Lung cancer risk factors

89% (91% in males and 87% in females) of lung cancer cases each year in the UK are linked to major lifestyle and other risk factors.[1]

Lung cancer is associated with a number of risk factors.[2,3]

Lung Cancer Risk Factors

Increases risk ('sufficient' or 'convincing' evidence) May increase risk ('limited' or 'probable' evidence) Decreases risk ('sufficient' or 'convincing' evidence) May decrease risk ('limited' or 'probable' evidence)
  • Production of aluminum, iron and steel
  • Arsenic and inorganic arsenic compoundsa
  • Asbestos (all forms)
  • Beryllium (and compounds)
  • Bis(chloromethyl)ether; chloromethyl methyl ether (technical grade)
  • Cadmium (and compounds)
  • Chromium (VI) compounds
  • Household coal combustion emissions
  • Production of coal/coke
  • Coal-tar pitch
  • Diesel engine exhaust
  • Hematite mining
  • MOPP (vincristine-prednisone-nitrogen mustard-procarbazine mixture)
  • Nickel compounds
  • Outdoor air pollution (and particulate matter within)
  • Painting
  • Plutonium
  • Radon-222 and its decay products
  • Production of rubber
  • Crystalline silica dust
  • Soot
  • Sulphur mustard
  • Environmental tobacco smoke
  • Tobacco smoking
  • X-radiation, gamma-radiation
  • Beta-carotene supplements (high dose, in smokers)
  • Strong inorganic acid mists
  • Production of art glass, glass containers and pressed ware
  • Household biomass fuel (primarily wood), combustion emissions
  • Working as a roofer (due to oxidized bitumens exposure)
  • Working with mastic asphalt (due to hard bitumens exposure)
  • Manufacture of carbon electrodes
  • alpha-Chlorinated toluenes with benzoyl chloride
  • Cobalt metal with tungsten carbide
  • Creosotes
  • Emissions from high-temperature frying
  • Working as a non-arsenical insecticides sprayer
  • Printing processes
  • 2,3,7,8-Tetrachlorodibenzopara-dioxin
  • Welding fumes
-
  • Fruits (not salted or pickled)
  • Dietary carotenoids

International Agency for Research on Cancer (IARC) and The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classifications.

a WCRF/AICR classifies arsenic in drinking water as a cause of lung cancer.

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Tobacco smoking and environmental tobacco smoke are classified by the International Agency for Research on Cancer (IARC) as causes of lung cancer.[1] An estimated 86% of lung cancers in the UK are linked to tobacco smoking - 83% due to active smoking, and 3% due to environmental tobacco smoke exposure in non-smokers.[2] An estimated 86% of lung cancer deaths in the UK are causes by tobacco smoking.[3]

Around 1 in 5 UK adults currently smoke cigarettes.

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Lung cancer death risk is around 15 times higher in current smokers compared with never-smokers, a cohort study of British males showed.[1]

Lung cancer risk increases with both smoking duration and amount,[1] but duration has the most effect on risk: smoking one pack of cigarettes a day for 40 years is more hazardous than smoking two packs a day for 20 years.[2-4] Lung cancer risk in smokers is higher in those who start smoking at a younger age.[5-7] Lung cancer death risk is 37% higher per five years younger at smoking initiation, a cohort study of women showed.[8]

Lung cancer risk is around 26 times higher in men who smoke 15-24 cigarettes per day, compared with never-smokers, a cohort study showed.[9] Lung cancer death risk is around 5 times higher in smokers of 1-4 cigarettes per day,[10] around 12 times higher in smokers of 8-12 cigarettes per day; at least 24 times higher in smokers of 25+ cigarettes per day;[1,11] and 39 times higher in smokers of 42+ cigarettes per day,[11] all compared with never-smokers, cohort studies (some including only women or middle-aged people) have shown.

Smoking is more strongly linked with risk of small cell lung cancer and squamous cell carcinoma (SCC) than other lung cancer types, meta- and pooled analyses have shown.[12,13]

