Dose-response relationship between cooking fumes exposures and lung cancer among Chinese nonsmoking women

Characteristics of Singapore lung cancer patients who miss out on lung cancer screening recommendations

INTRODUCTION

The National Lung Screening Trial (NLST) identified individuals at high risk for lung cancer and showed that serial low-dose helical computed tomography could identify lung cancer at an earlier stage, leading to mortality reduction. However, there is little evidence regarding the effectiveness of the NLST criteria for the Asian population.

METHODS

We performed a retrospective audit in our hospital from January 2018 to December 2018, with the aim to describe the characteristics of patients diagnosed with lung cancer and to identify patients who would miss out on lung cancer screening when the NLST criteria was applied.

RESULTS

We found that only 38.1% of our cohort who were diagnosed with lung cancer met the NLST criteria strictly by age and smoking status. Patients who met the screening criteria would have derived significant benefits from it, as 85.4% of our patients had presented at an advanced stage and 54.6% died within 1 year. When the United States Preventive Services Task Force criteria was applied, it increased the sensitivity of lung cancer diagnosis to 58.7%. Only 15.5% of the female patients with lung cancer met the NLST criteria; their low smoking quantity was a significant contributing factor for exclusion.

CONCLUSION

The majority of Singapore patients diagnosed with lung cancer, especially females, would not have been identified with the NLST criteria. However, those who met the inclusion criteria would have benefited greatly from screening. Extending the screening age upper limit may yield benefits and improved sensitivity in the Singapore context.

A Retrospective Analysis: Investigating Factors Linked to High Lung-RADS Scores in a Nonsmoking, Non-Family History Population

Low-dose computed tomography screening for lung cancer is currently targeted at heavy smokers or those with a family history of lung cancer. This study aimed to identify risk factors for lung cancer in individuals who do not meet the current lung cancer screening criteria as stipulated by the Taiwan Health Promotion Agency's low-dose computed tomography (LDCT) screening policy. A cohort analysis was conducted on 12,542 asymptomatic healthy subjects aged 20-80 years old who voluntarily underwent LDCT scans from January 2016 to December 2021. Logistic regression demonstrated that several factors, including age over 55 years, female gender, a body mass index (BMI) less than 23, a previous history of respiratory diseases such as tuberculosis or obstructive respiratory diseases (chronic obstructive pulmonary disease [COPD], asthma), and previous respiratory symptoms such as cough or dyspnea, were associated with high-risk lung radiology scores according to LDCT scans. These findings indicate that risk-based assessments using primary data and questionnaires to identify risk factors other than heavy smoking and a family history of lung cancer may improve the efficiency of lung cancer screening.

Lung cancer in patients who have never smoked - an emerging disease

Lung cancer is the most common cause of cancer-related deaths globally. Although smoking-related lung cancers continue to account for the majority of diagnoses, smoking rates have been decreasing for several decades. Lung cancer in individuals who have never smoked (LCINS) is estimated to be the fifth most common cause of cancer-related deaths worldwide in 2023, preferentially occurring in women and Asian populations. As smoking rates continue to decline, understanding the aetiology and features of this disease, which necessitate unique diagnostic and treatment paradigms, will be imperative. New data have provided important insights into the molecular and genomic characteristics of LCINS, which are distinct from those of smoking-associated lung cancers and directly affect treatment decisions and outcomes. Herein, we review the emerging data regarding the aetiology and features of LCINS, particularly the genetic and environmental underpinnings of this disease as well as their implications for treatment. In addition, we outline the unique diagnostic and therapeutic paradigms of LCINS and discuss future directions in identifying individuals at high risk of this disease for potential screening efforts.

Low-dose CT screening among never-smokers with or without a family history of lung cancer in Taiwan: a prospective cohort study

BACKGROUND

In Taiwan, lung cancers occur predominantly in never-smokers, of whom nearly 60% have stage IV disease at diagnosis. We aimed to assess the efficacy of low-dose CT (LDCT) screening among never-smokers, who had other risk factors for lung cancer.

METHODS

The Taiwan Lung Cancer Screening in Never-Smoker Trial (TALENT) was a nationwide, multicentre, prospective cohort study done at 17 tertiary medical centres in Taiwan. Eligible individuals had negative chest radiography, were aged 55-75 years, had never smoked or had smoked fewer than 10 pack-years and stopped smoking for more than 15 years (self-report), and had one of the following risk factors: a family history of lung cancer; passive smoke exposure; a history of pulmonary tuberculosis or chronic obstructive pulmonary disorders; a cooking index of 110 or higher; or cooking without using ventilation. Eligible participants underwent LDCT at baseline, then annually for 2 years, and then every 2 years up to 6 years thereafter, with follow-up assessments at each LDCT scan (ie, total follow-up of 8 years). A positive scan was defined as a solid or part-solid nodule larger than 6 mm in mean diameter or a pure ground-glass nodule larger than 5 mm in mean diameter. Lung cancer was diagnosed through invasive procedures, such as image-guided aspiration or biopsy or surgery. Here, we report the results of 1-year follow-up after LDCT screening at baseline. The primary outcome was lung cancer detection rate. The p value for detection rates was estimated by the χ2 test. Univariate and multivariable logistic regression analyses were used to assess the association between lung cancer incidence and each risk factor. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of LDCT screening were also assessed. This study is registered with ClinicalTrials.gov, NCT02611570, and is ongoing.

FINDINGS

Between Dec 1, 2015, and July 31, 2019, 12 011 participants (8868 females) were enrolled, of whom 6009 had a family history of lung cancer. Among 12 011 LDCT scans done at baseline, 2094 (17·4%) were positive. Lung cancer was diagnosed in 318 (2·6%) of 12 011 participants (257 [2·1%] participants had invasive lung cancer and 61 [0·5%] had adenocarcinomas in situ). 317 of 318 participants had adenocarcinoma and 246 (77·4%) of 318 had stage I disease. The prevalence of invasive lung cancer was higher among participants with a family history of lung cancer (161 [2·7%] of 6009 participants) than in those without (96 [1·6%] of 6002 participants). In participants with a family history of lung cancer, the detection rate of invasive lung cancer increased significantly with age, whereas the detection rate of adenocarcinoma in situ remained stable. In multivariable analysis, female sex, a family history of lung cancer, and age older than 60 years were associated with an increased risk of lung cancer and invasive lung cancer; passive smoke exposure, cumulative exposure to cooking, cooking without ventilation, and a previous history of chronic lung diseases were not associated with lung cancer, even after stratification by family history of lung cancer. In participants with a family history of lung cancer, the higher the number of first-degree relatives affected, the higher the risk of lung cancer; participants whose mother or sibling had lung cancer were also at an increased risk. A positive LDCT scan had 92·1% sensitivity, 84·6% specificity, a PPV of 14·0%, and a NPV of 99·7% for lung cancer diagnosis.

INTERPRETATION

TALENT had a high invasive lung cancer detection rate at 1 year after baseline LDCT scan. Overdiagnosis could have occurred, especially in participants diagnosed with adenocarcinoma in situ. In individuals who do not smoke, our findings suggest that a family history of lung cancer among first-degree relatives significantly increases the risk of lung cancer as well as the rate of invasive lung cancer with increasing age. Further research on risk factors for lung cancer in this population is needed, particularly for those without a family history of lung cancer.

FUNDING

Ministry of Health and Welfare of Taiwan.

Cooking oil fume exposure and Lung-RADS distribution among school cafeteria workers of South Korea

Background

Cooking oil fumes (COFs) from cooking with hot oil may contribute to the pathogenesis of lung cancer. Since 2021, occupational lung cancer for individual cafeteria workers has been recognized in South Korea. In this study, we aimed to identify the distribution of lung-imaging reporting and data system (Lung-RADS) among cafeteria workers and to determine factors related to Lung-RADS distribution.

Methods

We included 203 female participants who underwent low-dose computed tomography (LDCT) screening at a university hospital and examined the following variables: age, smoking status, second-hand smoke, height, weight, and years of service, mask use, cooking time, heat source, and ventilation. We divided all participants into culinary and non-culinary workers. Binomial logistic regression was conducted to determine the risk factors on LDCT of Category ≥ 3, separately for the overall group and the culinary group.

