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Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines Online Only Articles |

Epidemiology of Lung CancerEpidemiology of Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Anthony J. Alberg, PhD, MPH; Malcolm V. Brock, MD; Jean G. Ford, MD, MPH, FCCP; Jonathan M. Samet, MD, FCCP; Simon D. Spivack, MD, MPH
Author and Funding Information

From the Hollings Cancer Center (Dr Alberg) and the Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC; Department of Surgery (Dr Brock), School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology (Dr Ford), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Preventive Medicine (Dr Samet), Keck School of Medicine, University of Southern California, Los Angeles, CA; and Division of Pulmonary Medicine (Dr Spivack), Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.

Correspondence to: Anthony J. Alberg, PhD, MPH, Hollings Cancer Center, Medical University of South Carolina, 68 President St, MSC 955, Charleston, SC 29425; e-mail: alberg@musc.edu


Dr Ford is currently at the Department of Medicine, Brooklyn Hospital Center (Brooklyn, NY).

Funding/Sponsors: The overall process for the development of these guidelines, including matters pertaining to funding and conflicts of interest, are described in the methodology article.1 The development of this guideline was supported primarily by the American College of Chest Physicians. The lung cancer guidelines conference was supported in part by a grant from the Lung Cancer Research Foundation. The publication and dissemination of the guidelines was supported in part by a 2009 independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.

COI grids reflecting the conflicts of interest that were current as of the date of the conference and voting are posted in the online supplementary materials.

Disclaimer: American College of Chest Physician guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this guideline can be accessed at http://dx.doi.org/10.1378/chest.1435S1.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(5_suppl):e1S-e29S. doi:10.1378/chest.12-2345
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Background:  Ever since a lung cancer epidemic emerged in the mid-1900s, the epidemiology of lung cancer has been intensively investigated to characterize its causes and patterns of occurrence. This report summarizes the key findings of this research.

Methods:  A detailed literature search provided the basis for a narrative review, identifying and summarizing key reports on population patterns and factors that affect lung cancer risk.

Results:  Established environmental risk factors for lung cancer include smoking cigarettes and other tobacco products and exposure to secondhand tobacco smoke, occupational lung carcinogens, radiation, and indoor and outdoor air pollution. Cigarette smoking is the predominant cause of lung cancer and the leading worldwide cause of cancer death. Smoking prevalence in developing nations has increased, starting new lung cancer epidemics in these nations. A positive family history and acquired lung disease are examples of host factors that are clinically useful risk indicators. Risk prediction models based on lung cancer risk factors have been developed, but further refinement is needed to provide clinically useful risk stratification. Promising biomarkers of lung cancer risk and early detection have been identified, but none are ready for broad clinical application.

Conclusions:  Almost all lung cancer deaths are caused by cigarette smoking, underscoring the need for ongoing efforts at tobacco control throughout the world. Further research is needed into the reasons underlying lung cancer disparities, the causes of lung cancer in never smokers, the potential role of HIV in lung carcinogenesis, and the development of biomarkers.


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