References

  1. Doll R, Peto R, Boreham J, et al. Mortality from cancer in relation to smoking: 50 years observations on British doctors. Br J Cancer 2005;92(3):426-29.
  2. Cancer Research UK Statistical Information Team. Calculated using formula in Doll R, Peto R. Cigarette smoking and bronchial carcinoma: dose and time relationships among regular smokers and lifelong non-smokers. J Epidemiol Community Health 1978;32(4):303-13.
  3. Lubin JH, Caporaso NE. Cigarette Smoking and Lung Cancer: Modeling Total Exposure and Intensity. Cancer Epidem Biomar 2006;15(3):517-23.
  4. Flanders WD, Lally CA, Zhu B-P, et al. Lung Cancer Mortality in Relation to Age, Duration of Smoking, and Daily Cigarette Consumption: Results from Cancer Prevention Study II. Cancer Res 2003;63(19):6556-62.
  5. Wiencke JK, Thurston SW, Kelsey KT, et al. Early Age at Smoking Initiation and Tobacco Carcinogen DNA Damage in the Lung. J Natl Cancer I 1999;91(7):614-19.
  6. Peto R, Darby S, Deo H, et al. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. BMJ 2000;321(7257):323-29.
  7. Pirie K, Peto R, Reeves GK, et al. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet 2012.
  8. Kenfield SA, Wei EK, Rosner BA, et al. Burden of smoking on cause-specific mortality: application to the Nurses' Health Study. Tob Control 2010;19(3):248-54.
  9. Darby S, Hill D, Auvinen A, et al. Radon in homes and risk of lung cancer: collaborative analysis of individual data from 13 European case-control studies. BMJ 2005;330(7485):223.
  10. Bjartveit K, Tverdal A. Health consequences of smoking 1–4 cigarettes per day. Tob Control 2005;14(5):315-20.
  11. Pope CA, Burnett RT, Turner MC, et al. Lung cancer and cardiovascular disease mortality associated with ambient air pollution and cigarette smoke: shape of the exposure-response relationships. Environ Health Persp 2011;119(11):1616-21.
  12. Khuder SA. Effect of cigarette smoking on major histological types of lung cancer: a meta-analysis. Lung Cancer 2001; 31(2-3):139-48.
  13. Pesch B, Kendzia B, Gustavsson P, et al. Cigarette smoking and lung cancer--relative risk estimates for the major histological types from a pooled analysis of case-control studies. Int J Cancer 2012; 131(5):1210-9.
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Smoking cessation has very significant health benefits, including improved life expectancy, compared with continued smokers - even for long-term smokers, older smokers,[1-3] and smokers who quit after lung cancer diagnosis.[4]

Giving up smoking in middle age avoids most of the subsequent risk of lung cancer, cohort studies from around the world show.[1,5-7] In men, 15.9% of those who smoke all their lives die from lung cancer by age 75, compared with 9.9% of those who stop smoking by age 60, 6% of those who stop by age 50, 3% of those who stop by age 40, and 1.7% of those who stop by age 30.[1] In women, 9.5% of those who smoke all their lives die from lung cancer by age 75, compared with 5.3% of those who stop smoking by age 60, and 2.2% of those who stop by age 50.[1]

Reducing cigarette intake rather than stopping may not be as beneficial: lung cancer risk is similar in heavy smokers (around 16-18 cigarettes per day) who halve their intake, compared with sustained heavy smokers.[8]

References

  1. Peto R, Darby S, Deo H, et al. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. BMJ 2000;321(7257):323-29.
  2. Pirie K, Peto R, Reeves GK, et al. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet 2012.
  3. Gellert C, Schöttker B, Brenner H. Smoking and all-cause mortality in older people: Systematic review and meta-analysis. Arch Int Med 2012;172(11):837-44.
  4. Parsons A, Daley A, Begh R, et al. Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis. BMJ 2010;340.
  5. Crispo A, Brennan P, Jockel KH, et al. The cumulative risk of lung cancer among current, ex- and never-smokers in European men. Br J Cancer 2004;91(7):1280-86.
  6. Brennan P, Crispo A, Zaridze D, et al. High Cumulative Risk of Lung Cancer Death among Smokers and Nonsmokers in Central and Eastern Europe. Am J Epidemiol 2006;164(12):1233-41.
  7. Halpern MT, Gillespie BW, Warner KE. Patterns of Absolute Risk of Lung Cancer Mortality in Former Smokers. J Natl Cancer I 1993;85(6):457-64.
  8. Tverdal A, Bjartveit K. Health consequences of reduced daily cigarette consumption. Tob Control 2006;15(6):472-80.
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Environmental tobacco smoke (ETS, also called second-hand smoke) is classified by the International Agency for Research on Cancer (IARC) as a cause of lung cancer.[1] An estimated 15% of lung cancer cases in never-smokers in the UK are linked to ETS.[2]

Lung cancer risk in non-smokers is around a quarter higher in those exposed to ETS at home or at work, compared with those not exposed to ETS, meta-analyses have shown.[3,4] Lung cancer risk in non-smokers is doubled in those with the highest workplace ETS exposure levels, versus those not exposed to ETS, a meta-analysis showed.[4]

Small cell lung cancer risk in never-smokers is tripled in those exposed to ETS, compared with those not exposed to ETS, a pooled analysis showed; non-small cell lung cancer risk is increased to a lesser degree (28%).[5]

Lung cancer risk is probably not associated with ETS exposure in childhood, a meta-analysis and large cohort study have shown.[6,7]

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Lung cancer risk may be associated with cannabis use, but evidence is unclear.[1,2] Residual confounding by tobacco is likely.

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Radon is classified by the International Agency for Research on Cancer (IARC) as a cause of lung cancer.[1] An estimated 0.5% of lung cancers in the UK are linked to radon (home rather than occupational exposure) alone, though 3% of lung cancers in the UK are linked to radon and smoking in combination.[2] An estimated 9% of lung cancer deaths in Europe are linked to indoor radon exposure.[3]

