Lung cancer incidence in never smokers.
OBJECTIVE
Lung cancer is a leading cause of cancer death worldwide. Although smoking remains the predominant cause of lung cancer, lung cancer in never smokers is an increasingly prominent public health issue. However, data on this topic, particularly lung cancer incidence rates in never smokers, are limited.


METHODS
We reviewed the existing literature on lung cancer incidence and mortality rates among never smokers and present new data regarding rates in never smokers from the following large, prospective cohorts: Nurses' Health Study; Health Professionals Follow-Up Study; California Teachers Study; Multiethnic Cohort Study; Swedish Lung Cancer Register in the Uppsala/Orebro region; and First National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study.


RESULTS
Truncated age-adjusted incidence rates of lung cancer among never smokers age 40 to 79 years in these six cohorts ranged from 14.4 to 20.8 per 100,000 person-years in women and 4.8 to 13.7 per 100,000 person-years in men, supporting earlier observations that women are more likely than men to have non-smoking-associated lung cancer. The distinct biology of lung cancer in never smokers is apparent in differential responses to epidermal growth factor receptor inhibitors and an increased prevalence of adenocarcinoma histology in never smokers.


CONCLUSIONS
Lung cancer in never smokers is an important public health issue, and further exploration of its incidence patterns, etiology, and biology is needed.
Wakelee
Heather A
HA
Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, USA. hwakelee@stanford.edu
Chang
Ellen T
ET
Gomez
Scarlett L
SL
Keegan
Theresa H
TH
Feskanich
Diane
D
Clarke
Christina A
CA
Holmberg
Lars
L
Yong
Lee C
LC
Kolonel
Laurence N
LN
Gould
Michael K
MK
West
Dee W
DW
D000230:Adenocarcinoma / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D013548:Sweden / Q000453:epidemiology; D014481:United States / Q000453:epidemiology