Pinheiro Paulo S, Callahan Karen E, Medina Heidy N, Koru-Sengul Tulay, Kobetz Erin N, Gomez Scarlett Lin, de Lima Lopes Gilberto
Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, United States; Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, United States.
School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, United States.
Lung Cancer. 2022 Dec;174:50-56. doi: 10.1016/j.lungcan.2022.10.009. Epub 2022 Oct 30.
Epidemiological patterns for lung cancer among never smokers (LCNS) are largely unknown, even though LCNS cases comprise 15% of lung cancers. Past studies were based on epidemiologic or health system cohorts, and not fully representative of the underlying population. The objective was to analyze rates (and trends) of LCNS by sex, age group, and race and ethnicity based on all-inclusive truly population-based sources.
Individual-level data from 2014 to 2018 on smoking status among microscopically-confirmed lung cancer cases from Florida's cancer registry were combined with population denominators adjusted with NHIS data on smoking prevalence to compute population-based LCNS incidence rates and rate ratios. Incidence rates and proportional mortality were ranked against other cancers. Joinpoint regression analyses examined trends.
Proportions of LCNS ranged from 9% among White men to 83% among Chinese women. Overall, LCNS was 13% (IRR 1.13, 95%CI 1.08-1.17) more common among men than women, but variation occurred by age group, with female rates exceeding male in younger ages. Age-adjusted rates per 100,000 were highest among Asian/Pacific Islander (API) men and women (15.3 and 13.5, respectively) and Black populations (14.6, 12.9), intermediate for White (13.2, 11.8) and lowest among the Hispanic population (12.1, 10.6). Among API women, LCNS was the second leading cause of cancer death, surpassed only by breast cancer. LCNS trends were stable over time.
LCNS is the 11th most frequently occurring cancer in men and 8th in women. LCNS differences by race/ethnicity are small, within a 15% range of the White population's rates. Surprisingly, API men and women have the highest LCNS rates and proportional mortality. As smoking prevalence decreases in the US, LCNS cases will inevitably increase, warranting inquiry into risk factors across the lifespan.
尽管不吸烟肺癌患者（LCNS）病例占肺癌病例的15%，但其流行病学模式在很大程度上仍不为人所知。过去的研究基于流行病学或卫生系统队列，不能完全代表潜在人群。目的是根据全面的基于真实人群的数据源，分析按性别、年龄组以及种族和族裔划分的LCNS发病率（及趋势）。
将2014年至2018年佛罗里达州癌症登记处微观确诊肺癌病例的吸烟状况个体层面数据，与根据美国国家健康访谈调查（NHIS）吸烟流行率数据调整后的人口分母相结合，以计算基于人群的LCNS发病率和率比。将发病率和比例死亡率与其他癌症进行排名比较。采用Joinpoint回归分析研究趋势。
LCNS的比例在白人男性中为9%，在华裔女性中为83%。总体而言，LCNS在男性中比女性多13%（发病率比1.13，95%置信区间1.08 - 1.17），但各年龄组存在差异，较年轻年龄段女性发病率超过男性。每10万人的年龄调整发病率在亚裔/太平洋岛民（API）男性和女性中最高（分别为15.3和13.5）以及黑人人群中（14.6，12.9），白人中处于中等水平（13.2，11.8），西班牙裔人群中最低（12.1，10.6）。在API女性中，LCNS是仅次于乳腺癌的第二大癌症死亡原因。LCNS趋势随时间保持稳定。
LCNS是男性中第11大常见癌症，女性中第8大常见癌症。LCNS在种族/族裔方面的差异较小，在白人人群发病率的15%范围内。令人惊讶的是，API男性和女性的LCNS发病率和比例死亡率最高。随着美国吸烟流行率下降，LCNS病例将不可避免地增加，有必要对全生命周期的危险因素进行调查。