Lung cancer risk is 16% higher per 100 becquerel/cubic metre (Bq/m3) increment in usual home radon level, a pooled analysis showed.[3] The average UK home usually contains 20 Bq/m3.[4] The effect of radon exposure on lung cancer risk does not appear to differ between smokers and non-smokers.[3,5] But because smokers’ underlying risk of lung cancer is already much higher, smokers exposed to radon have much higher lung cancer risks than do non-smokers exposed to radon.[3]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. J Natl Cancer I 2011;103(24):1827-39.
  2. Parkin DM, Darby SC. 12. Cancers in 2010 attributable to ionising radiation exposure in the UK. Br J Cancer 2011;105(S2):S57-S65.
  3. Darby S, Hill D, Auvinen A, et al. Radon in homes and risk of lung cancer: collaborative analysis of individual data from 13 European case-control studies. BMJ 2005;330(7485):223.
  4. Health Protection Agency (HPA). UK Radon. Newsletters and Reports. Accessed December 2012.
  5. Bräuner EV, Andersen CE, Sørensen M, et al. Residential radon and lung cancer incidence in a Danish cohort. Environ Res 2012;118:130-6.
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X radiation and gamma radiation are classified by the International Agency for Research on Cancer (IARC) as causes of lung cancer.[1] An estimated 0.8% of lung cancers in the UK are linked to radiotherapy, 0.3% to diagnostic radiation, and 0.2% to natural background radiation.[2]

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A number of occupational exposures are classified by the International Agency for Research on Cancer (IARC) as causes of lung cancer.[1] An estimated 21% of lung cancers in men in the UK, and 4-5% in women in the UK, are linked to occupational exposures.[1,2]

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Asbestos exposure is classified by the International Agency for Research on Cancer (IARC) as a cause of lung cancer.[1] An estimated 6-8% of lung cancer deaths in the UK each year are linked to asbestos exposure.[2,3]

Lung cancer mortality is 77% higher in asbestos-exposed workers, compared with the general population, a meta-analysis showed.[3] Lung cancer mortality is 19-26 times higher in asbestos-exposed current smokers, compared with asbestos-exposed never-smokers, a cohort study showed.[4-7]

This reflects the higher risk of lung cancer death in current smokers compared with never-smokers, but indicates that smoking and asbestos have a synergistic (combination effect stronger than sum of independent effects) effect on lung cancer development.[4-7] Age at asbestos exposure may modify the risk, but evidence is unclear, a systematic review showed.[8]

Asbestos exposure in the UK (typically in construction and shipyard workers[9]) peaked around 1963 and decreased rapidly thereafter, it is estimated.[10] Asbestos is thought to cause as many lung cancer cases as mesothelioma cases, because lung cancer is much more common than mesothelioma.[2,3]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. J Natl Cancer I 2011;103(24):1827-39.
  2. Brown T, Darnton A, Fortunato L, et al. Occupational cancer in Britain: Respiratory cancer sites: larynx, lung and mesothelioma. Br J Cancer 2012;107(S1):S56-S70.
  3. McCormack V, Peto J, Byrnes G, et al. Estimating the asbestos-related lung cancer burden from mesothelioma mortality. Br J Cancer 2012;106(3):575-84.
  4. Frost G, Darnton A, Harding A-H. The Effect of Smoking on the Risk of Lung Cancer Mortality for Asbestos Workers in Great Britain (1971–2005). Ann Occup Hyg 2011;55(3):239-47.
  5. International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 83 (2004): Tobacco Smoke and Involuntary Smoking. France: IARC, 2004.
  6. Erren TC, Jacobsen M, Piekarski C. Synergy between asbestos and smoking on lung cancer risks. Epidemiology 1999;10(4):405-11.
  7. Lee PN. Relation between exposure to asbestos and smoking jointly and the risk of lung cancer. Occup Environ Med 2001;58(3):145-53.
  8. Kang D, Myung MS, Kim YK, et al. Systematic Review of the Effects of Asbestos Exposure on the Risk of Cancer between Children and Adults. Ann Occup Environ Med 2013;25(1):10.
  9. Rake C, Gilham C, Hatch J, et al. Occupational, domestic and environmental mesothelioma risks in the British population: a case-control study. Br J Cancer 2009;100(7):1175-83.
  10. Tan E, Warren N, Darnton AJ, et al. Projection of mesothelioma mortality in Britain using Bayesian methods. Br J Cancer 2010;103(3):430-36.
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Silica dust exposure is classified by the International Agency for Research on Cancer (IARC) as a cause of lung cancer.[1] An estimated 0.02% of lung cancers in Britain are linked to silica (typically in glass manufacture).[2]

Lung cancer risk is 55% higher in men who have ever worked as bricklayers, compared with men who have never done so, a pooled analysis showed; this is probably due to silica exposure.[3]

Lung cancer risk is higher in people exposed to silica probably because it causes silicosis: it is not probably not associated with lung cancer risk in people without silicosis.[4,5]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. J Natl Cancer I 2011;103(24):1827-39.
  2. Brown T, Darnton A, Fortunato L, et al. Occupational cancer in Britain: Respiratory cancer sites: larynx, lung and mesothelioma. Br J Cancer 2012;107(S1):S56-S70.
  3. Consonni D, De Matteis S, Pesatori AC, et al. Lung cancer risk among bricklayers in a pooled analysis of case-control studies. Int J Cancer 2015;136(2):360-71.
  4. Pelucchi C, Pira E, Piolatto G, et al. Occupational silica exposure and lung cancer risk: a review of epidemiological studies 1996–2005. Ann Oncol 2006;17(7):1039-50.
  5. Erren TC, Morfeld P, Glende CB, et al. Meta-analyses of published epidemiological studies, 1979-2006, point to open causal questions in silica-silicosis-lung cancer research. Med Lav 2011;102(4):321-35.
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Diesel engine exhaust exposure is classified by the International Agency for Research on Cancer (IARC) as a cause of lung cancer.[1] An estimated 0.02% of lung cancers in Britain are linked to occupational exposure to diesel engine exhaust.[2]