Results

In this study, Lung-RADS-positive occurred in 17 (8.4%) individuals, all of whom were culinary workers. Binary logistic regression analyses were performed and no variables were found to have a significant impact on Lung-RADS results. In the subgroup analysis, the Lung-RADS-positive, and -negative groups differed only in ventilation. Binary logistic regression showed that the adjusted odds ratio (aOR) of the Lung-RADS-positive group for inappropriate ventilation at the workplace was 14.89 (95% confidence interval [CI]: 3.296-67.231) compared to appropriate ventilation as the reference, and the aOR for electric appliances at home was 4.59 (95% CI: 1.061-19.890) using liquid fuel as the reference.

Conclusions

The rate of Lung-RADS-positive was significantly higher among culinary workers who performed actual cooking tasks than among nonculinary workers. In addition, appropriate ventilation at the workplace made the LDCT results differ. More research is needed to identify factors that might influence LDCT findings among culinary workers, including those in other occupations.

Molecular pathways in the development of HPV-induced oropharyngeal cancer

Oropharyngeal cancer, a subset of head and neck cancer, is increasingly recognized as a unique clinical entity primarily influenced by high-risk human papillomavirus (HPV) infections, particularly HPV-16. This review delves into the viral life cycle of HPV-16 and its interactions with host cells, with a specific focus on the crucial roles played by the viral oncoproteins E6 and E7. These oncoproteins drive cellular proliferation by targeting critical tumor suppressor proteins like p53 and Rb, resulting in uncontrolled cell growth and genomic instability. Furthermore, the significance of epigenetic modifications induced by HPV-16 and their implications is important for cancer progression. This comprehensive review provides valuable insights into the intricate molecular landscape of HPV-induced oropharyngeal cancer, shedding light on the development of targeted therapies and preventive strategies for this emerging global health concern. Video Abstract.

Online Exploring the Gaseous Oil Fumes from Oleic Acid Thermal Oxidation by Synchrotron Radiation Photoionization Mass Spectrometry

Cooking oil fumes are an intricate and dynamic mixture containing a variety of poisonous and hazardous substances, and their real-time study remains challenging. Based on tunable synchrotron radiation photoionization mass spectrometry (SR-PIMS), isomeric/isobaric compounds in the gaseous oil fumes from oleic acid thermal oxidation were determined in real time and distinguished by photoionization efficiency (PIE) curve simulation combined with multiple linear regression (MLR) analysis. A series of common carcinogens such as formaldehyde, acetaldehyde, acrolein, and several unreported chemicals including diethyl ether and formylcyclohexane were successfully characterized. Moreover, time-resolved profiles of certain components in gaseous oil fumes were monitored for 55 h. Distinct evolutionary processes were observed, indicating the consumption and formation of parent molecules, intermediates, and final products.

Cancer Burden Variations and Convergences in Globalization: A Comparative Study on the Tracheal, Bronchus, and Lung (TBL) and Liver Cancer Burdens Among WHO Regions from 1990 to 2019

Lung cancer and liver cancer are the leading and third causes of cancer death, respectively. Both lung and liver cancer are with clear major risk factors. A thorough understanding of their burdens in the context of globalization, especially the convergences and variations among WHO regions, is useful in precision cancer prevention worldwide and understanding the changing epidemiological trends with the expanding globalization. The Global Burden of Disease (GBD) and WHO Global Health Observatory (GHO) database were analyzed to evaluate the burden metrics and risk factors of trachea, bronchus, and lung (TBL) cancer and liver cancer. Western Pacific Region (WPR) had the highest age-standardized incidence rate (ASIR) for both liver cancer (11.02 [9.62-12.61] per 100,000 population) and TBL cancer (38.82 [33.63-44.04] per 100,000 population) in 2019. Disability-adjusted life years (DALYs) for liver and TBL cancer elevated with the increasing sociodemographic index (SDI) level, except for liver cancer in WPR and TBL cancer in European Region (EUR). Region of the Americas (AMR) showed the biggest upward trends of liver cancer age-standardized rates (ASRs), as well as the biggest downward trends of TBL cancer ASRs, followed by Eastern Mediterranean Region (EMR). Alcohol use and smoking were the leading cause of liver and TBL cancer death in most WHO regions. Variances of ASRs for liver and TBL cancer among WHO memberships have been decreasing during the past decade. The homogenization and convergence of cancer burdens were also demonstrated in different agegroups and sexes and in the evolution of associated risk factors and etiology. In conclusion, our study reflects the variations and convergences in the liver and lung cancer burdens among the WHO regions with the developing globalization, which suggests that we need to be acutely aware of the global homogeneity of the disease burden that accompanies increasing globalization, including the global convergences in various populations, risk factors, and burden metrics.

Different gene alterations in patients with non-small-cell lung cancer between the eastern and southern China

Geographical differences are conspicuous in lung cancer, and the distinct molecular features of lung tumor between Western patients and Asian patients have been demonstrated. However, the etiology of non-small-cell lung cancer (NSCLC) and the distribution of associated molecular aberrations in China have not been fully elucidated. The mutational profiles of 12 lung cancer-related genes were investigated in 85 patients from eastern China and 88 patients from southern China who had been histologically confirmed NSCLC. Overall, 93.6% (162/173) of tumor samples harbored at least one somatic alteration. The most frequently mutated genes were TP53 (56.1%), EGFR (50.3%), and KRAS (14.5%). We found that EGFR mutated much more frequently (60.0% vs 40.9%, P = 0.012) and TP53 mutations had significantly lower incidence (47.1% vs 64.8%, P = 0.019) in eastern cohort than that in southern cohort. Mutational signature analysis revealed a region-related mutagenesis mechanism characterized by a high prevalence of C to T transitions mainly occurring at CpG dinucleotides in southern patients. This study reveals the difference in the mutational features between NSCLC patients in eastern and southern China. The distinct patterns of gene mutation could provide clues for the mechanism of carcinogenesis of lung cancer, offering opportunities to stratify patients into optimal treatment plans based on genomic profiles.

Spatial distributions of particle number size distributions generated during cooking processes and the impacts of range hoods

Cooking oil fume (COF) is associated with an increased risk of health effects. The particle number size distribution (PNSD) of COF presenting as lognormal structures is recognized as a key metric in determining its exposure toxicities, but the information of its spatial distributions and impacting factors are still lacking. This study conducted real-time monitoring COF PNSD during the cooking processes in a kitchen laboratory. Results showed that COF PNSD presented as a combination of two lognormal distributions. The peak diameters of PNSD inside the kitchen were: 385 nm (very close to the source), 126 nm (5 cm above the source), 85 nm (10 cm above the source) to 36 nm (breath point, 50 cm above the source), 33 nm (sucking surface of the ventilation hood), 31 nm (1 m horizontally to the source), and 29 nm (3.5 m horizontally to the source). The reasons of this observation was the sharp decrease of temperature from the pot to the indoor environment reduced the surface partial pressure of the COF particles and caused a large amount of semi-volatile organic carbons (SVOCs) with lower saturation ratios condensed on the COF surface. With the temperature difference became insignificant with the distance further to the source, the reduction of the supersaturation helped the gasification of these SVOCs. Dispersion led to a linearly horizontal decreases ((1.85 ± 0.10) × 10⁶#/cm³/m) in particle numbers with further distances, making the peak particle number concentrations decrease from 3.5 × 10⁵#/cm³ at the breath point to 1.1 × 10⁵#/cm³ at the point 3.5 m to the source. Cooking dishes also presented as mode diameters of 22-32 nm at the breath point. The amount of edible oil used in different dishes is positively correlated with the peak concentration of COF. Only increasing the exhaust force of the range hood cannot significantly change the sucked COF particle numbers and sizes, owning to that COF particles are mainly small sizes. New technologies on cleaning small size particles and efficient supplemental air should be given more considerations.

How Does Environmental and Occupational Exposure Contribute to Carcinogenesis in Genitourinary and Lung Cancers?

Environmental and occupational exposures have been associated with an increased risk of different types of cancers, although the exact mechanisms of higher carcinogenesis risk are not always well understood. Lung cancer is the leading cause of global cancer mortality, and, also, genitourinary neoplasms are among the main causes of cancer-related deaths in Western countries. The purpose of this review is to describe the main environmental and occupational factors that increase the risk of developing lung and genitourinary cancers and to investigate carcinogenesis mechanisms that link these agents to cancer onset. Further objectives are to identify methods for the prevention or the early detection of carcinogenic agents and, therefore, to reduce the risk of developing these cancers or to detect them at earlier stages.

