A Study of the Clinical, Pathological and Radiological Profile of Lung Cancer in Non-Smokers

Aim and Objective: To study the clinical, pathological andradiological profile of lung cancer in non-smokers in a tertiarycare center.Methods: 53 non-smokers diagnosed with lung cancerattending the Department of Respiratory Medicine, KingGeorge’s Medical College from September 2015 to August2017 were enrolled. Record of all diagnostic investigations andprocedures performed namely transthoracic fine needleaspiration cytology (FNAC) and biopsy, bronchoscopy,thoracoscopy, closed pleural biopsy, lymph-node FNAC andbiopsy, routine blood and sputum examinations and a detailedhistory were obtained. Data was analysed retrospectively.Results: The mean age of presentation was 53.8±11.6 years.Majority were females (60.4%). Most common presentingsymptom was cough (84.9%). Mean duration of symptoms was6.9 months. Pallor was the most common clinical examinationfinding (41.5%). Mass with effusion was the most commonradiological lesion (45.3%). 22.6% masses were centrallylocated. Transthoracic biopsy could diagnose 32 (60.4%)cases. Adenocarcinoma was the most common type in bothmales (76.2%) and females (78.1%). Epidermal growth factorreceptor (EGFR) mutation was positive in 46.3% ofadenocarcinoma. Exon 19 deletion was the more commonmutation.Conclusion: Lung cancer among never smokers is a distinctclass with risk factors and genetic features discrete from thoseassociated with tobacco smoke. Indoor air pollutants as well asETS are definitely implicated risk factors. Targetable mutationsare commoner in non-smokers and hence mutation testingshould always be done in such patients. It is important toconduct studies about the diverse characteristics of this entityto consolidate our knowledge of this growing group of cancer.

Epidemiology of lung cancer in a tertiary health-care center: A retrospective study

Background: Lung cancer is the most common cancer diagnosed worldwide. Tobacco smoking is the most important environmental factor associated with the development of lung cancer. However, a large number of patients with lung cancer have no history of smoking frequently among female patients. There are no enough data in Eastern India regarding epidemiological study of lung cancer. Objectives: The aim of our study was to evaluate the prevalence and pattern of lung cancer in our institution (NRS Medical College and Hospital). Materials and Methods: Our study was a retrospective analysis of prospectively collected data for newly diagnosed adult patients. All patients were registered only after lung cancer diagnosis was confirmed by histopathological and/or cytological examination. The following information was collected from the database such as age, sex, smoking status and histological type, disease location, and stage. Results: A number of male patients were 786 (82%) and a number of female patients were 172 (18%). 692 (72.2%) patients had a history of smoking and 266 (27.8%) patients had no history of smoking in their life. Among the non-smoker patients, female patients were 147 (55.3%) and male patients were 119 (44.7%). 80% of patients came from rural areas and 20% of patients came from urban areas. In our study; histologically, the adenocarcinoma was 398 (41.6%) found most prevalent which is followed by squamous cell carcinoma 365 (38.1%). Conclusion: Adenocarcinoma lung with the right upper lobe involvement was prevalent in our study and non-smoker female patients were predominant. The major etiological factor was smoking. Awareness in the society is needed about cancerous effect of tobacco smoking for reducing the incidence of lung cancer.

Free gingival graft: An effective technique to create healthy keratinised gingiva

The high labial frenal attachment in mandibular anterior segment is most commonly associated with inadequate width of attached gingiva. Insufficient attached gingiva contributed to the difficulty in oral hygiene maintenance and ultimately poor gingival health. Frenectomy, vestibular extension and gingival augmentation procedures either alone or in combination are often required to maintain adequate health of the gingiva. Clinical relevance Inadequate width of keratinised gingiva contributed to the difficulty in oral hygiene maintenance and ultimately poor gingival health. Frenotomy with free gingival graft (FGG) technique is most predictable in these situations. Objective To highlight the importance of keratinised gingiva and overview of the FGG technique.