Lung cancer risk is 19-47% higher in professional drivers compared with the general population, meta-analyses have shown;[3,4] however, the evidence does not allow a dose-response relationship to be established.[5] Lung cancer risk associated with diesel exhaust exposure varies markedly by occupation group; most evidence comes from highly-exposed workers including drivers and mechanics.[2,3,6]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. J Natl Cancer I 2011;103(24):1827-39.
  2. Brown T, Darnton A, Fortunato L, et al. Occupational cancer in Britain: Respiratory cancer sites: larynx, lung and mesothelioma. Br J Cancer 2012;107(S1):S56-S70.
  3. Lipsett M, Campleman S. Occupational exposure to diesel exhaust and lung cancer: a meta-analysis. Am J Public Health. 1999 Jul;89(7):1009-17.
  4. Tsoi CT, Tse LA. Professional drivers and lung cancer: a systematic review and meta-analysis. Occup Environ Med 2012.
  5. Sun Y, Bochmann F, Nold A, et al. Diesel exhaust exposure and the risk of lung cancer-a review of the epidemiological evidence. Int J Environ Res Public Health 2014;11(2):1312-40.
  6. International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 105: Diesel and gasoline engine exhausts and some nitroarenes. France: IARC, 2012.
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Working as a painter is classified by the International Agency for Research on Cancer (IARC) as a cause of lung cancer.[1] An estimated 0.01% of lung cancers in Britain are linked to working as a painter.[2]

Lung cancer risk is 22-57% higher in painters compared with the general population, meta-analyses have shown.[3-5] This may be linked with solvent exposure.

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. J Natl Cancer I 2011;103(24):1827-39.
  2. Brown T, Darnton A, Fortunato L, et al. Occupational cancer in Britain: Respiratory cancer sites: larynx, lung and mesothelioma. Br J Cancer 2012;107(S1):S56-S70.
  3. Bachand A, Mundt KA, Mundt DJ, et al. Meta-analyses of occupational exposure as a painter and lung and bladder cancer morbidity and mortality 1950–2008. Crit Rev Toxicol 2010;40(2):101-25.
  4. Guha N, Merletti F, Steenland NK, et al. Lung cancer risk in painters: a meta-analysis. Ciência Saúde Coletiva 2011;16:3613-32.
  5. Chen R, Seaton A. A meta-analysis of painting exposure and cancer mortality. Cancer Detect Prev 1998;22(6):533-39.
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TCDD is classified by the International Agency for Research on Cancer (IARC) as a probable cause of lung cancer, based on limited evidence.[1] An estimated 0.01% of lung cancers in Britain are linked to TCDD (typically in metal and pesticide production).[2]

Lung cancer death risk is 22% higher in pesticide production workers compared with the general population, a meta-analysis showed.[3]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. J Natl Cancer I 2011;103(24):1827-39.
  2. Brown T, Darnton A, Fortunato L, et al. Occupational cancer in Britain: Respiratory cancer sites: larynx, lung and mesothelioma. Br J Cancer 2012;107(S1):S56-S70.
  3. Jones DR, Sutton AJ, Abrams KR, et al. Systematic review and meta-analysis of mortality in crop protection product manufacturing workers. Occup Environ Med 2009;66(1):7-15.
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Radon is classified by the International Agency for Research on Cancer (IARC) as a cause of lung cancer.[1] An estimated 0.01% of lung cancers in Britain are linked to working in sites of naturally-occurring high radon.[2]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. J Natl Cancer I 2011;103(24):1827-39.
  2. Brown T, Darnton A, Fortunato L, et al. Occupational cancer in Britain: Respiratory cancer sites: larynx, lung and mesothelioma. Br J Cancer 2012;107(S1):S56-S70.
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Exposure to mineral oils is not classified as a cause of lung cancer by the International Agency for Research on Cancer (IARC),[1] but an estimated 0.01% of lung cancers in Britain are linked to mineral oil exposure (typically in metalworkers and printworkers).[2]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. J Natl Cancer I 2011;103(24):1827-39.
  2. Brown T, Darnton A, Fortunato L, et al. Occupational cancer in Britain: Respiratory cancer sites: larynx, lung and mesothelioma. Br J Cancer 2012;107(S1):S56-S70.
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Working with arsenic and inorganic arsenic compounds is classified by the International Agency for Research on Cancer (IARC) as a cause of lung cancer.[1] An estimated 0.003% of lung cancers in Britain are linked to arsenic and inorganic arsenic compounds (typically in metal production, pesticide production/use, wood preservation).[2]