Diet as a Source of Acrolein: Molecular Basis of Aldehyde Biological Activity in Diabetes and Digestive System Diseases

Acrolein, a highly reactive α,β-unsaturated aldehyde, is a compound involved in the pathogenesis of many diseases, including neurodegenerative diseases, cardiovascular and respiratory diseases, diabetes mellitus, and the development of cancers of various origins. In addition to environmental pollution (e.g., from car exhaust fumes) and tobacco smoke, a serious source of acrolein is our daily diet and improper thermal processing of animal and vegetable fats, carbohydrates, and amino acids. Dietary intake is one of the main routes of human exposure to acrolein, which is a major public health concern. This review focuses on the molecular mechanisms of acrolein activity in the context of its involvement in the pathogenesis of diseases related to the digestive system, including diabetes, alcoholic liver disease, and intestinal cancer.

Association of ambient carbon monoxide exposure with hospitalization risk for respiratory diseases: A time series study in Ganzhou, China

Background

Ambient carbon monoxide (CO) exposure is associated with increased mortality and hospitalization risk for total respiratory diseases. However, evidence on the risk of hospitalization for specific respiratory diseases from ambient CO exposure is limited.

Methods

Data on daily hospitalizations for respiratory diseases, air pollutants, and meteorological factors from January 2016 to December 2020 were collected in Ganzhou, China. A generalized additive model with the quasi-Poisson link and lag structures was used to estimate the associations between ambient CO concentration and hospitalizations of total respiratory diseases, asthma, chronic obstructive pulmonary disease (COPD), upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), and influenza-pneumonia. Possible confounding co-pollutants and effect modification by gender, age, and season were considered.

Results

A total of 72,430 hospitalized cases of respiratory diseases were recorded. Significant positive exposure-response relationships were observed between ambient CO exposure and hospitalization risk from respiratory diseases. For each 1 mg/m³ increase in CO concentration (lag0-2), hospitalizations for total respiratory diseases, asthma, COPD, LRTI, and influenza-pneumonia increased by 13.56 (95% CI: 6.76%, 20.79%), 17.74 (95% CI: 1.34%, 36.8%), 12.45 (95% CI: 2.91%, 22.87%), 41.25 (95% CI: 18.19%, 68.81%), and 13.5% (95% CI: 3.41%, 24.56%), respectively. In addition, the associations of ambient CO with hospitalizations for total respiratory diseases and influenza-pneumonia were stronger during the warm season, while women were more susceptible to ambient CO exposure-associated hospitalizations for asthma and LRTI (all P < 0.05).

Conclusion

In brief, significant positive exposure-response relationships were found between ambient CO exposure and hospitalization risk for total respiratory diseases, asthma, COPD, LRTI, and influenza-pneumonia. Effect modification by season and gender was found in ambient CO exposure-associated respiratory hospitalizations.

In vitro and in vivo low-dose exposure of simulated cooking oil fumes to assess adverse biological effects

Cooking oil fumes (COFs) represent a major indoor environmental pollutant and exhibit potent mutagenic or carcinogenic health effects caused by containing various heterocyclic aromatic amines (HAAs) and long-chain aldehydes. Despite some evaluation of the cumulative exposure of COFs to cancer cells under high concentration were evaluated, their biological adverse effects with low-dose exposure to healthy cells had been inadequately investigated. Herein, we firstly scrutinized the three selected typically toxic compounds of heterocyclic amine 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP), 3,8-dimethylammidazo[4,5-f]quinoxalin-2-amine (MeIQx) and trans, trans-2,4-decadienal (TDA)) emitted from COFs. In vitro studies revealed that the PhIP, MeIQx and TDA aerosol particles were negligible toxicity to cancer cells (A549 and HepG-2) but strong cytotoxicity to normal healthy cells (HelF and L02) under 0.5–4 μg/mL low dose exposure based on the reactive oxygen species (ROS) mechanism. In vivo studies demonstrated that PhIP caused significant lung and liver damage after exposure to PhIP for 30 days with mice. These results indicated the direct proof of healthy cell damage even at low-dose exposure to HAAs and aldehydes.

Organic pollutant exposure and health effects of cooking emissions on kitchen staff in food services

This study was conducted to determine the exposure and health risk to cooking fumes of a total of 88 volunteer kitchen staff aged between 18 and 65 years working in five different kitchens in Ankara. Gas- and particle-phase polycyclic aromatic hydrocarbons (PAHs), and volatile organic compound (VOCs) concentrations were evaluated in the indoor air of 5 kitchens. Serum malondialdehyde (MDA) and superoxide dismutase (SOD) levels were analyzed to determine the oxidative damage as a result of the exposure to cooking fumes among the cooks and waiters. Significant positive relationships were found between serum MDA levels of the hot kitchen workers and indoor chrysene (Chr), indeno(1,2,3-c,d)pyrene (Ind), and total VOC levels. Although the carcinogenic risks estimated for the exposed population were between the acceptable/tolerable levels, the hazard quotient (HQ) estimated for the exposure to indoor benzene exceeded the safe level. The results of the study revealed that exposure to organic pollutants in indoor air may be a risk factor for the development of oxidative stress, especially in hot kitchen workers. The importance of efficient ventilation in the kitchen has been pointed out to reduce health risks caused by cooking fumes.

Particulate matters, aldehydes, and polycyclic aromatic hydrocarbons produced from deep-frying emissions: comparisons of three cooking oils with distinct fatty acid profiles

It is recognized that hazardous emissions produced from frying oils may be related to oil properties, particularly the fatty acid composition. However, investigations have been limited and partial. In this work, the emissions from deep-frying foods with three oils (palm, olive, and soybean oils) with distinct fatty acid profiles were comprehensively examined in a simulated kitchen, and the interrelationship among emitted substances, oil quality parameters, and fatty acids profiles was explored. Firstly, palm oil emitted the highest number concentration of total particle matters ((3895 ± 1796) × 103 #/cm3), mainly in the Aitken mode (20-100 nm). We observed a positive correlation between particle number concentration and levels of palmitic acid, a major saturated fatty acid (SAFA) (rs = 0.73, p < 0.05), and total polar compounds (TPC) (rs = 0.68, p < 0.05) in the fried oil, a degradation marker which was also positively correlated with that of black carbon (BC) (rs = 0.68, p < 0.05). Secondly, soybean oil emitted the highest level of gaseous aldehydes (3636 ± 607 μg/m3), including acrolein, propinoaldehyde, crotonaldehyde, hexanal, and trans-2-heptenal; the total aldehyde concentration were positively correlated with α-linolenic acid (ALA) percentage (rs = 0.78, p < 0.01), while hexanal and trans-2-heptenal were with linoleic acid (LA) (rs = 0.73 and 0.67, p < 0.05). LA and ALA were two major polyunsaturated fatty acids in non-tropical plant oils. Thirdly, palm oil emitted the most particle-bound polycyclic aromatic hydrocarbons (PAHs), and a positive association was discovered between two PAHs and SAFA percentage. Olive oil seems superior to soybean and palm oils with regards to toxic emissions during deep-frying.

Hazard Levels of Cooking Fumes in Korea schools

Background and Purpose

In 2021, lung cancer in school food workers was first recognized as an occupational cancer. The classification of the carcinogenicity of cooking fumes by International Agency for Research on Cancer (IARC) was based on Chinese epidemiological data. This study aimed to determine the hazard levels of school cooking fumes in Korea.

Materials and Methods

Based on public school cafeterias in one area, 25 locations were selected for the survey according to the number per school type, ventilation states, and environmental pre-assessments of cafeterias. Two inside cooking areas using a heat source and one outside cooking area were selected as control measurement points. Measurements of CO, CO₂, polycyclic aromatic hydrocarbons (PAHs), and total volatile organic compounds (TVOCs), including benzene, formaldehyde, and particulate matter (PM10, PM2.5, PM1, respectively), were taken. The concentrations and patterns of each substance in the kitchens were compared with the outdoor air quality.

