Epidemiology of lung cancer and lung cancer screening programs in China and the United States

Lung cancer is a heterogeneous disease that is impacted by environmental exposures and by constitutional genetic or epigenetic susceptibilities to disease development and progression. The United States and China have distinct and diverse populations and geographic environmental exposures that contri...

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Published in:	Cancer letters Vol. 468; pp. 82 - 87
Main Authors:	Yang, Dawei, Liu, Yang, Bai, Chunxue, Wang, Xiandong, Powell, Charles A.
Format:	Journal Article
Language:	English
Published:	Clare Elsevier B.V 01.01.2020 Elsevier Limited
Subjects:	Air pollution Cancer screening Epidemiology ETS Incidence LDCT Legislation Lung cancer Mortality PM2.5 Pollutants Risk factors Smoking Trends Womens health United States > US China LDCT ETS Mortality PM2.5 Incidence
ISSN:	0304-3835, 1872-7980, 1872-7980
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Abstract	Lung cancer is a heterogeneous disease that is impacted by environmental exposures and by constitutional genetic or epigenetic susceptibilities to disease development and progression. The United States and China have distinct and diverse populations and geographic environmental exposures that contribute to unique patterns of lung cancer incidence and mortality. In this paper, the authors compare trends of incidence and mortality of lung cancer in the US and China, and the impact on lung cancer screening programs in the two countries. It is worth noting that the mortality of lung cancer in the US has decreased gradually while in China it is still increasing over recent years. While decreasing smoking prevalence and the impact of clean air legislation have helped to mitigate the trend in the US relative to China, the increasingly widespread implementation of lung cancer chest CT screening is expected to impact lung cancer incidence and mortality in both countries. Currently there are few studies to compare the environmental and genetic risk factors for US and Chinese populations with regards to lung cancer incidence and mortality. The authors discuss the impact of gender and exposure risks, mainly smoking and environmental pollutants. Of high importance is the incidence of lung cancer in never smokers that is significantly higher in China than in the United States; this is particularly notable in women. These data suggest inclusion of ambient air pollution exposure and gender into lung cancer risk prognostic models to better capture high-risk individuals, especially for non-smoking women. •Recently, the lung cancer motality rate has decreased gradually in the US while it is still increasing in China.•The decline in smoking prevalence and impact of clean air legislation are main contributors to the falling trend in the US.•In China, the crude mortality rate is highest in more developed areas (the east coast) with highest levels of ambient fine particulate matter (PM2.5).•Lung cancer screening impact in China may increase by including women with high exposures to PM2.5 and environmental tobacco smoke.
AbstractList	Lung cancer is a heterogeneous disease that is impacted by environmental exposures and by constitutional genetic or epigenetic susceptibilities to disease development and progression. The United States and China have distinct and diverse populations and geographic environmental exposures that contribute to unique patterns of lung cancer incidence and mortality. In this paper, the authors compare trends of incidence and mortality of lung cancer in the US and China, and the impact on lung cancer screening programs in the two countries. It is worth noting that the mortality of lung cancer in the US has decreased gradually while in China it is still increasing over recent years. While decreasing smoking prevalence and the impact of clean air legislation have helped to mitigate the trend in the US relative to China, the increasingly widespread implementation of lung cancer chest CT screening is expected to impact lung cancer incidence and mortality in both countries. Currently there are few studies to compare the environmental and genetic risk factors for US and Chinese populations with regards to lung cancer incidence and mortality. The authors discuss the impact of gender and exposure risks, mainly smoking and environmental pollutants. Of high importance is the incidence of lung cancer in never smokers that is significantly higher in China than in the United States; this is particularly notable in women. These data suggest inclusion of ambient air pollution exposure and gender into lung cancer risk prognostic models to better capture high-risk individuals, especially for non-smoking women.Lung cancer is a heterogeneous disease that is impacted by environmental exposures and by constitutional genetic or epigenetic susceptibilities to disease development and progression. The United States and China have distinct and diverse populations and geographic environmental exposures that contribute to unique patterns of lung cancer incidence and mortality. In this paper, the authors compare trends of incidence and mortality of lung cancer in the US and China, and the impact on lung cancer screening programs in the two countries. It is worth noting that the mortality of lung cancer in the US has decreased gradually while in China it is still increasing over recent years. While decreasing smoking prevalence and the impact of clean air legislation have helped to mitigate the trend in the US relative to China, the increasingly widespread implementation of lung cancer chest CT screening is expected to impact lung cancer