Arsenic exposure increases lung cancer risk more in smokers than in non-smokers.[3-5]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. J Natl Cancer I 2011;103(24):1827-39.
  2. Brown T, Darnton A, Fortunato L, et al. Occupational cancer in Britain: Respiratory cancer sites: larynx, lung and mesothelioma. Br J Cancer 2012;107(S1):S56-S70.
  3. International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 83 (2004): Tobacco Smoke and Involuntary Smoking. France: IARC, 2004.
  4. Hertz-Picciotto I, Smith AH, et al. Synergism between occupational arsenic exposure and smoking in the induction of lung cancer. Epidemiology 1992;3(1):23-31.
  5. Putila JJ, Guo NL. Association of Arsenic Exposure with Lung Cancer Incidence Rates in the United States. PLoS ONE 2011;6(10):e25886.
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Welding fumes are classified by the International Agency for Research on Cancer (IARC) as a probable cause of lung cancer, based on limited evidence.[1] An estimated 0.001% of lung cancers in Britain are linked to working as a welder.[2]

Lung cancer risk is 26% higher in welders compared with the general population, a meta-analysis showed.[3]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. J Natl Cancer I 2011;103(24):1827-39.
  2. Brown T, Darnton A, Fortunato L, et al. Occupational cancer in Britain: Respiratory cancer sites: larynx, lung and mesothelioma. Br J Cancer 2012;107(S1):S56-S70.
  3. Ambroise D, Wild P, Moulin JJ. Update of a meta-analysis on lung cancer and welding. Scand J Work Environ Hea 2006;32(1):22-31.
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A number of other occupational exposures are classified by the International Agency for Research on Cancer (IARC) as causes or probable causes of lung cancer.[1] Most of these exposures are thought to affect few workers in Britain.[2]

Lung cancer risk may be higher in rock wool and glass wool production workers (though not end-users), a meta-analysis found;[3] however residual confounding by smoking and asbestos exposure is likely.[3]

Lung cancer risk is higher in iron and steel foundry workers, a meta-analysis showed.[4]

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Outdoor air pollution (and the particulate matter within it) is classified by the International Agency for Research on Cancer (IARC) as a cause of lung cancer.[1] An estimated 7.8% of lung cancers each year in the UK are attributable to PM2.5 air pollution exposure.[2] Lung adenocarcinoma risk is 40% higher per 10µg/m3 of PM2.5 air pollution, a meta-analysis showed.[3] Lung adenocarcinoma risk is 29% higher per 10µg/m3 of PM10 air pollution.[3] Lung cancer risk overall is associated only with PM2.5 (9% higher risk per 10µg/m3); the association with PM10 is not significant.[3] Lung adenocarcinoma is less closely linked with smoking compared with other lung cancer types.

Lung cancer death risk is higher in people living near major roads, a meta-analysis showed.[4] Though most evidence linking lung cancer risk with diesel exhaust emissions comes from studies of highly-exposed workers, IARC states diesel exhaust may increase lung cancer risk in the general public.[5]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. J Natl Cancer I 2011;103(24):1827-39.
  2. Calculated by Cancer Research UK Statistical Information Team, November 2014. Based on: Public Health England. Estimating local mortality burdens associated with particulate air pollution. PHE London 2014; and 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):906-11.
  3. 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):906-11.
  4. Chen H, Goldberg MS, Villeneuve PJ. A systematic review of the relation between long-term exposure to ambient air pollution and chronic diseases. Rev Environ Health 2008;23(4):243-97.
  5. International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 105: Diesel and gasoline engine exhausts and some nitroarenes. France: IARC, 2012.
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Emissions from household coal combustion are classified by the International Agency for Research on Cancer (IARC) as a cause of lung cancer; emissions from household biomass fuel (primarily wood) combustion or high-temperature frying are classified as probable causes, based on limited evidence.[1]

Lung cancer risk is around doubled in people who use coal in the home for cooking or heating, meta-analyses (primarily from China and Taiwan, where coals may be more harmful than those used in the UK) have shown.[2,3] Lung cancer risk is not associated with domestic coal use, a European case-control study showed.[4]

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Lung cancer risk is 82% higher in people whose sibling has/had lung cancer, and 25-37% higher in people whose parent has/had the disease, a meta-analysis showed.[1] The association is independent of smoking.[1]

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Lung cancer risk may be increased in breast cancer survivors who had radiotherapy for their primary cancer, however modern radiotherapy techniques may not have the same effect.[1] The association may vary by breast cancer type and smoking status, perhaps indicating the link is not solely due to radiotherapy.[2]

Lung cancer risk is 5 times higher in Hodgkin lymphoma survivors compared with the general population, a meta-analysis showed.[3] Again, radiotherapy treatment for the primary cancer is implicated in this association, as is smoking status.[3]

Lung cancer risk is also increased in survivors of non-Hodgkin lymphoma;[4-6] testicular cancer;[7] uterine sarcomas;[8] head and neck cancers;[4,9] lip, oesophagus, bladder cancers, and chronic lymphocytic leukaemia (males); and liver, cervix, uterus, and kidney cancers (females),[4] cohort studies have shown.

