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Histologic Types of Lung Carcinoma and Age at Onset.
Cancer Cytopathol. 85, 1958-1965 (1999)
BACKGROUND
Previous research has demonstrated that adenocarcinoma is the leading cell type among patients with early age onset lung carcinoma. An increase in adenocarcinoma at the expense of squamous cell carcinoma in general was observed in recent years and may be due to the smoking of filtered cigarettes.
METHODS
To rule out whether shifts in smoking patterns or other etiologic factors are responsible for the high rates of adenocarcinoma in young patients, personal interviews regarding smoking, occupation, and family history of cancer were conducted in 251 young patients (age ≤ 45 years) and 2009 older patients (ages 55–69 years) with histologically confirmed lung carcinoma from selected study clinics in Germany between 1990 and 1996.
RESULTS
Young male patients were found to have significantly more adenocarcinomas (41%) than older male patients (28%), whereas adenocarcinomas were dominant in young and older women (43% and 47%, respectively). Because smoking patterns were different between young and older patients, the authors stratified for comparable levels of smoking exposure. Histology did not differ in never smokers (dominance of adenocarcinomas in both age groups) and in male heavy smokers (dominance of squamous cell carcinomas in both age groups), whereas young male low dose smokers showed significantly more cases of adenocarcinoma than older low dose smokers. A family history of lung carcinoma was significantly higher in young patients compared with older patients, but no association with histologic type was observed.
CONCLUSIONS
The results of the current study show that differences in the histologic type of lung carcinoma based on age at onset can be explained in part by differences in smoking patterns. However, there still are unknown factors that appear to favor the development of adenocarcinoma in the young. Cancer 1999;85:1958–65. © 1999 American Cancer Society.
Carcinoma of the lung occurs most commonly in the sixth and seventh decades of life and is rarely found in young patients. Most studies over the past decades reported adenocarcinoma as the most frequent cell subtype among patients with early onset lung carcinoma of both genders,1–12 which is in contrast to squamous cell carcinoma as the most frequent type in older men.13 The predominance of adenocarcinoma in the young could reflect either a propensity of young individuals to develop this subtype or an increase in this subtype in recent years, which initially is reflected in younger cohorts. Some studies suggest that the reduction of tar yield and the introduction of filtered cigarettes in the 1960s could have favored the development of adenocarcinoma at the expense of squamous cell carcinoma.14, 15 Such shifts in the incidences of different histologic types of lung carcinoma have been found in the United States, where adenocarcinoma had become the most frequent subtype at the beginning of the 1980s.16–18 In Europe, squamous cell carcinoma still predominates in most countries. Levi and colleagues19 reported a remarkable rise in adenocarcinoma incidence in men and women from Switzerland, with rates of adenocarcinoma incidence among young adults in the early 1990s being more than three times higher than rates of squamous cell carcinoma.
Up to now, it is still inconclusive whether or not high rates of adenocarcinoma in young subjects are mainly attributable to shifts in smoking pattern or whether other still unknown factors are causal. In a previous analysis of a case–control study of lung carcinoma, we found smoking and a possible genetic predisposition as risk factors for lung carcinoma in young subjects (≤45 years).20 In addition, a high percentage of adenocarcinomas in this young group compared with older patients (55–69 years) was observed. The aim of the present analysis of these data is to further investigate the association between histologic type and age of onset of lung carcinoma. This study provides a large number of young and older lung carcinoma patients of both genders, a detailed quantification of life-long smoking and occupational exposure, and information on family history of cancer.
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Publikationstyp
Artikel: Journalartikel
Dokumenttyp
Wissenschaftlicher Artikel
Schlagwörter
lung carcinoma;smoking;histology;family
ISSN (print) / ISBN
1934-662X
e-ISSN
1097-0142
Zeitschrift
Cancer Cytopathology
Quellenangaben
Band: 85,
Heft: 9,
Seiten: 1958-1965
Verlag
Wiley
Nichtpatentliteratur
Publikationen
Begutachtungsstatus
Peer reviewed
Institut(e)
Institute of Epidemiology (EPI)