GAB2 Amplification in Squamous Cell Lung Cancer of Non-Smokers

Lung squamous cell cancer (SCC) is typically found in smokers and has a very low incidence in non-smokers, indicating differences in the tumor biology of lung SCC in smokers and non-smokers. However, the specific mutations that drive tumor growth in non-smokers have not been identified. To identify mutations in lung SCC of non-smokers, we performed a genetic analysis using arrays comparative genomic hybridization (ArrayCGH). We analyzed 19 patients with lung SCC who underwent surgical treatment between April 2005 and April 2015. Clinical characteristics were reviewed, and DNA was extracted from fresh frozen lung cancer specimens. All of copy number alterations from ArrayCGH were validated using The Cancer Genome Atlas (TCGA) copy number variation (CNV) data of lung SCC. We examined the frequency of copy number changes according to the smoking status (non-smoker [n = 8] or smoker [n = 11]). We identified 16 significantly altered regions from ArrayCGH data, three gain and four loss regions overlapped with the TCGA lung squamous cell carcinoma (LUSC) patients. Within these overlapped significant regions, we detected 15 genes that have been reported in the Cancer Gene census. We also found that the proto-oncogene GAB2 (11q14.1) was significantly amplified in non-smokers patients and vice versa in both ArrayCGH and TCGA data. Immunohistochemical analyses showed that GAB2 protein was relatively upregulated in non-smoker than smoker tissues (37.5% vs. 9.0%, P = 0.007). GAB2 amplification may have an important role in the development of lung SCC in non-smokers. GAB2 may represent a potential biomarker for lung SCC in non-smokers.

Exposure to environmental tobacco smoke among non-smoker adult females in urban households of Aligarh, India.

Background: Environmental tobacco smoke is a serious global public health problem. A better understanding of the correlates of Environmental tobacco smoke exposure could guide the development of evidence based Environmental tobacco smoke exposure reduction interventions. The study is conducted with the objective to describe the pattern of and factors associated with Environmental tobacco smoke exposure among non-smoking adult females in urban areas of Aligarh, Uttar Pradesh, India. Methods: A total of 439 households were selected by systematic random sampling. One non-smoker adult female was selected randomly from each household. Her exposure to Environmental tobacco smoke was recorded along with socio-demographic characteristic as age, education, occupation, type of family, socio-economic status using a semi-structured questionnaire based on Global Adult Tobacco Survey methodology. Her knowledge regarding harmful effects of Environmental tobacco smoke was also enquired. Data analysis was done using Chi Square test. Results: Environmental tobacco smoke exposure rate at home among the participants was 33.5%. Females with lower levels of education and lower socio-economic status had higher exposure to Environmental tobacco smoke than their counterparts with the difference being statistically significant. Only 59.2% of the participants considered exposure to Environmental tobacco smoke to be harmful to health with the knowledge being significantly poor in those who were not exposed to Environmental tobacco smoke and had lower levels of education and socio-economic status. Conclusion: The findings suggest the need for comprehensive tobacco control measures that would improve public understanding about health hazards of Environmental tobacco smoke exposure at home and encourage educational initiatives to promote smoke-free homes.

Decline in non-smoking workers' urine cotinine levels after increased smoking regulation in Korea