Result

Known carcinogens, such as the concentrations of PAHs, formaldehyde, TVOC (benzene), and particulate matter in school cooking fumes, were all detected at similar or slightly higher levels than those found outside. Additionally, substances were detected at relatively low concentrations compared to the Chinese cooking fumes reported in the literature. However, the short-term exposure to high concentrations of CO (or composite exposure with CO₂) and PM2.5 in this study were shown.

Conclusion

The school cooking fumes in South Korea was a relatively less harmful than Chinese cooking fumes, however short-term, high exposure of toxic substances can cause a critical health effect.

Risk of lung cancer among women in relation to lifetime history of tobacco smoking: a population-based case-control study in France (the WELCA study)

Background

This study aims to provide new insights on the role of smoking patterns and cigarette dependence in female lung cancer, and to examine differences by histological subtype.

Methods

We conducted a population-based case-control study in the great Paris area among women including 716 incident cases diagnosed between 2014 and 2017 and 757 age-matched controls. Detailed data on smoking history was collected during in-person interviews to assess intensity and duration of tobacco smoking, time since cessation, smoking habits (depth of smoke inhalation, use of filter, type of tobacco, and type of cigarettes) and Fagerström test for cigarette dependence. The comprehensive smoking index (CSI), a score modelling the combined effects of intensity, duration and time since quitting smoking was determined for each subject. Multivariable logistic regression models were fitted to calculate odds ratios (ORs) and their confidence intervals (95%CI) of lung cancer associated with smoking variables.

Results

Lung cancer risk increased linearly with intensity and duration of tobacco smoking while it decreased with time since cessation, to reach the risk in never-smokers after 20 years of abstinence. The combined effect of intensity and duration of tobacco smoking was more than multiplicative (p-interaction 0.012). The OR in the highest vs the lowest quartile of CSI was 12.64 (95%CI 8.50; 18.80) (p-trend < 0.001). The risk of small cell or squamous cell carcinomas increased with the CSI more sharply than the risk of adenocarcinomas. Deep smoke inhalation, dark vs blond tobacco, conventional vs light cigarettes, and unfiltered vs filtered cigarettes, as well as having mixed smoking habits, were found to be independent risk factors. Having high cigarette addiction behaviours also increased the risk after adjusting for CSI.

Conclusion

This study provides additional insights on the effects of tobacco smoking patterns on lung cancer risk among women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08433-z.

Colorimetric Sensing of Volatile Organic Compounds Produced from Heated Cooking Oils

Measurement of cooking-associated air pollution indoors is an integral part of exposure monitoring and human health risk assessment. There is a need for easy to use, fast, and economical detection systems to quantify the various emissions from different sources in the home. Addressing this challenge, a colorimetric sensor array (CSA) is reported as a new method to characterize volatile organic compounds produced from cooking, a major contributor to indoor air pollution. The sensor array is composed of pH indicators and aniline dyes from classical spot tests, which enabled molecular recognition of a variety of aldehydes, ketones, and carboxylic acids as demonstrated by hierarchical clustering and principal component analyses. To demonstrate the concept, these CSAs were employed for differentiation of emissions from heated cooking oils (sunflower, rapeseed, olive, and groundnut oils). Sensor results were validated by gas chromatography-mass spectrometry analysis, highlighting the potential of the sensor array for evaluating cooking emissions as a source of indoor air pollution.

Factors Impacting Range Hood Use in California Houses and Low-Income Apartments

Venting range hoods can control indoor air pollutants emitted during residential cooktop and oven cooking. To quantify their potential benefits, it is important to know how frequently and under what conditions range hoods are operated during cooking. We analyzed data from 54 single family houses and 17 low-income apartments in California in which cooking activities, range hood use, and fine particulate matter (PM2.5) were monitored for one week per home. Range hoods were used for 36% of cooking events in houses and 28% in apartments. The frequency of hood use increased with cooking frequency across homes. In both houses and apartments, the likelihood of hood use during a cooking event increased with the duration of cooktop burner use, but not with the duration of oven use. Actual hood use rates were higher in the homes of participants who self-reported more frequent use in a pre-study survey, but actual use was far lower than self-reported frequency. Residents in single family houses used range hoods more often when cooking caused a discernible increase in PM2.5. In apartments, residents used their range hood more often only when high concentrations of PM2.5 were generated during cooking.

Metabolic Syndrome and Risk of Lung Cancer: An Analysis of Korean National Health Insurance Corporation Database

INTRODUCTION

Metabolic syndrome is known to increase the risk of several cancers. However, the association between lung cancer and metabolic syndrome remains unclear. Thus, we investigated the impact of metabolic syndrome on the incidence of lung cancer.

METHODS

This study enrolled participants in a health screening program provided by the Korean National Health Insurance Service between January 2009 and December 2012. The incidence of lung cancer was observed until December 2016. We analyzed the risk of lung cancer according to the presence of metabolic syndrome, metabolic syndrome components, and number of metabolic syndrome components.

RESULTS

During the study, 45 635 new cases of lung cancer were recorded among 9 586 753 participants. The presence of metabolic syndrome and all its components was positively associated with the risk of lung cancer in men after multivariate adjustment (hazard ratio [HR] of metabolic syndrome 1.15; 95% confidence interval [CI], 1.12-1.18). The risk of lung cancer increased with the number of components present. The effect of metabolic syndrome on the increasing risk of lung cancer is may be higher in underweight male ever-smokers than in other participants.

CONCLUSION

Metabolic syndrome was associated with an increased risk of lung cancer in men. Moreover, the higher the number of metabolic syndrome components, the higher the risk of lung cancer.

Impact of cooking oil fume exposure and fume extractor use on lung cancer risk in non-smoking Han Chinese women

Smoking tobacco is the major risk factor for developing lung cancer. However, most Han Chinese women with lung cancer are nonsmokers. Chinese cooking methods usually generate various carcinogens in fumes that may inevitably be inhaled by those who cook the food, most of whom are female. We investigated the associations of cooking habits and exposure to cooking fumes with lung cancer among non-smoking Han Chinese women. This study was conducted on 1,302 lung cancer cases and 1,302 matched healthy controls in Taiwan during 2002-2010. Two indices, "cooking time-years" and "fume extractor use ratio," were developed. The former was used to explore the relationship between cumulative exposure to cooking oil fumes and lung cancer; the latter was used to assess the impact of fume extractor use for different ratio-of-use groups. Using logistic models, we found a dose-response association between cooking fume exposure and lung cancer (odds ratios of 1, 1.63, 1.67, 2.14, and 3.17 across increasing levels of cooking time-years). However, long-term use of a fume extractor in cooking can reduce the risk of lung cancer by about 50%. Furthermore, we provide evidence that cooking habits, involving cooking methods and oil use, are associated with risk of lung cancer.

Evaluation of the effectiveness of a portable air cleaner in mitigating indoor human exposure to cooking-derived airborne particles

Gas cooking is an important source of airborne particulate matter (PM) indoors. Exposure to cooking-derived PM can lead to adverse human health impacts on non-smokers, especially in poorly-ventilated residential homes. Most of the previous studies on gas cooking emissions mainly focused on fine particles (PM_2.5) with little information on their size-fractionation. Moreover, studies dealing with mitigation of indoor human exposure to cooking-derived PM are currently sparse. Therefore, a systematic study was conducted to investigate the characteristics of PM_2.5 and size-fractionated PM derived from five commonly used cooking methods, namely, steaming, boiling, stir-frying, pan-frying and deep-frying in a poorly-ventilated domestic kitchen under controlled experimental conditions. Additionally, an indoor portable air cleaner was employed as a mitigation device to capture cooking-derived PM and improve indoor air quality (IAQ). Results revealed that the oil-based deep-frying cooking released the highest airborne particles which were about 170 folds higher compared to the baseline levels for PM_2.5 mass concentrations. The use of the air cleaner showed a statistically significant (p < 0.05) reduction in the indoor PM_2.5 levels. Moreover, PM_<0.25 (particles with diameter ≤ 250 nm) showed a very high mass concentration (378.2 μg/m³) during deep-frying, raising human health concern. A substantial reduction (~60-85%) in PM_<0.25 mass concentrations and their total respiratory deposition doses (RDD) in the human respiratory tract was observed while using the air cleaner during the five cooking methods. Furthermore, morphological characteristics and the relative abundance of trace elements in cooking-derived PM were also investigated. This study provides useful insights into the assessment and mitigation of indoor human exposure to cooking-derived PM.