References

  1. Lorigan P, Califano R, Faivre-Finn C, et al. Lung cancer after treatment for breast cancer. Lancet Oncol 2010;11(12):1184-92.
  2. Lubin JH, Caporaso NE. Cigarette Smoking and Lung Cancer: Modeling Total Exposure and Intensity. Cancer Epidem Biomar 2006;15(3):517-23.
  3. Ibrahim EM, Kazkaz GA, Abouelkhair KM et al. Increased risk of second lung cancer in Hodgkin's lymphoma survivors: a meta-analysis. Lung 2013; 191(1):117-34).
  4. Mudie NY, Swerdlow AJ, Higgins CD, et al. Risk of Second Malignancy After Non-Hodgkin's Lymphoma: A British Cohort Study. J Clin Oncol 2006;24(10):1568-74.
  5. Morton LM, Curtis RE, Linet MS, et al. Second Malignancy Risks After Non-Hodgkin's Lymphoma and Chronic Lymphocytic Leukemia: Differences by Lymphoma Subtype. J Clin Oncol 2010;28(33):4935-44.
  6. Jégu J, Colonna M, Daubisse-Marliac L, et al. The effect of patient characteristics on second primary cancer risk in France. BMC Cancer 2014;14:94.
  7. Travis LB, Fosså SD, Schonfeld SJ, et al. Second Cancers Among 40 576 Testicular Cancer Patients: Focus on Long-term Survivors. J Natl Cancer I 2005;97(18):1354-65.
  8. Koivisto-Korander R, Scélo G, Ferro G, et al. Second primary malignancies among women with uterine sarcoma. Gynecol Oncol 2012;126(1):30-35.
  9. Youlden DR, Baade PD. The relative risk of second primary cancers in Queensland, Australia: a retrospective cohort study. BMC Cancer 2011;11:83.
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Higher lung cancer risk in people with previous lung disease does not necessarily mean these diseases cause lung cancer. The associations may to an extent (though not entirely) reflect reverse causality (e.g. diseases caused by weakened immune system in early undiagnosed lung cancer), misdiagnosis (e.g. lung tumours misdiagnosed as other lung diseases), or detection bias (e.g. lung cancer more likely to be picked up in people undergoing testing/surveillance for other lung diseases).[1-3]

References

  1. Brenner DR, McLaughlin JR, Hung RJ. Previous Lung Diseases and Lung Cancer Risk: A Systematic Review and Meta-Analysis. PLoS ONE 2011;6(3):e17479.
  2. Brenner DR, Boffetta P, Duell EJ, et al. Previous lung diseases and lung cancer risk: a pooled analysis from the International Lung Cancer Consortium. Am J Epidemiol 2012; 176(7):573-85.
  3. Denholm R, Schüz J, Straif K, et al. Is previous respiratory disease a risk factor for lung cancer? Am J Respir Crit Care Med 2014;190(5):549-59.
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Lung cancer risk is 43-57% higher in people with a history of pneumonia, with slightly smaller risk increase (35-36%) in never-smokers, a meta-analysis and pooled analysis of case-control studies have shown.[1,2] Lung cancer risk is increased in pneumococcal and community-acquired pneumonia.[3,4]

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Lung cancer risk is 48-72% higher in people with a history of tuberculosis (TB), including never-smokers (50-90% higher risk), meta-analyses and a pooled analysis have shown.[1-3] The risk increase may persist for 20+ years after TB diagnosis, and may be limited to lung adenocarcinoma.[2]

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Lung cancer risk is around doubled in people with silicosis (caused by silica exposure) meta-analyses have shown.[1,2]

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Chronic obstructive pulmonary disease (COPD) is a collection of smoking-related lung diseases including emphysema, chronic bronchitis, and chronic obstructive airways disease.

Lung cancer risk is 104-144% higher in people with a history of emphysema, though there may be no association for never-smokers, meta- and pooled analyses have shown.[1,2]

Lung cancer risk is 47-52% higher in ever-smokers with a history of chronic bronchitis; there is no association for never-smokers, meta- and pooled analyses have shown.[1,2]

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Lung cancer risk is almost three times higher in people with HIV or AIDS, meta-analyses have shown.[1,2] The association is independent of smoking, and is slightly stronger in AIDS than HIV, and in women than men.[2,3]

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Lung cancer risk is around doubled in organ transplant recipients, a meta-analysis and large cohort study have shown.[1,2]

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Lung cancer risk is up to doubled in people with systemic lupus erythematosus, compared with the general population, meta-analyses have shown.[1-3]

Lung cancer risk is higher in rheumatoid arthritis patients compared with the general population, a systematic review showed.[2]

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Lung cancer risk may be higher in diabetics, particularly diabetic women, a meta-analysis showed.[1]

Lung cancer risk among diabetics is not associated with use of metformin,[2,3] sulfonylurea,[3] thiazolidinediones,[3,4] or insulin (though some evidence of risk increase with insulin use),[3] compared with non-use of these treatments, meta-analyses have shown.

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Red and processed meats are classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as possible causes of lung cancer.[1]

Lung cancer risk is 21% higher in people with the highest red meat intake versus those with the lowest, a meta-analysis of cohort studies showed.[2] Lung cancer risk is not associated with processed meat intake, a meta-analysis of cohort studies showed; though there was some evidence of higher risk in case-control studies.[2]

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Beta-carotene supplements (in smokers only) are classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as possible causes of lung cancer.[1]

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Total fat, butter, and retinol supplements (in smokers only) are classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as possible causes of lung cancer.[1]

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Low body fatness is classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as a possible cause of lung cancer.[1]

Lung cancer risk may be lower in current and former smokers with a higher body mass index (BMI) a meta-analysis showed.[2] Confounding by smoking and reverse causality (weight loss caused by undiagnosed lung cancer) are possibl

