Smoking, occupational risk factors, and bronchial tumor location: a possible impact for lung cancer computed tomography scan screening.
BACKGROUND
The aim of this study was to describe associations between lung tumor location and smoking as well as selected occupational exposures. In the context of lung cancer screening by computed tomography scan, tumor location may have an interest. Computed tomography scan is known to better detect more peripheral tumors.


METHODS
Lung cancer cases diagnosed in two French University hospitals between 1997 and 2009 were included. Tumors visible on white-light bronchoscopy were defined as central. Occupational exposures were assessed by the same expert. Data were analyzed by case-case comparisons using unconditional logistic regressions.


RESULTS
A total of 1701 cases were included, comprising mainly men (86.3%), current smokers (52.8%), or former smokers (42.8%). Main histological subtypes of cancer were adenocarcinomas (33.8%) and squamous cell carcinomas (32.6%). The tumor location was found to be central in 61% of cases, and never smokers and women had more often peripheral tumors. Exposure to asbestos was significantly associated with central location with dose-response relationship (odds ratio [OR] for peripheral tumors = 0.45, 95% confidence interval [CI] 0.29-0.70) for the highest level of exposure. Exposure to silica dust was significantly associated with peripheral tumor (OR for peripheral tumors = 3.28, 95%CI 1.50-7.17) for the highest level of exposure. Exposure to welding fumes was associated with central location (OR for peripheral tumors = 0.51, 95% CI 0.26-0.96) for the first level of exposure).


CONCLUSIONS
Smoking characteristics and occupational exposures have to be considered to define more accurately high-risk populations suitable for lung cancer screening or early detection programs.
Occupational Diseases Department, University Hospitals, Strasbourg, France.
Maria
M
Gonzalez
Jean-Michel
JM
Vignaud
Christelle
C
Clement-Duchene
Amandine
A
Luc
Pascal
P
Wild
Odile
O
Bertrand
Luc
L
Thiberville
Yves
Y
Martinet
Jacques
J
Benichou
Christophe
C
Paris
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D001194:Asbestos / Q000009:adverse effects; D001984:Bronchial Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D001999:Bronchoscopy; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D018287:Carcinoma, Large Cell / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D018288:Carcinoma, Small Cell / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004391:Dust; D005260:Female; D005740:Gases / Q000009:adverse effects; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008168:Lung / Q000473:pathology*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D016017:Odds Ratio; D012737:Sex Factors; D012822:Silicon Dioxide / Q000009:adverse effects; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D014896:Welding; D055815:Young Adult
D004391:Dust; D005740:Gases; D001194:Asbestos; D012822:Silicon Dioxide