Lung cancer occurrence attributable to passive smoking among never smokers in China: a systematic review and meta-analysis

Background

Quantifying the occurrence of lung cancer due to passive smoking is a necessary step when forming public health policy. In this study, we estimated the proportion of lung cancer cases attributable to passive smoking among never smokers in China.

Methods

Six databases were searched up to July 2019 for original observational studies reporting relative risks (RRs) or odds ratios (ORs) for the occurrence of lung cancer associated with passive smoking in Chinese never smokers. The population attributable fraction (PAF) was then calculated using the combined proportion of lung cancer cases exposed to passive smoking and the pooled ORs from meta-analysis. Data are reported with their 95% confidence intervals.

Results

We identified 31 case-control studies of never smokers and no cohort studies. These comprised 9,614 lung cancer cases and 13,093 controls. The overall percentages of lung cancers attributable to passive smoking among never smokers were 15.5% (9.0-21.4%) for 9 population-based studies and 22.7% (16.6-28.3%) for 22 hospital-based studies. The PAFs for women were 17.9% (11.4-24.0%) for the population-based studies and 20.9% (14.7-26.7%) for the hospital-based studies. The PAF for men was only calculable for hospital-based studies, which was 29.0% (95% CI: 8.0-45.2%). Among women, the percentage of lung cancer cases attributable to household exposure (19.5%) was much higher than that due to workplace exposure (7.2%).

Conclusions

We conclude that approximately 16% of lung cancer cases among never smokers in China are potentially attributable to passive smoking. This is slightly higher among women (around 18%), with most cases occurring due to household exposure.

Potential Adverse Public Health Effects Afforded by the Ingestion of Dietary Lipid Oxidation Product Toxins: Significance of Fried Food Sources

Exposure of polyunsaturated fatty acid (PUFA)-rich culinary oils (COs) to high temperature frying practices generates high concentrations of cytotoxic and genotoxic lipid oxidation products (LOPs) via oxygen-fueled, recycling peroxidative bursts. These toxins, including aldehydes and epoxy-fatty acids, readily penetrate into fried foods and hence are available for human consumption; therefore, they may pose substantial health hazards. Although previous reports have claimed health benefits offered by the use of PUFA-laden COs for frying purposes, these may be erroneous in view of their failure to consider the negating adverse public health threats presented by food-transferable LOPs therein. When absorbed from the gastrointestinal (GI) system into the systemic circulation, such LOPs may significantly contribute to enhanced risks of chronic non-communicable diseases (NCDs), e.g. cancer, along with cardiovascular and neurological diseases. Herein, we provide a comprehensive rationale relating to the public health threats posed by the dietary ingestion of LOPs in fried foods. We begin with an introduction to sequential lipid peroxidation processes, describing the noxious effects of LOP toxins generated therefrom. We continue to discuss GI system interactions, the metabolism and biotransformation of primary lipid hydroperoxide LOPs and their secondary products, and the toxicological properties of these agents, prior to providing a narrative on chemically-reactive, secondary aldehydic LOPs available for human ingestion. In view of a range of previous studies focused on their deleterious health effects in animal and cellular model systems, some emphasis is placed on the physiological fate of the more prevalent and toxic α,β-unsaturated aldehydes. We conclude with a description of targeted nutritional and interventional strategies, whilst highlighting the urgent and unmet clinical need for nutritional and epidemiological trials probing relationships between the incidence of NCDs, and the frequency and estimated quantities of dietary LOP intake.

Daily cooking duration and its joint effects with genetic polymorphisms on lung cancer incidence: Results from a Chinese prospective cohort study

OBJECTIVES

In this study, we conducted a prospective cohort study to investigate the joint effects of daily cooking duration with single nucleotide polymorphisms (SNPs) on lung cancer incidence.

MATERIALS AND METHODS

A total of 33,868 individuals recruited in 2013 from Dongfeng-Tongji cohort study were included in our research, in which 5178 participants were genotyped. Daily cooking duration was accessed by questionnaire, and the incident lung cancer cases were confirmed. Fifteen lung cancer related SNPs were selected according to the previous reports. We used the multiple Cox regression models to evaluate the separate and joint effects of daily cooking duration and SNPs on lung cancer incidence.

RESULTS

Each 1-h increase in daily cooking duration was associated with a 17% elevated risk of lung cancer incidence [hazard ratio (HR) (95%CI) = 1.17(1.03, 1.33)]. Specifically, subjects with daily cooking duration >2 h/day had a 2.05-fold increased incident risk of lung cancer than those without cooking [HR(95%CI) = 2.05(1.20, 3.53)] (P_trend = 0.011). The rs2395185 and rs3817963, both located at 6p21.32, were significantly associated with lung cancer incidence. Compared with no cooking subjects with rs2395185GG or rs3817963TT genotype, subjects with daily cooking >2 h/day and carrying rs2395185GT + TT genotypes had a 2.48-fold increased risk of lung cancer [HR(95%CI) = 2.48(1.03, 5.97)], and there were significant joint effects of rs3817963TC + CC with daily cooking 1-2 and >2 h/day [HR(95%CI) = 2.23(1.07, 4.64) and 2.22(1.05, 4.68), respectively].

CONCLUSIONS

Longer daily cooking duration, especially daily cooking >2 h/day, was associated with increased risk of lung cancer. There were significant joint effects of rs2395185 and rs3817963 with daily cooking duration on lung cancer incidence. This study offered a new indicator of cooking related pollution exposure and added new evidence for the joint effects of environment and genetic factors on lung cancer incidence.

Cooking frequency and hypertension with gender as a modifier

Background

The effect of cooking frequency on hypertension is understudied. This study aimed to examine the effect of cooking on hypertension with a particular focus on gender differences.

Methods

The present study utilized cross-sectional data from China Kadoorie Biobank with a 512,891-population of China. Hypertension was identified by established diagnosis or by the 1999 WHO/ISH Guidelines for the Management of Hypertension on examination. Cooking frequency was obtained from a self-reported questionnaire and categorized as daily cooking, weekly or monthly cooking and never cooking. Multivariable logistic regression models were employed to examine the associations between cooking frequency and hypertension in men and women, respectively. Stratified analyses by demographic and socio-economic characteristics were conducted.

Results

Men who ever cooked had higher odds of hypertension compared with those who never cooked (weekly or monthly cooking adjusted odds ratio (AOR): 1.05, 95% CI: 1.02–1.07; Daily cooking AOR: 1.09, 95% CI: 1.06–1.11), while protective effects of cooking against hypertension were observed in women (weekly or monthly cooking AOR: 0.94, 95% CI: 0.89–0.99; daily cooking AOR: 0.96, 95% CI: 0.92–0.99). Socio-economic status including occupation, household income, education and region could further modify the effect of daily cooking on hypertension among men and women, respectively.

Conclusion

The present study highlighted the effect of cooking on hypertension. We found the opposite trends in men and women with regards to the association between cooking and hypertension. Factors relating to socio-economic status such as education, household income and occupation could further modify the gender-specific effects. Interventions to reduce hypertension should consider the gender differences in food choice and psycho-social stress related to cooking.

Cooking smoke exposure and respiratory symptoms among those responsible for household cooking: A study in Phitsanulok, Thailand

Cooking smoke affects the health of millions of people worldwide. In Thailand, however, information in regard to household cooking and the effects of cooking smoke is scarce. The objective of this descriptive study was to explore the risk factors and respiratory symptoms in household members responsible for household cooking. Participants from 1,134 rural households in Phitsanulok province, Thailand were randomly selected, using multistage sampling. Data on cooking activities and chronic respiratory problems, and symptoms identified in the past 30 days were collected using a modified questionnaire from the British Medical Research. Most of the participants were women aged over 40 years, who were responsible for food preparation in the household, and who usually cook with vegetable oil, using LPG gas, without a ventilation hood, according to the responses that we received, and our particular knowledge of household cooking facilities in rural areas in Thailand.

The most common chronic respiratory symptoms were runny nose (24.5% males, 21.8% females), dyspnea (26.1% females, 19.0% males) and chronic cough (9.2% females, 6.4% males). The most common respiratory symptoms experienced in the past 30 days were having a cold (28.3% females, 18.7% males), coughing (25.5% females, 21.1% ,males) and having sputum (13.0% females, 8.2% males). These symptoms were associated with tears while cooking, the number of hours present in the kitchen grilling food, and the number of stir-fried and deep-fried dishes prepared. This study demonstrated that cooking even with a clean fuel can quantitatively increase the risk of respiratory difficulties and symptoms. Since cooking is undertaken in every household in Thailand, this is a serious public health matter that demands more attention.