incidence and mortality in both countries. Currently there are few studies to compare the environmental and genetic risk factors for US and Chinese populations with regards to lung cancer incidence and mortality. The authors discuss the impact of gender and exposure risks, mainly smoking and environmental pollutants. Of high importance is the incidence of lung cancer in never smokers that is significantly higher in China than in the United States; this is particularly notable in women. These data suggest inclusion of ambient air pollution exposure and gender into lung cancer risk prognostic models to better capture high-risk individuals, especially for non-smoking women. Lung cancer is a heterogeneous disease that is impacted by environmental exposures and by constitutional genetic or epigenetic susceptibilities to disease development and progression. The United States and China have distinct and diverse populations and geographic environmental exposures that contribute to unique patterns of lung cancer incidence and mortality. In this paper, the authors compare trends of incidence and mortality of lung cancer in the US and China, and the impact on lung cancer screening programs in the two countries. It is worth noting that the mortality of lung cancer in the US has decreased gradually while in China it is still increasing over recent years. While decreasing smoking prevalence and the impact of clean air legislation have helped to mitigate the trend in the US relative to China, the increasingly widespread implementation of lung cancer chest CT screening is expected to impact lung cancer incidence and mortality in both countries. Currently there are few studies to compare the environmental and genetic risk factors for US and Chinese populations with regards to lung cancer incidence and mortality. The authors discuss the impact of gender and exposure risks, mainly smoking and environmental pollutants. Of high importance is the incidence of lung cancer in never smokers that is significantly higher in China than in the United States; this is particularly notable in women. These data suggest inclusion of ambient air pollution exposure and gender into lung cancer risk prognostic models to better capture high-risk individuals, especially for non-smoking women. •Recently, the lung cancer motality rate has decreased gradually in the US while it is still increasing in China.•The decline in smoking prevalence and impact of clean air legislation are main contributors to the falling trend in the US.•In China, the crude mortality rate is highest in more developed areas (the east coast) with highest levels of ambient fine particulate matter (PM2.5).•Lung cancer screening impact in China may increase by including women with high exposures to PM2.5 and environmental tobacco smoke. Lung cancer is a heterogeneous disease that is impacted by environmental exposures and by constitutional genetic or epigenetic susceptibilities to disease development and progression. The United States and China have distinct and diverse populations and geographic environmental exposures that contribute to unique patterns of lung cancer incidence and mortality. In this paper, the authors compare trends of incidence and mortality of lung cancer in the US and China, and the impact on lung cancer screening programs in the two countries. It is worth noting that the mortality of lung cancer in the US has decreased gradually while in China it is still increasing over recent years. While decreasing smoking prevalence and the impact of clean air legislation have helped to mitigate the trend in the US relative to China, the increasingly widespread implementation of lung cancer chest CT screening is expected to impact lung cancer incidence and mortality in both countries. Currently there are few studies to compare the environmental and genetic risk factors for US and Chinese populations with regards to lung cancer incidence and mortality. The authors discuss the impact of gender and exposure risks, mainly smoking and environmental pollutants. Of high importance is the incidence of lung cancer in never smokers that is significantly higher in China than in the United States; this is particularly notable in women. These data suggest inclusion of ambient air pollution exposure and gender into lung cancer risk prognostic models to better capture high-risk individuals, especially for non-smoking women.
Author	Yang, Dawei Liu, Yang Powell, Charles A. Wang, Xiandong Bai, Chunxue
Author_xml	– sequence: 1 givenname: Dawei orcidid: 0000-0002-8928-143X surname: Yang fullname: Yang, Dawei organization: Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China – sequence: 2 givenname: Yang orcidid: 0000-0001-6557-6439 surname: Liu fullname: Liu, Yang organization: Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA – sequence: 3 givenname: Chunxue surname: Bai fullname: Bai, Chunxue organization: Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China – sequence: 4 givenname: Xiandong surname: Wang fullname: Wang, Xiandong email: xiangdong.wang@clintransmed.org organization: Zhongshan Hospital Institute for Clinical Science, Shanghai Medical College, Fudan University, Shanghai, China – sequence: 5 givenname: Charles A. surname: Powell fullname: Powell, Charles A. email: charles.powell@mssm.edu organization: Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Copyright	2019 Elsevier B.V. 2019. Elsevier B.V. Copyright © 2019 Elsevier B.V. All rights reserved.
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Title	Epidemiology of lung cancer and lung cancer screening programs in China and the United States
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