichikawa H, Kubo T, et al. Vaginal Transmission of Cancer from Mothers with Cervical Cancer to Infants. N Engl J Med. 2021; 384(1): 42–50.
  37. Rodriguez-Lara V, Hernandez-Martinez JM, Arrieta O. Influence of estrogen in non-small cell lung cancer and its clinical implications. J Thorac Dis. 2018; 10(1): 482–497.
  38. Hsu LH, Chu NM, Kao SH. Estrogen, Estrogen Receptor and Lung Cancer. Int J Mol Sci. 2017; 18(8): 1713.
  39. Smida T, Bruno TC, Stabile LP. Influence of Estrogen on the NSCLC Microenvironment: A Comprehensive Picture and Clinical Implications. Front Oncol. 2020; 10: 137.
  40. Almotlak AA, Farooqui M, Siegfried JM. Inhibiting Pathways Predicted From a Steroid Hormone Gene Signature Yields Synergistic Antitumor Effects in NSCLC. J Thorac Oncol. 2020; 15(1): 62–79.
  41. Kurmi OmP, Arya PH, Lam KBH, et al. Lung cancer risk and solid fuel smoke exposure: a systematic review and meta-analysis. Eur Respir J. 2012; 40(5): 1228–1237.
  42. Hamra GB, Guha N, Cohen A, et al. Outdoor particulate matter exposure and lung cancer: a systematic review and meta-analysis. Environ Health Perspect. 2014; 122(9): 906–911.
  43. Schraufnagel DE, Balmes JR, Cowl CT, et al. Air Pollution and Noncommunicable Diseases: A Review by the Forum of International Respiratory Societies' Environmental Committee, Part 2: Air Pollution and Organ Systems. Chest. 2019; 155(2): 417–426.
  44. Silverman DT. Diesel exhaust causes lung cancer: now what? Occup Environ Med. 2017; 74(4): 233–234.
  45. Benbrahim-Tallaa L, Baan R, Grosse Y, et al. Carcinogenicity of diesel-engine and gasoline-engine exhausts and some nitroarenes. Lancet Oncol. 2012; 13(7): 663–664.
  46. Katsouyanni K. Ambient air pollution and health. Br Med Bull. 2003; 68: 143–156.
  47. Xing DF, Xu CD, Liao XY, et al. Spatial association between outdoor air pollution and lung cancer incidence in China. BMC Public Health. 2019; 19(1): 1377.
  48. Li Na, Zhai Z, Zheng Yi, et al. Association of 13 Occupational Carcinogens in Patients With Cancer, Individually and Collectively, 1990-2017. JAMA Netw Open. 2021; 4(2): e2037530.
  49. Cheng E, Egger S, Hughes S, et al. Systematic review and meta-analysis of residential radon and lung cancer in never-smokers. European Respiratory Review. 2021; 30(159): 200230.
  50. Fakhri G, Al Assaad M, Tfayli A. Association of various dietary habits and risk of lung cancer: an updated comprehensive literature review. Tumori. 2020; 106(6): 445–456.
  51. Fortmann SP, Burda BU, Senger CA, et al. Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: An updated systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013; 159(12): 824–834.
  52. Nagasaka M, Lehman A, Chlebowski R, et al. COPD and lung cancer incidence in the Women's Health Initiative Observational Study: A brief report. Lung Cancer. 2020; 141: 78–81.
  53. Tyl M, Domagała-Kulawik J. Rak płuca i przewlekła obturacyjna choroba płuc – narastający problem kliniczny [Lung cancer and COPD - growing clinical problem]. Pol Merkur Lekarski. 2017; 43(253): 5–9.
  54. Gut-Gobert C, Cavaillès A, Dixmier A, et al. Women and COPD: do we need more evidence? Eur Respir Rev. 2019; 28(151).
  55. Watson L, Vestbo J, Postma DS, et al. Gender differences in the management and experience of Chronic Obstructive Pulmonary Disease. Respir Med. 2004; 98(12): 1207–1213.
  56. Kiri VA, Soriano J, Visick G, et al. Recent trends in lung cancer and its association with COPD: an analysis using the UK GP Research Database. Prim Care Respir J. 2010; 19(1): 57–61.
  57. Izquierdo JL, Resano P, El Hachem A, et al. Impact of COPD in patients with lung cancer and advanced disease treated with chemotherapy and/or tyrosine kinase inhibitors. Int J Chron Obstruct Pulmon Dis. 2014; 9: 1053–1058.
  58. Naccache JM, Gibiot Q, Monnet I, et al. Lung cancer and interstitial lung disease: a literature review. J Thorac Dis. 2018; 10(6): 3829–3844.
  59. Yu Y, Yang A, Hu S, et al. Correlation of HPV-16/18 infection of human papillomavirus with lung squamous cell carcinomas in Western China. Oncol Rep. 2009; 21(6): 1627–1632.
  60. Ragin C, Obikoya-Malomo M, Kim S, et al. HPV-associated lung cancers: an international pooled analysis. Carcinogenesis. 2014; 35(6): 1267–1275.
  61. Zhai K, Ding J, Shi HZ, et al. HPV and lung cancer risk: a meta-analysis. J Clin Virol. 2015; 63: 84–90.
  62. Sigel K, Pitts R, Crothers K. Lung Malignancies in HIV Infection. Semin Respir Crit Care Med. 2016; 37(2): 267–276.
  63. Worm SW, Bower M, Reiss P, et al. D:A:D Study Group. Non-AIDS defining cancers in the D:A:D Study--time trends and predictors of survival: a cohort study. BMC Infect Dis. 2013; 13: 471.
  64. Shebl FM, Engels EA, Goedert JJ, et al. Pulmonary infections and risk of lung cancer among persons with AIDS. J Acquir Immune Defic Syndr. 2010; 55(3): 375–379.
  65. Hessol NA, Martínez-Maza O, Levine AM, et al. Lung cancer incidence and survival among HIV-infected and uninfected women and men. AIDS. 2015; 29(10): 1183–1193.
  66. Sadhukhan P, Ugurlu MT, Hoque MO. Effect of COVID-19 on Lungs: Focusing on Prospective Malignant Phenotypes. Cancers (Basel). 2020; 12(12).
  67. Migliore M, Fornito M, Palazzolo M, et al. Ground glass opacities management in the lung cancer screening era. Ann Transl Med. 2018; 6(5): 90.
  68. Park CM, Goo JMo, Lee HJu, et al. Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up. Radiographics. 2007; 27(2): 391–408.
  69. Tay MZ, Poh CM, Rénia L, et al. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol. 2020; 20(6): 363–374.
  70. Wang L, Cao L, Wang H, et al. Cancer-associated fibroblasts enhance metastatic potential of lung cancer cells through IL-6/STAT3 signaling pathway. Oncotarget. 2017; 8(44): 76116–76128.
  71. Peckham H, de Gruijter NM, Raine C, et al. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nat Commun. 2020; 11(1): 6317.