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Fruits and foods containing carotenoids are classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as probably protective against lung cancer (though beta-carotene supplements are classified as a cause of lung cancer in smokers).[1] An estimated 9% of lung cancers in the UK are linked to people eating less than 2-3 portions of fruit each day.[2]

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Non-starchy vegetables, dietary or supplementary selenium, and dietary quercetin are classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as possibly protective against lung cancer, based on limited evidence.[1]

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Physical activity is classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as possibly protective against lung cancer, based on limited evidence.[1]

Lung cancer risk is lower in people with moderate or high physical activity levels versus those with low levels, meta-analyses have shown.[2-5] Confounding by smoking is likely,[2] and vigorous activity may be required to obtain benefit.[6]

References

  1. World Cancer Research Fund / American Institute for Cancer Research (WCRF/AICR). Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007.
  2. Friedenreich CM, Neilson HK, Lynch BM. State of the epidemiological evidence on physical activity and cancer prevention. Eur J Cancer 2010;46(14):2593-604.
  3. Tardon A, Lee WJ, Delgado-Rodriguez M, et al. Leisure-time physical activity and lung cancer: a meta-analysis. Cancer Cause Control 2005;16(4):389-97.
  4. Buffart LM, Singh AS, van Loon EC et al. Physical activity and the risk of developing lung cancer among smokers: A meta-analysis. J Sci Med Sport 2013; pii:S1440-2440(13) 00047-9. doi: 10.1016/j.jsams.2013.02.015.
  5. Sun JY, Shi L, Gao XD et al. Physical activity and risk of lung cancer: a meta-analysis of prospective cohort studies. Asian Pac J Cancer Prev. 2012;13(7):3143-7.
  6. Wiggins MS, Simonavice EM. Cancer prevention, aerobic capacity, and physical functioning in survivors related to physical activity: a recent review. Cancer Manag Res 2010;2:157-64.
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Lung cancer risk is lower in the following people, meta- and pooled analyses or systematic reviews have shown:

  • People with multiple sclerosis (MS) (smoking causes both MS and lung cancer).[1]
  • People with Parkinson’s disease (PD) (smoking rates are lower in PD patients).[2,3]
  • People with Alzheimer's disease.[4]
  • People with coeliac disease (probably due to lower smoking rates in this group).[5,6]
  • Women with older age at menarche (first menstrual period).[7]
  • Cotton textile industry and agriculture workers (probably due to endotoxins exposure).[8]

References

  1. Handel AE, Joseph A, Ramagopalan SV. Multiple sclerosis and lung cancer: an unexpected inverse association. QJM 2010;103(8):625-26.
  2. Ong EL, Goldacre R, Goldacre M. Differential risks of cancer types in people with Parkinson's disease: a national record-linkage study. Eur J Cancer 2014;50(14):2456-62.
  3. Bajaj A, Driver JA, Schernhammer ES. Parkinson's disease and cancer risk: a systematic review and meta-analysis. Cancer Causes Control 2010;21(5):697-707.
  4. Shi HB, Tang B, Liu YW, et al. Alzheimer disease and cancer risk: a meta-analysis. J Cancer Res Clin Oncol 2014. [Epub ahead of print]
  5. Ilus T, Kaukinen K, Virta LJ, et al. Incidence of malignancies in diagnosed celiac patients: a population-based estimate. Am J Gastroenterol 2014;109(9):1471-7.
  6. West J, Logan RF, Smith CJ, et al. Malignancy and mortality in people with coeliac disease: population based cohort study. BMJ 2004;329(7468):716-9.
  7. Zhang Y, Yin Z, Shen L, et al. Menstrual factors, reproductive factors and lung cancer risk: a meta-analysis. Zhonggui Fei Ai Za Zhi 2012;15(12):701-19.
  8. Lenters V, Basinas I, Beane-Freeman L, et al. Endotoxin exposure and lung cancer risk: a systematic review and meta-analysis of the published literature on agriculture and cotton textile workers. Cancer Cause Control 2010;21(4):523-55.
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The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) make no judgment on the association between lung cancer risk and intake of cereals (grains) and their products; starchy tubers; dietary fibre; pulses (legumes); poultry; fish; eggs; milk and dairy products; total fat; animal fats; plant oils; soft drinks; coffee; tea; alcohol; preservation, processing, and preparation; carbohydrate; protein; vitamin A; thiamin; riboflavin; niacin; vitamin B6; folate; vitamin C; vitamin E; multivitamins; calcium; copper; iron; zinc; pro-vitamin A carotenoids; lycopene; flavonoids; culturally-defined diets; body size, shape, and composition (except low body fatness); or energy intake, due to limited evidence.[1]

Lung cancer risk is not associated with the following factors, meta- and pooled analyses or systematic reviews have shown:

