Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, Liverpool, L3 9TA, UK.

Using a model-based approach, we estimated the probability that an individual, with a specified combination of risk factors, would develop lung cancer within a 5-year period.Data from 579 lung cancer cases and 1157 age- and sex-matched population-based controls were available for this analysis. Significant risk factors were fitted into multivariate conditional logistic regression models. The final multivariate model was combined with age-standardised lung cancer incidence data to calculate absolute risk estimates.Combinations of lifestyle risk factors were modelled to create risk profiles. For example, a 77-year-old male non-smoker, with a family history of lung cancer (early onset) and occupational exposure to asbestos has an absolute risk of 3.17% (95% CI, 1.67-5.95). Choosing a 2.5% cutoff to trigger increased surveillance, gave a sensitivity of 0.62 and specificity of 0.70, while a 6.0% cutoff gave a sensitivity of 0.34 and specificity of 0.90. A 10-fold cross validation produced an AUC statistic of 0.70, indicating good discrimination.If independent validation studies confirm these results, the LLP risk models’ application as the first stage in an early detection strategy is a logical evolution in patient care.

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Occupational and Environmental Medicine, Sahlgrenska University Hospital/Sahlgrenska, Goeteborg, Sweden. karl.forsell@amm.gu.se

OBJECTIVE: The aim of this article is to illustrate, by means of case reports on occupational exposure in four men with cancer, the hazards of previous and ongoing carcinogenic exposures in ships’ engine rooms. Several cases of cancer occurred within a few years among the engine room crew of a passenger ferry. An investigation was undertaken to establish the number of cases, the types of cancers involved, and their possible relation to work. SUBJECTS AND METHODS: Nine cases of cancer among crew members of the ferry were reported between 2001 and 2006, six of which occurred in crew working in the engine room. During the investigated time period, 65 men had been employed in the engine room (mean age 40, range 16-65, years). Four cases were referred to our department. Medical history, personal risk factors and specific diagnoses were collected by medical examinations and from the medical files. An experienced occupational hygienist evaluated work-related exposure to carcinogens. RESULTS: Two engine room ratings contracted lung cancer at the age of 54 and 61, respectively. Both men had been smokers for many years (33 and 45 years, respectively). One engine room rating and one electrical engineer were diagnosed with mesothelioma at the age of 61 and 63, respectively. All four had started to work in engine rooms between 1959 and 1967. Carcinogenic exposure included asbestos, with an estimated cumulative exposure of 2-5 fibreyears/mL, as well as polycyclic aromatic hydrocarbons (PAHs) and nitroarenes from oils, soot and engine exhaust. CONCLUSIONS: For the lung cancer cases, smoking and asbestos exposure were considered clear risk factors, and PAHs and nitroarenes possible risk factors. For the mesothelioma cases, former asbestos exposure was considered a causal factor. Asbestos can still be present on ships. Steps should be taken to reduce the exposure to asbestos, PAHs and nitroarenes, and smoking.

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Department of Chest Diseases, Yedikule Chest Diseases and Chest Surgery Education and Research Hospital.

Objectives Our study aimed to determine the frequency of sick euthyroid syndrome (SES) among patients diagnosed as non-small cell lung cancer (NSCLC) and its association with the stage of the disease, Karnofsky index (KI), and nutritional parameters. Methods We enrolled 80 consecutive patients with newly diagnosed NSCLC. Cases with NSCLC were staged by using the TNM system. The cases were examined for thyroid function tests, KI and nutritional evaluation before treatment. Moreover, cases were investigated for their overall survival ratio. Results Out of 80 patients, SES was identified in 28 (35%). SES was more frequent among stage III (26%) and stage IV (62%) cases. The body mass index (BMI), KI and serum albumin level were found to be significantly low in cases with SES when compared to cases without SES. SES was found to be negatively correlated with BMI, KI and serum albumin level, and it was positively correlated with disease stage and weight loss. Additionally, the presence of SES was found as a prognostic factor at survival analysis (p=0.0002). Conclusion SES was frequently seen in cases with NSCLC. SES can be used as a predictor of poor prognosis in NSCLC patients.

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School of Medicine, University of Colorado Comprehensive Cancer Center, Box F-519, 13001 East 17th Place, Aurora, CO 80045. tim.byers@uchsc.edu.

BACKGROUND: There is a need for early detection methods for lung cancer. Radiologic imaging may be more sensitive for peripheral cancers than for cancers arising in the central airways, from which bronchial epithelial cells are exfoliated into the sputum. METHODS: Sputum samples were collected at baseline and periodically thereafter in a cohort of smokers and former smokers with chronic obstructive lung disease. The association between cytologic atypia and incident lung cancer was assessed by hazard ratios (HR; 95% confidence intervals) using Cox regression and by odds ratios (95% confidence intervals) using logistic regression, adjusting for potential confounding factors. RESULTS: We observed 174 incident lung cancers in a cohort of 2,521 people over 9,869 person-years of observation. Risk for incident lung cancer was increased among those with cytologic atypia graded as moderate or worse (adjusted HR, 2.37; 1.68-3.34). The association between sputum atypia and lung cancer incidence was greatest for those sputum samples collected 5 months or less before the diagnosis of lung cancer (odds ratio, 10.32; 5.34-19.97). The association was substantially stronger for squamous cell lung cancers (HR, 5.13; 2.89-9.10) than for adenocarcinomas (HR, 1.85; 0.94-3.65). CONCLUSION: Cytologic atypia is a marker for increased lung cancer risk. These cytologic changes seem to arise from late events that are most apparent for cancers arising in the central respiratory airways. Whether cytologic atypia might complement radiologic imaging in a combined approach to lung cancer, early detection requires additional evaluation of those two methods used together. (Cancer Epidemiol Biomarkers Prev 2008;17(1):158-63).

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Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA, swtoh@hsph.harvard.edu.

OBJECTIVE: To evaluate the effect of antidepressant use on lung cancer risk. METHODS: We conducted a case-control study nested in a cohort of patients 40-84 year-old in 1995-2004, without a prior diagnosis of cancer using The Health Improvement Network (THIN) database in the UK. Cases comprised 4,336 patients with a first diagnosis of primary lung cancer. A sample of 10,000 controls was frequency-matched to the cases for age, sex, and the calendar year of diagnosis. The index date for exposure definition was one year before the diagnosis for cases and one year before a random date for controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression models adjusted for potential confounders. RESULTS: Selective serotonin reuptake inhibitor (SSRI) use during the year preceding the index date with treatment duration of at least one year had an OR of 0.59 (95% CI 0.41, 0.86). The corresponding OR was 1.23 (95% CI 0.96, 1.58) for tricyclic antidepressants (TCAs). CONCLUSIONS: SSRI use did not increase the lung cancer risk and might be associated with a reduced risk. However, residual confounding might explain the apparent protective effect found for SSRI use, as well as the marginally elevated risk observed among TCA users.

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