Polymorphism in CYP24A1 Is Associated with Lung Cancer Risk: A Case-Control Study in Chinese Female Nonsmokers

CYP24A1 plays important roles in antiproliferative effects, which have been proved in many human tumor cells. Polymorphisms in CYP24A1 may affect the risk of lung cancer, but the results remained inconclusive. To enhance the understanding of possible relationship between CYP24A1 polymorphism rs6068816 and lung cancer risks, we first carried out this case-control study among Chinese female nonsmokers, including 345 lung cancer patients and 351 noncancer controls. Our results revealed that individuals carrying CT and CC genotype were associated with decreasing lung cancer risk (adjusted odds ratios were 0.71 and 0.59, and 95% confidence intervals were 0.52-0.97 and 0.35-0.99, p-values were 0.031 and 0.048, respectively). Patients carrying allele-T showed lower hazard risks, especially in adenocarcinoma and advanced stage cancers. We also found that subjects with allele-T showed a relatively low risk of lung cancer when they were exposed to oil fume. But neither additive scale nor multiplicative scale revealed interactions between allele-T and environmental exposures, including oil fume, coal fuel fume, and passive smoking. Overall, these findings indicated that CYP24A1 polymorphism rs6068816 could be significantly associated with susceptibility of lung cancer in Chinese female nonsmokers.

Clinicopathological profile of lung cancer at a tertiary care center

BACKGROUND

Lung cancer is one of the most common malignancies with high morbidity and mortality. Nonsmall cell lung cancer (NSCLC) accounts for majority of cases. AIMS: This study aims to study the clinical and pathological features of lung cancer patients treated at our institute between January 2011 and December 2016.

SUBJECTS AND METHODS

It is a retrospective study. 446 patients of lung cancer were retrospectively analyzed for demographic data, history of smoking, histological type, and presence of epidermal growth factor receptor (EGFR) mutation/anaplastic lymphoma kinase (ALK) mutations.

RESULTS

Of the 446 patients analyzed, 304 (68%) were males and 142 (32%) were females, with the ratio being 2:1. Most of our patients had a lesion localizing to the right side (45.7%) than left (37.8%). NSCLC was reported in 81.1% of our patients. EGFR mutation was found in 60 (24%) patients, the most common mutation being the deletion of exon 19 (73%) followed by L858R mutation (21.6%).

CONCLUSIONS

EGFR and ALK mutation testing of all the lung cancer patients is to be encouraged as these mutations form druggable targets.

Gender differences and lung cancer risk in occupational chefs: analyzing more than 350,000 chefs in Taiwan, 1984-2011

OBJECTIVES

Cooking oil fumes (COFs) contain many carcinogens. We investigated the association between COFs and incidence risk of any cancer and lung cancer in chefs.

METHODS

We identified Chinese food chefs and non-Chinese food chefs from Taiwan's national database of certified chefs in 1984-2007. Of them, 379,275 had not been diagnosed as having any cancer before chef certification. We followed them in Taiwan's Cancer Registry Database (1979-2010) and Taiwan's National Death Statistics Database (1985-2011) for any newly diagnosed cancer or lung cancer.

RESULTS

378,126 and 379,215 chefs were included for risk analysis of cancer and lung cancer, respectively. 6099 chefs developed cancer and 339 developed lung cancer over the follow-up periods of 4,183,550 and 4,220,163 person-years, respectively. Compared to non-Chinese food chefs, the adjusted IRR of cancer for Chinese food chefs was 1.69 (95% CI 1.51-1.89). For lung cancer, the risk was significantly higher among Chinese food chefs who had been certified for more than 5 years (adjusted IRR 2.12, 95% CI 1.32-3.40). This increased risk was pronounced in female chefs (adjusted IRR 4.73, 95% CI 1.74-12.86).

CONCLUSIONS

Chinese food chefs had an increased risk of cancer and lung cancer, particularly in females.

CT-pathologic correlation in lung adenocarcinoma and squamous cell carcinoma

Distinguishing lung adenocarcinoma from squamous cell carcinoma (SCC) is clinically important. Computed tomography (CT) scan is an economical, effective, noninvasive, commonly available, and quick diagnostic way for lung cancer. In this study, we aim to compare the CT characteristics in adenocarcinoma and SCC.Data from 275 cases (259 adenocarcinoma and 16 SCC) were retrospectively compared. CT characteristics, including lesion size and shape, single/multifocal lesions, location of the tumor, the margin of lobes, whether the lesion had deep lobulated margin, bronchial cut-off sign, signs of dilated bronchial arteries, signs of vascular bundle thickening, signs of short burrs, spinous processes, and pleural indentation, were compared in 148 cases (137 adenocarcinoma and 11 SCC).Patients with adenocarcinoma were more likely to be female (44.2% vs 25.0%, P = .017). Compared with SCC, adenocarcinomas were more likely to have deep lobulated margin (81.0% vs 54.5%, P = .038), less likely to have smooth lobes margin (2.7% vs 83.3%, P < .001), more likely to have vascular bundle thickening (37.2% vs 0, P = .016) and pleural indentation (59.9% vs 18.2%, P = .01), and marginally less likely to have dilated bronchial arteries (17.5% vs 45.5%, P = .064). No significant difference was observed regarding to characteristics, including tumor size, location of the tumor, signs of bronchial cut-off, dilated bronchial arteries, short burrs, or spinous processes.CT scan has the potential to help to distinguish lung adenocarcinoma and SCC in a fast and commonly available way. CT could be a rough but fast way to diagnosis, and may thus shorten the waiting time to treatment and allow more time for clinicians, patients, and their families to prepare for future treatment.

Interaction Between Environmental Risk Factors and Catechol-O-Methyltransferase (COMT) and X-Ray Repair Cross-Complementing Protein 1 (XRCC1) Gene Polymorphisms in Risk of Lung Cancer Among Non-Smoking Chinese Women: A Case-Control Study

Backgrpound

Various studies have highlighted the link between polymorphisms in the XRCC1 gene (encoding X-ray repair cross-complementing group 1) with the incidence of decreased DNA repair capacity and an increased predisposition to cancer. Catechol-O-methyltransferase (COMT) plays a crucial role in estrogen-induced cancers. In the present study was analyzed the potential influence of XRCC1 and COMT gene polymorphisms as predisposing factors from a lung cancer perspective, in addition to conducting an investigation into their interaction with environmental risk factors in relation to lung cancer among non-smoking Chinese women.

Material/Methods

The XRCC1 gene T-77C, Arg194Trp, Arg280His, Arg399Gln, COMT gene 186C>T, and Val158Met mutations were evaluated in peripheral blood collected from 261 non-smoking female patients diagnosed with primary lung cancer and 265 female patients with benign lung disease.

Result

The results obtained from this study demonstrated that XRCC1–77TC + CC, XRCC1 399Gln/Gln, COMT 186CT + TT, COMT 158Val/Met genotypes, type of occupation, cooking-oil fumes, and soot exposures were all independent risk factors involved with the occurrence of lung cancer among non-smoking women. Moreover, interactions between environmental exposure factors as well as XRCC1 and COMT gene polymorphisms were determined to play significant contributory roles regarding susceptibility of non-smoking females to lung cancer.

Conclusions

Taken together, T-77C and Arg399Gln polymorphisms of the XRCC1 gene, as well as the 186C>T and Val158Met polymorphisms of the COMT gene, increased the risk of lung cancer in non-smoking women, with the factors of occupation type, cooking-oil fumes, and soot exposures representing key contributing factors.

