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Risk Factors for Lung Cancer Risk factors for lung cancer An overview of the evidence 2014 Risk factors for lung cancer: an overview of the evidence was prepared and produced by: Cancer Australia Locked Bag 3 Strawberry Hills NSW 2012 Australia Tel: +61 2 9357 9400 Fax: +61 2 9357 9477 canceraustralia.gov.au © Cancer Australia 2014. Published with minor amendments. ISBN Print: 978-1-74127-269-7 ISBN Online: 978-1-74127-262-8 Recommended citation Cancer Australia, 2014. Risk factors for lung cancer: an overview of the evidence, Cancer Australia, Surry Hills, NSW. Risk factors for lung cancer: an overview of the evidence can be downloaded from the Cancer Australia website: canceraustralia.gov.au or ordered by telephone: 1800 624 973. Copyright statements Paper-based publications This work is copyright. You may reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from Cancer Australia to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Publications and Copyright contact officer, Cancer Australia, Locked Bag 3, Strawberry Hills, NSW 2012. Internet sites This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from Cancer Australia to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Publications and Copyright contact officer, Cancer Australia, Locked Bag 3, Strawberry Hills, NSW 2012. Disclaimer Cancer Australia does not accept any liability for any injury, loss or damage incurred by use of or reliance on the information. Cancer Australia develops material based on the best available evidence, however it cannot guarantee and assumes no legal liability or responsibility for the currency or completeness of the information. Foreword Lung cancer is the fourth most common cancer diagnosed in both men and women in Australia and the leading cause of cancer death. Risk factors for lung cancer: an overview of the evidence is a comprehensive, evidence-based summary of factors that affect a person’s risk of developing lung cancer, based on a systematic review of the international literature commissioned by Cancer Australia. This overview aims to increase awareness and understanding of the key lifestyle, environmental and occupational factors that affect lung cancer risk, in addition to the role of family history. The overview also highlights factors where the evidence is either limited or inconsistent in relation to risk of lung cancer. We anticipate the overview will be a valuable resource to support health professionals, policy makers and the community with evidence about exposure to risk factors for lung cancer, to increase understanding of those who may be at greatest risk of lung cancer, and to inform interventions to ultimately reduce the burden of lung cancer. Helen Zorbas AO CEO Cancer Australia Risk factors for lung cancer | An overview of the evidence i Contents Foreword i Family history 24 Executive summary v Factors with limited evidence of an association with lung cancer 25 Background 1 Consumption of red meat and What is lung cancer? 1 processed meat 25 Lung cancer in Australia 1 Alcohol consumption 26 What is a risk factor? 1 Dietary and blood cholesterol 26 How do we measure risk? 1 Exposure to birds 27 About this overview 3 Exposure to wood dust 27 What does this overview mean Physical activity 28 for individuals? 4 Glossary 29 Tobacco smoking 5 Appendix 1 Active smoking 5 International Agency for Research Passive smoking 7 on Cancer (IARC) 31 Environmental and occupational References 32 risk factors 8 Radon 8 Arsenic 10 Polycyclic aromatic hydrocarbons 12 Cadmium 13 Asbestos 14 Silica 16 Iron and steel founding 17 Nickel 18 Beryllium 20 Painting as an occupation 21 Chromium VI 22 Air pollution 23 Risk factors for lung cancer | An overview of the evidence iii Acknowledgments Cancer Australia gratefully acknowledges the contributions to the development of Risk factors for lung cancer: an overview of the evidence from: the Project Working Group, which provided expert guidance and direction to the project the Joanna Briggs Institute, University of Adelaide, which was commissioned by Cancer Australia to undertake a systematic review of national and international literature regarding risk factors for lung cancer, which formed the basis of this overview Biotext Pty Ltd, which was commissioned by Cancer Australia to summarise the findings of the systematic review and contributed technical editing and design. Project Working Group Mr Andrew Bowen, consumer Professor Kwun Fong, Thoracic and Sleep Physician; Professor, School of Medicine, University of Queensland Professor Don Iverson, Behavioural Scientist; Executive Dean, Faculty of Science, Medicine and Health, University of Wollongong Professor Bernard Stewart, Environmental Cancer Specialist and Head, Cancer Control Program, South East Sydney Local Health District Professor David Roder: Cancer Epidemiologist; Chair of Cancer Epidemiology and Population Health, University of South Australia Cancer Australia Ms Sue Sinclair, General Manager, Service Development and Clinical Practice Dr Vivienne Milch, Medical Officer Ms Liz King, Manager, Lung Cancer Ms Kathleen Mahoney, Senior Project Officer, Lung Cancer Dr Rona Hiam, Clinical and Primary Care Adviser, Lung Cancer Ms Julie Mueller, Project Manager, Lung Cancer Funding The development of this overview was funded by the Australian Government through Cancer Australia. iv Risk factors for lung cancer | An overview of the evidence Executive summary Tobacco smoking Active smoking In Australia, lung cancer is the fourth most common cancer in both men and women, and the fifth most Active smoking refers to smoking tobacco in any commonly diagnosed cancer overall.1 Lung cancer form, but does not include exposure to other people’s causes more deaths than any other cancer, accounting tobacco smoke (passive smoking). There is clear for 18.9% of all cancer deaths.2 A person’s chance evidence that active smoking significantly increases of developing lung cancer may be increased by a a person’s risk of developing lung cancer.4 Overall, number of factors, known as risk factors. Risk factors current smokers are approximately 9 times more likely can include behaviours (such as tobacco smoking), to develop lung cancer than people who have never chemical agents in the environment or the workplace smoked (relative risk 9.0).5 Former smokers are almost (such as asbestos, arsenic or radon) or a family history 4 times more likely to develop lung cancer than of cancer. Some risk factors are modifiable, meaning people who have never smoked (relative risk 3.9).5 The the risk can be altered by changing behaviour or length of time since quitting smoking varied among adopting safety measures. Other risk factors, such as studies of ‘former smokers’, but was at least one year age, are regarded as non-modifiable. in the studies that specified a timeframe.5 The more a person smokes, the greater their risk of developing This overview summarises the evidence for a range lung cancer. For example, men who smoke more than of factors that are associated with a person’s risk of 20 cigarettes per day are almost 14 times more likely to developing lung cancer, and is based on a systematic develop lung cancer than people who do not smoke 3 review of published scientific studies. The systematic (relative risk 13.7)5 while those who smoke fewer review examined the published research on than 10 cigarettes per day are 1.4 times more likely primary lung cancer up to April 2011 to identify any to develop lung cancer than non-smokers.5 Smoking associations between particular risk factors and lung can also interact with other lung cancer risk factors to cancer, and to determine the magnitude of each risk. further compound a person’s risk. Pleural mesothelioma, however, is not regarded as a malignant tumour of the lung in the current version of the international coding standards for cancer, and is Passive smoking not considered in this report. Passive smoking occurs when tobacco smoke is A person’s risk of developing lung cancer can be inhaled by people other than through active smoking presented as either absolute risk or relative risk. (i.e. exposure to other people’s tobacco smoke). It Absolute risk is a person’s chance of developing lung is most common in indoor settings, where smoke cancer over a specified time period, while relative may not be as easily dispersed as it is outdoors. risk describes how many times more likely a person Passive smoking does not present as pronounced a exposed to the risk factor is of developing lung cancer risk as active smoking, although the risk can still be than a person who is not exposed to the risk factor.
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