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Original Research: LUNG CANCER |

Association Between Sputum Atypia and Lung Cancer Risk in an Occupational Cohort in Yunnan, China

Ya-Guang Fan, MD; Ping Hu, SM, ScD; Yong Jiang, MPH; Run-Sheng Chang, MD; Shu-Xiang Yao, MD; Wendy Wang, PhD; Jie He, MD; Philip Prorok, PhD; You-Lin Qiao, MD, PhD
Author and Funding Information

*From the Department of Biology (Dr. Fan), Institute of Radiation Medicine, Chinese Academy of Medical Sciences, Tianjin, People's Republic of China; Department of Cancer Epidemiology (Drs. Jiang and Qiao), Cancer Institute, Chinese Academy of Medical Sciences, Beijing, People's Republic of China; Third People's Hospital of Honghe Autonomous District (Dr. Chang), Gejiu, Yunnan Province, People's Republic of China; Department of Epidemiology (Dr. Yao), Kunming Medical College, Kunming, Yunnan Province, People's Republic of China; Cancer Biomarkers Research Group (Dr. Wang), Division of Cancer Prevention, National Cancer Institute/National Institute of Health, Bethesda, MD; Cancer Institute (Dr. He), Chinese Academy of Medical Sciences, Beijing, People's Republic of China; and Biometry Research Group (Drs. Hu and Prorok), Divisions of Cancer Prevention, National Cancer Institute/National Institute of Health, Bethesda, MD.

Correspondence to: Ping Hu, SM, ScD, Mathematical Statistician, Biometry Research Group, Divisions of Cancer Prevention, National Cancer Institute/National Institute of Health, Executive Plaza North, Suite 3131, 6130 Executive Blvd, MSC 7354, Bethesda, MD 20892-7354; e-mail: ph107y@nih.gov


None of the authors have any financial interests in the subject matter or any actual or potential conflicts of interest.

This study was supported by the National Cancer Institute/National Institutes of Health, grant No. 263-MQ-511694. This article describes an ancillary study for the National Cancer Institute project “The Study of Early Markers of Lung Cancer Among Tin Miners in Yunnan China,” a federally funded registered clinical trial.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(3):778-785. doi:10.1378/chest.08-1469
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Background:  Individuals with cytologic atypia in sputum may be at high risk for the development of lung cancer.

Methods:  A prospective cohort study was conducted among occupational tin miners in Yunnan China based on an annual lung cancer screening program. Sputum samples were collected prospectively at baseline and the following seven annual screenings. The associations between risk factors and sputum cytology were analyzed by univariate and multivariate logistic regression. A proportional hazard model was used to analyze the association between the baseline sputum results and the incidence of lung cancer. The effect of consecutive sputum cytology on the increase of lung cancer risk was analyzed by logistic regression.

Results:  Sputum cytologic atypia was associated with age, smoking, occupational radon and arsenic exposure, and asthma. Sputum cytologic atypia was an independent risk factor for lung cancer with an adjusted hazard ratio (HR) of 3.82 (95% confidence interval [CI], 2.82 to 5.18) in comparing normal to moderate or worse atypia. Compared to the lung cancer risk associated with normal sputum, the risk was significantly higher according to the degree of atypia for squamous carcinomas, small cell lung cancer and central lung cancer, with adjusted HRs of 5.70 (95% CI, 3.78 to 8.59), 3.32 (95% CI, 1.31 to 8.45), and 4.93 (95% CI, 3.51 to 6.92), respectively.

Conclusions:  Sputum atypia is associated with an increased risk of lung cancer. Sputum cytologic examination combined with other screening examinations may play an important role in the early detection of lung cancer or in the selection of the optimal target population for more intensive lung cancer screening among this occupational cohort or similar population.

Trial registration:  Clinicaltrials.gov Identifier: NCT00340405.


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