Lung cancer in never smokers-the East Asian experience

Approximately one third of all lung cancer patients in East Asia are never-smokers. Furthermore, the proportion of lung cancer in never smokers (LCINS) has been increasing over time. Never-smokers are more often diagnosed with adenocarcinoma in East Asia, a subtype largely defined by oncogenic drivers. In this subgroup of patients, as high as 90% of patients have been found to harbor well-known oncogenic mutations and can be successfully managed with targeted therapies inhibiting specific oncogenic mutant kinases. EGFR tyrosine kinase inhibitor (EGFR-TKI) treatment has been the most important targeted therapy in lung adenocarcinoma from East Asian never-smokers as approximately 70% of these patients have the opportunity to receive EGFR-TKI treatment. Lung squamous cell carcinoma (SQCC) and small cell lung cancer (SCLC) are two common histologic types of smoking-related non-small cell lung cancer (NSCLC). The proportion of never-smokers with SQCC and SCLC in East Asian patients seems to be higher than that in Caucasian patients. Recent studies also suggest that lung SQCC and SCLC in never-smokers may be distinct subtypes. Therefore, better understanding of the biologic characteristics of these subtypes of patients may provide new insights for the treatment. In this review, we will provide an overview of East Asian experience in the treatment of advanced, never-smoking lung cancer, focusing on etiologic factors in the development of LCINS, targeted therapy for never-smokers with adenocarcinoma, distinct characteristics of never-smokers with lung SQCC and SCLC, and the role of immunotherapy in never-smokers with NSCLC.

Meta-Analysis and Systematic Review in Environmental Tobacco Smoke Risk of Female Lung Cancer by Research Type

More than 50% of women worldwide are exposed to Environmental Tobacco Smoke (ETS). The impact of ETS on lung cancer remains unclear. Cohort studies since the late 1990s have provided new evidence of female lung cancer risk due to ETS. The objective of this meta-analysis and systematic review was to analyze the association of ETS with female lung cancer risk from 1997 to 2017, organised based on research design. According to our applied inclusion and exclusion criteria, 41 published studies were included. The relative risk (RR) from the cohort studies or odds ratio (OR) from case-control studies were extracted to calculate the pooled risks based on the type of study. The summary risks of ETS were further explored with the modulators of ETS exposure sources and doses. The pooled risks of lung cancer in non-smoking women exposed to ETS were 1.35 (95% CI: 1.17⁻1.56), 1.17 (95% CI: 0.94⁻1.44), and 1.33 (95% CI: 1.17⁻1.51) for case-control studies, cohort studies, and both types of studies, respectively. The summary RR estimate of the cohort studies was not statistically significant, but the RR increased with increasing doses of ETS exposure (p trend < 0.05). Based on the results of this study, ETS might be an important risk factor of female lung cancer in non-smokers.

Female non-smokers' environmental tobacco smoking exposure by public transportation mode

Background

This study aimed to analyze environmental tobacco smoking exposure in female nonsmokers by public transportation mode using representative data of Koreans.

Methods

Data from the Second Korean National Environmental Health Survey (2012–2014) were analyzed. Urine cotinine was analyzed by public transport behavior, secondhand smoke exposure, socioeconomic factors, and health-related factors. Participants were 1322 adult females; those with the top 75% urine cotinine concentrations were assigned to the high exposure group. A logistic regression analysis was performed considering appropriate weights and stratification according to the sample design of the Second Korean National Environmental Health Survey.

Results

The geometric mean of urine cotinine concentrations differed according to public transportation modes: subway (1.66 μg/g creatinine) bus (1.77 μg/g creatinine), and taxi (1.94 μg/g creatinine). The odds ratio [OR] was calculated for the high exposure group. The OR of the taxi (2.39; 95% confidence interval, 1.00–5.69) was statistically significantly higher than the subway value (reference), and marginally significant after adjusted with life style, sociodemographic factors and involuntary smoking frequency (2.42, 95% confidence interval, 0.97–6.04).

Conclusions

The odds ratio of passengers who mainly used taxis was marginally significantly higher than those of passengers who used subways and buses after adjusted with life style and sociodemographic factors. Implementation of supplementary measures and further studies on exposure to environmental tobacco smoking in taxis are warranted.

Trends in the incidence rate of lung cancer by histological type and gender in Sichuan, China, 1995-2015: A single-center retrospective study

BACKGROUND

In recent years, lung cancer incidence has been increasing; however the impact of different histological types of lung cancer is not yet clear.

METHODS

Trends in the lung cancer incidence rate by histological type were examined based on data of 36 658 primary lung cancer patients from West China Hospital between 1995 and 2015.

RESULTS

The most common histological type of lung cancer in our hospital was adenocarcinoma (ADC) in both genders, followed by squamous cell carcinoma (SQCC), and small cell carcinoma (SCLC), which is consistent with general worldwide trends. The proportion of young patients with SCLC showed a downward trend. In the overall population with lung cancer, the number of elderly patients with lung cancer increased significantly, while the proportion of elderly patients increased gradually. The mean age at diagnosis also increased. The number of women with ADC increased sharply in recent years, especially in young patients, and the incidence rate in women is now greater than in men.

CONCLUSION

Significant increases in the number of patients with ADC and the rate of lung cancer in women over recent years were observed, indicating that research on the pathogenesis of disease in these patients is urgent.

Metastatic nonsmall cell lung cancer in South India: A regional demographic study

BACKGROUND

Nonsmall cell lung cancer (NSCLC) has varying epidemiological patterns in different countries and also in different regions of each country. In a country with a high prevalence of lung cancer such as India, regional variations in demography exist.

AIM

A study of unique demographic trends of metastatic NSCLC patients presenting to our regional cancer center.

MATERIALS AND METHODS

We did a retrospective analysis of histologically confirmed metastatic NSCLC patients who presented to our Department of Medical Oncology between August 2012 and July 2014.

RESULTS

A total of 304 patients were analyzed. About 55.6% of the patients were in the age group of 41-60 years. About 79.6% of the patients were symptomatic for <6 months before presentation. About 63.5% of the patients were smokers presenting with a median age of 59 years whereas nonsmokers formed 36.51% of the patients presenting with a median age of 47 (P < 0.001). About 82.6% of the male patients and 4.1% of female patients were smokers. Equal number of all patients had adenocarcinoma (AC) and squamous cell carcinoma (SCC) histology. AC histology was more common in the nonsmoking group (62% of patients). SCC histology was seen in 54.3% of smokers. Metastasis to the contralateral lung and pleura was seen in 58.2% of patients.

CONCLUSION

NSCLC presents at a young age. Smoking is a significant risk factor and it is common in the urban populations as in the rural areas. Both AC and SCC histologies presented in equal proportions.

The risk of lung cancer among cooking adults: a meta-analysis of 23 observational studies

PURPOSE

Cooking has been regarded as a potential risk factor for lung cancer. We aim to investigate the evidence of cooking oil fume and risk of lung cancer.

METHODS

Medline and Embase were searched for eligible studies. We conducted a meta-analysis to summarize the evidences of case-control or cohort studies, with subgroup analysis for the potential discrepancy. Sensitivity analysis was employed to test the robustness.

RESULTS

We included 23 observational studies, involving 9411 lung cancer cases. Our meta-analysis found that, for cooking female, the pooled OR of cooking oil fume exposure was 1.98 (95% CI 1.54, 2.54, I ² = 79%, n = 15) among non-smoking population and 2.00 (95% CI 1.46, 2.74, I ² = 75%, n = 10) among partly smoking population. For cooking males, the pooled OR of lung cancer was 1.15 (95% CI 0.71, 1.87; I ² = 80%, n = 4). When sub grouped by ventilation condition, the pooled OR for poor ventilation was 1.20 (95% CI 1.10, 1.31, I ² = 2%) compared to good ventilation. For different cooking methods, our results suggested that stir frying (OR = 1.89, 95% CI 1.23, 2.90; I ² = 66%) was associated with increased risk of lung cancer while not for deep frying (OR = 1.41, 95% CI 0.87, 2.29; I ² = 5%). Sensitivity analysis suggested our results were stable.

CONCLUSION

Cooking oil fume is likely to be a risk factor for lung cancer for female, regardless of smoking status. Poor ventilation may increase the risk of lung cancer. Cooking methods may have different effect on lung cancer that deep frying may be healthier than stir frying.

