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Rol asbest in het milieu bij niet-rokers met longkanker onduidelijk

21-03-2007 00:00

De invloed van blootstelling aan asbest in het milieu op het risico op longkanker bij mensen die nooit gerookt hebben is onduidelijk. Longkanker heeft bij mensen die nooit gerookt hebben andere moleculaire en biologische kenmerken dan bij rokers. Twee recente overzichtsstudies beschrijven dat niet-rokende vrouwen vaker longkanker krijgen dan niet-rokende mannen: tussen de 15 en 25% van de vrouwelijke longkankerpatiënten heeft nooit gerookt, bij mannelijke longkankerpatiënten is dat tussen de 5 en 10%. Bron: Wakelee H.A. et al. (2007). Lung cancer incidence in never smokers. Journal of Clinical Oncology, Feb 10.25(5):469-71. Subramanian, J. & Govindan, R. (2007). Lung cancer in never smokers: a review. Journal of Clinical Oncology feb 10. 25(5), 561-70.
Wakelee H.A., Chang ET, Gomez SL, Keegan TH, Feskanich D, Clarke CA, Holmberg L, Yong LC, Kolonel LN, Gould MK, West DW (2007). Lung cancer incidence in never smokers. Journal of Clinical Oncology, Feb 10.25(5):469-71.

ABSTRACT

PURPOSE:
Lung cancer is a leading cause of cancer death worldwide. Although smoking remains the predominant cause of lung cancer, lung cancer in never smokers is an increasingly prominent public health issue. However, data on this topic, particularly lung cancer incidence rates in never smokers, are limited. METHODS: We reviewed the existing literature on lung cancer incidence and mortality rates among never smokers and present new data regarding rates in never smokers from the following large, prospective cohorts: Nurses' Health Study. Health Professionals Follow-Up Study. California Teachers Study. Multiethnic Cohort Study. Swedish Lung Cancer Register in the Uppsala/Orebro region. and First National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study. RESULTS: Truncated age-adjusted incidence rates of lung cancer among never smokers age 40 to 79 years in these six cohorts ranged from 14.4 to 20.8 per 100,000 person-years in women and 4.8 to 13.7 per 100,000 person-years in men, supporting earlier observations that women are more likely than men to have non-smoking-associated lung cancer. The distinct biology of lung cancer in never smokers is apparent in differential responses to epidermal growth factor receptor inhibitors and an increased prevalence of adenocarcinoma histology in never smokers. CONCLUSION: Lung cancer in never smokers is an important public health issue, and further exploration of its incidence patterns, etiology, and biology is needed.



Subramanian, J. & Govindan, R. (2007). Lung cancer in never smokers: a review. Journal of Clinical Oncology feb 10. 25(5), 561-70.

ABSTRACT


Lung cancer is the leading cause of cancer-related death in the United States. Although tobacco smoking accounts for the majority of lung cancer, approximately 10% of patients with lung cancer in the United States are lifelong never smokers. Lung cancer in the never smokers (LCINS) affects women disproportionately more often than men. Only limited data are available on the etiopathogenesis, molecular abnormalities, and prognosis of LCINS. Several etiologic factors have been proposed for the development of LCINS, including exposure to radon, cooking fumes, asbestos, heavy metals, and environmental tobacco smoke, human papillomavirus infection, and inherited genetic susceptibility. However, the relative significance of these individual factors among different ethnic populations in the development of LCINS has not been well-characterized. Adenocarcinoma is the predominant histologic subtype reported with LCINS. Striking differences in response rates and outcomes are seen when patients with advanced non-small-cell lung cancer (NSCLC) who are lifelong never smokers are treated with epidermal growth factor receptor tyrosine kinase (EGFR-TK) inhibitors such as gefitinib or erlotinib compared with the outcomes with these agents in patients with tobacco-associated lung cancer. Interestingly, the activating mutations in the EGFR-TK inhibitors have been reported significantly more frequently in LCINS than in patients with tobacco-related NSCLC. This review will summarize available data on the epidemiology, risk factors, molecular genetics, management options, and outcomes of LCINS.