  • Folate (including folic acid supplementation,[2,3] and overall folate[4]) (some evidence of variation by sex[4]).
  • Circulating vitamin B6 and methionine levels.[5]
  • Foods containing soy.[6]
  • Cruciferous vegetables.[7]
  • Alcohol.[8,9]
  • Asthma[10] (increased risk shortly after asthma diagnosis probably misdiagnosis of early lung cancer symptoms as asthma[10]).
  • Statins.[11,12]
  • Aspirin (some evidence of risk decrease but limited to case-control studies,[13,14] lower-quality studies,[14] users of 7+ aspirin tablets per week,[15] and men.[16])
  • Non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs).[15,16]
  • Parity.[17]
  • Hormone replacement therapy (HRT) use[18] (also mixed evidence of risk decrease[18] and risk increase[19]).
  • Oral contraceptives (some evidence of risk decrease).[20]
  • Fish (some evidence of risk decrease).[21]
  • Vitamin D blood levels[22] or supplement use.[23]
  • Tea (some evidence of lower risk in case-control studies).[24]

References

  1. World Cancer Research Fund / American Institute for Cancer Research (WCRF/AICR). Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007.
  2. Wien TN, Pike E, Wisløff T, et al. Cancer risk with folic acid supplements: a systematic review and meta-analysis. BMJ Open 2012;2(1).
  3. Ebbing M, Bønaa KH, Nygård O, et al. Cancer incidence and mortality after treatment with folic acid and vitamin B12. JAMA 2009;302(19):2119-26.
  4. Zhang YF, Zhou L, Zhang HW1, et al. Association between folate intake and the risk of lung cancer: a dose-response meta-analysis of prospective studies. PLoS One 2014;9(4):e93465.
  5. Johansson M, Relton C, Ueland PM, et al. Serum B vitamin levels and risk of lung cancer. JAMA 2010;303(23):2377-85.
  6. Yang G, Shu XO, Chow WH et al. Soy food intake and risk of lung cancer: evidence from the Shanghai Women's Health Study and a meta-analysis. Am J Epidemiol 2012; 176(10):846-55.
  7. Wu, QJ, Xie L, Zheng W et al. Cruciferous vegetables consumption and the risk of female lung cancer: a prospective study and meta-analysis. Ann Oncol. 2013;24(7):1918-24.
  8. Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and lung cancer risk in never smokers: a meta-analysis. Ann Oncol 2011;22(12):2631-39.
  9. Chao C. Associations between Beer, Wine, and Liquor Consumption and Lung Cancer Risk: A Meta-analysis. Cancer Epidem Biomar 2007;16(11):2436-47.
  10. Rosenberger A, Bickeböller H, McCormack V, et al. Asthma and lung cancer risk: a systematic investigation by the International Lung Cancer Consortium. Carcinogenesis 2012;33(3):587-97.
  11. Jinliang Wang, Cheng Li, Haitao Tao, et al. Statin Use and Risk of Lung Cancer: a Meta-Analysis of Observational Studies and Randomized Controlled Trials PLoS One 2013; 8(10): e77950.
  12. Deng Z, Zhang S, Yi L, et al. Can statins reduce risk of lung cancer, especially among elderly people? A meta-analysis. Chin J Cancer Res 2013;25(6):679-88.
  13. Bosetti C, Rosato V, Gallus S, et al. Aspirin and cancer risk: a quantitative review to 2011. Ann Oncol 2012;23(6):1403-15.
  14. Oh S-W, Myung S-K, Park JY, et al. Aspirin use and risk for lung cancer: a meta-analysis. Ann Oncol 2011;22(11):2456-65.
  15. Xu J, Yin Z, Gao W, et al. Meta-analysis on the association between nonsteroidal anti-inflammatory drug use and lung cancer risk. Clin Lung Cancer 2012;13(1):44-51.
  16. McCormack V, Hung R, Brenner D, et al. Aspirin and NSAID use and lung cancer risk: a pooled analysis in the International Lung Cancer Consortium (ILCCO). Cancer Cause Control 2011;22(12):1709-20.
  17. Dahabreh IJ, Trikalinos TA, Paulus JK. Parity and risk of lung cancer in women: Systematic review and meta-analysis of epidemiological studies. Lung Cancer 2012;76(2):150-58.
  18. Oh SW, Myung SK, Park JY, et al. Hormone therapy and risk of lung cancer: a meta-analysis. J Womens Health (Larchmt) 2010;19(2):279-88.
  19. Slatore CG, Chien JW, Au DH, et al. Lung Cancer and Hormone Replacement Therapy: Association in the Vitamins and Lifestyle Study. J Clin Oncol 2010;28(9):1540-46.
  20. Wu W, Yin ZH, Guan P, et al. Association of oral contraceptives use and lung cancer risk among women: an updated meta-analysis based on cohort and case-control studies. Asian Pac J Cancer Prev 2014;15(3):1205-10.
  21. Song J, Su H, Wang BL, et al. Fish consumption and lung cancer risk: systematic review and meta-analysis. Nutr Cancer 2014;66(4):539-49.
  22. Skaaby T, Husemoen LL, Thuesen BH, et al. Prospective population-based study of the association between serum 25-hydroxyvitamin-D levels and the incidence of specific types of cancer. Cancer Epidemiol Biomarkers Prev 2014;23(7):1220-9.
  23. Bjelakovic G, Gluud LL, Nikolova D, et al. Vitamin D supplementation for prevention of cancer in adults. Cochrane Database Syst Rev 2014;6:CD007469.
  24. Wang L, Zhang X, Liu J, et al. Tea consumption and lung cancer risk: a meta-analysis of case-control and cohort studies. Nutrition 2014;30(10):1122-7.
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