National and Subnational Population-Based Incidence of Cancer in Thailand: Assessing Cancers with the Highest Burdens

In Thailand, five cancer types-breast, cervical, colorectal, liver and lung cancer-contribute to over half of the cancer burden. The magnitude of these cancers must be quantified over time to assess previous health policies and highlight future trajectories for targeted prevention efforts. We provide a comprehensive assessment of these five cancers nationally and subnationally, with trend analysis, projections, and number of cases expected for the year 2025 using cancer registry data. We found that breast (average annual percent change (AAPC): 3.1%) and colorectal cancer (female AAPC: 3.3%, male AAPC: 4.1%) are increasing while cervical cancer (AAPC: -4.4%) is decreasing nationwide. However, liver and lung cancers exhibit disproportionately higher burdens in the northeast and north regions, respectively. Lung cancer increased significantly in northeastern and southern women, despite low smoking rates. Liver cancers are expected to increase in the northern males and females. Liver cancer increased in the south, despite the absence of the liver fluke, a known factor, in this region. Our findings are presented in the context of health policy, population dynamics and serve to provide evidence for future prevention strategies. Our subnational estimates provide a basis for understanding variations in region-specific risk factor profiles that contribute to incidence trends over time.

Increasing frequency of non-smoking lung cancer: Presentation of patients with early disease to a tertiary institution in the UK

BACKGROUND

Never-smokers with lung cancer often present late as there are no established aetiological risk factors. The aim of the study is to define the frequency over time and characterise clinical features of never-smokers presenting sufficiently early to determine if it is possible to identify patients at risk.

METHODS

We retrospectively analysed data from a prospectively collected database of patients who underwent surgery. The frequency was defined as number of never-smokers versus current and ex-smokers by year. Clinical features at presentation were collated as frequency.

RESULTS

A total of 2170 patients underwent resection for lung cancer from March 2008 to November 2014. The annual frequency of developing lung cancer in never-smokers increased from 13% to 28%, attributable to an absolute increase in numbers and not simply a change in the ratio of never-smokers to current and ex-smokers. A total of 436 (20%) patients were never-smokers. The mean age was 60 (16 SD) years and 67% were female. Presenting features were non-specific consisting of cough in 34%, chest infections in 18% and haemoptysis in 11%. A total of 14% were detected on incidental chest film, 30% on computed tomography, 7% on positron-emission tomography/computed tomography and 1% on MRI.

CONCLUSIONS

We observed more than a double of the annual frequency of never-smokers in the last 7 years. Patients present with non-specific symptoms and majority were detected on incidental imaging, a modality that is likely to play an increasingly important role for early detection in this cohort that does not have any observable clinical risk factors.

Accumulative effects of indoor air pollution exposure on leukocyte telomere length among non-smokers

Indoor air pollution is an important environmental factor that contributes to the burden of various diseases. Long-term exposure to ambient air pollution is associated with telomere shortening. However, the association between chronic indoor air pollution from household fuel combustion and leukocyte telomere length has not been studied. In our study, 137 cancer-free non-smokers were recruited. Their exposure levels to indoor air pollution from 1985 to 2014 were assessed using a face-to-face interview questionnaire, and leukocyte telomere length (LTL) was measured using a monochrome multiplex quantitative PCR method. Accumulative exposure to solid fuel usage for cooking was negatively correlated with LTL. The LTL of residents who were exposed to solid fuel combustion for three decades (LTL = 0.70 ± 0.17) was significantly shorter than that of other populations. In addition, education and occupation were related to both exposure to solid fuel and LTL. Sociodemographic factors may play a mediating role in the correlation between leukocyte telomere length and environmental exposure to indoor air pollution. In conclusion, long-term exposure to indoor air pollution may cause LTL dysfunction.

Lung cancer-A global perspective

Lung cancer is the leading cause of cancer deaths worldwide. While tobacco exposure is responsible for the majority of lung cancers, the incidence of lung cancer in never smokers, especially Asian women, is increasing. There is a global variation in lung cancer biology with EGFR mutations being more common in Asian patients, while Kras mutation is more common in Caucasians. This review will focus on the global variations in lung cancer and its treatment.

Cooking smoke and respiratory symptoms of restaurant workers in Thailand

Background

Restaurant workers are at risk from exposure to toxic compounds from burning of fuel and fumes from cooking. However, the literature is almost silent on the issue. What discussion that can be found in the literature focuses on the potential effects from biomass smoke exposure in the home kitchen, and does not address the problem as occurring in the workplace, particularly in restaurants.

Methods

This was a cross-sectional survey of 224 worker from 142 food restaurants in the Tha Pho sub-district of Phitsanulok, a province in Thailand. The standard questionnaire from the British Medical Research Council was used to collect data on chronic respiratory symptoms, including cough, phlegm, dyspnea, severe dyspnea, stuffy nose in the participating workers. Data on their health symptoms experienced in the past 30 days was also asked. A constructed questionnaire was used to collect exposure data, including type of job, time in the kitchen, the frequency of frying food, tears while cooking (TWC), the type of restaurant, fuel used for cooking, the size and location of the kitchen, and the exhaust system and ventilation. The prevalence of the symptoms was compared with those obtained from 395 controls, who were neighbors of the participants who do not work in a restaurant.

Results

In comparison to the control group, the restaurant workers had twice or more the prevalence on most of the chronic health symptoms. Men had a higher risk for “dyspnea”, “stuffy nose” and “wheeze” while women had higher risk of “cough”. A Rate Ratio (RR) of susceptibility was established, which ranged from 1.4 up to 9.9. The minimum RR was for women with “severe dyspnea” (RR of 1.4, 95%CI 0.8, 2.5) while the men showed the maximum RR of 9.9 (95%CI 4.5–22.0) for “wheeze”. Possible risk factors identified were job description, job period, size of restaurant, kitchen location, type of cooking oil, hours of stay in the kitchen area, number of fry dishes prepared, frequency of occurrence of TWC, and additional cooking at home. Working for 6–10 year increased the risk of “cough” with an Odd Ratio (OR) of 3.19 (P < 0.01) while working for more than 10 years increased the risk of “cough” (OR = 3.27, P < 0.01), “phlegm” (OR = 3.87, P = 0.01) and “wheeze” (OR = 2.38, P = 0.05). Working as a chef had a higher risk of “cough” by 2.33 (P = 0.01) as comparing to other jobs. Workers in a relatively large restaurant using 4 or more stoves had increased risk of “wheeze” with OR of 3.81 (P < 0.01) and “stuffy nose” with OR of 3.56 (P < 0.01). Using vegetable oil increased the risk of “stuffy nose” by 2.94 (P < 0.01). Every 10 h of stay in the kitchen area was associated with a minimal increase in the risk of “cough”, “wheeze” and “symptoms in the past 30 days” by 1.15 (P = 0.02), 1.16 (P = 0.01) and 1.16 (P = 0.02), respectively.

Conclusions

Restaurant workers are at risk of respiratory symptoms caused by exposure to toxic compounds from cooking fumes. Job description, job period, size of restaurant, kitchen location, type of cooking oil, hours of stay in the kitchen area, number of fry dishes prepared, frequency of occurrence of TWC, and additional cooking at home were the predictive factors. Workplace Health and Safety protection of restaurant worker is urgently needed and the issue should receive more public attention.

Evaluation of Potential Average Daily Doses (ADDs) of PM2.5 for Homemakers Conducting Pan-Frying Inside Ordinary Homes under Four Ventilation Conditions

Several studies reported that commercial barbecue restaurants likely contribute to the indoor emission of particulate matters with a diameter of 2.5 micrometers or less (PM_2.5) while pan-frying meat. However, there is inadequate knowledge of exposure level to indoor PM_2.5 in homes and the contribution of a typical indoor pan-frying event. We measured the indoor PM_2.5 concentration and, using Monte-Carlo simulation, estimated potential average daily dose (ADD) of PM_2.5 for homemakers pan-frying a piece of pork inside ordinary homes. Convenience-based sampling at 13 homes was conducted over four consecutive days in June 2013 (n = 52). Although we pan-fried 100 g pork for only 9 min, the median (interquartile range, IQR) value was 4.5 (2.2-5.6) mg/m³ for no ventilation and 0.5 (0.1-1.3) mg/m³ with an active stove hood ventilation system over a 2 h sampling interval. The probabilities that the ADDs from inhalation of indoor PM_2.5 would be higher than the ADD from inhalation of PM_2.5 on an outdoor roadside (4.6 μg/kg·day) were 99.44%, 97.51%, 93.64%, and 67.23%, depending on the ventilation conditions: (1) no window open; (2) one window open in the kitchen; (3) two windows open, one each in the kitchen and living room; and (4) operating a forced-air stove hood, respectively.