OBJECTIVES: To identify any association between implementing smoking regulation policies and workers' urine cotinine concentration levels in Korea. METHODS: From the first stage of the Korean National Environmental Health Survey conducted by the National Institute of Environmental Research from 2009 to 2011, 2,475 non-smoking workers selected. We analyzed the trend in the changes of cotinine concentration in urine using the general linear model and linear regression, in various jobs as categorized by the National Center for Health Statistics (NCHS) and Korea Standard Classification of Occupations (KSCO). RESULTS: The urine cotinine concentration tended to decrease every year (2.91 ng/ml in 2009, 2.12 ng/ml in 2010, and 1.31 ng/ml in 2011), showing a decreasing trend (P < 0.001). The total subjects' decreased cotinine concentration in urine between 2009 and 2011 was 2.72 ng/ml (54.1 % relative decrease). The changes in each subgroup's urine cotinine concentration ranged from 1.59 to 6.03 ng/ml (33.2 to 77.5 %). All groups except for the managerial group (n = 49), which had a small sample size, had statistically significant negative regression coefficients (p < 0.05). The ranges of the decrease in urine cotinine were 2.75 ng/ml (53.6 %) for males and 2.72 ng/ml (54.9 %) for females. The negative slope in urine cotinine level was statistically significantly greater in men than women. The changes in urine cotinine by occupation as classified by the NCHS occupational categories ranged from 2.43 to 3.36 ng/ml (46.6 to 61.5 % relative decrease). The negative slopes in urine cotinine levels of the white-collar and farm workers were statistically significantly greater than those of the service workers and blue-collar workers. The change by occupation as classified by the KSCO ranged from 1.59 to 6.03 ng/ml (a 33.2 to 77.5 % relative decrease). The negative slopes in urine cotinine levels of the professionals and related workers and clerks were statistically significantly greater than those of the service workers and plant and machine operators and assemblers. CONCLUSIONS: The cotinine concentration in urine among non-smoking worker groups tended to decline from 2009 to 2011. Such a result may be an indirect indicator of the effectiveness of smoking regulation policies including the revision of the National Health Promotion Act.

An Elderly Female Non-smoker with Primary Small Cell Carcinoma of the Urinary Bladder / 계명의대학술지

Small cell carcinoma (SCC) primarily arises in the lung. Cases of primary extrapulmonary small cell carcinoma are uncommon, and may develop in various different organs. In particular, small cell carcinoma of the urinary bladder is very rare in female nonsmokers, and its prognosis is poor. The main part of treatment in SCC is a chemotherapy, which is a critical factor in its prognosis. In the present report, we describe the case of an 82-year-old female non-smoker who underwent transurethral resection of bladder tumor (TURBT) without chemotherapy for small-cell carcinoma of the bladder, and experienced a relapse at a same area to the primary tumor site.

Epidemiology of lung cancer in India: Focus on the differences between non-smokers and smokers: A single-centre experience.

Context: Lung cancer has varied epidemiology depending on the geographic region. Globally, there have been important changes in incidence trends amongst men and women, histology, and incidence in non-smokers. Indian epidemiological data on lung cancer is scarce. Aims: We set out to study the epidemiological patterns and clinical profile of lung cancer in India. Materials and Methods: We interviewed patients discussed in the thoracic oncology multidisciplinary meetings between 2008 and 2009. Demographic data, smoking history, place of residence, histology, stage at presentation, and treatment details were collected. Data was entered and analyzed in SPSS. Results: There were 489 patients, with a median age of 56 years, of which 255 (52%) were non-smokers and 234 (48%) were smokers. One hundred and thirty-three patients had consumed smokeless tobacco. The male-to-female ratio was 3.5:1. Sixty-nine patients (14.1%) were incorrectly diagnosed and treated with anti-tuberculosis treatment, which delayed the diagnosis of lung cancer by four months. Eight percent of patients had small-cell carcinoma; of the 92% patients with non-small-cell carcinoma (NSCLC), the most common histology was adenocarcinoma (43.8%), followed by squamous cell (26.2%), large cell (2.1%) and other (8.3%). Eighteen percent of patients were diagnosed by cytology, therefore were diagnosed as NSCLC, without further histologic subtyping. Most patients (43%) were in Stage III at presentation. Lung followed by bone were the common sites of metastases. The majority of the patients (49%) received palliative chemotherapy. Among definitive therapy, concurrent chemo-radiation (13%) was offered more frequently than surgery (6%). Conclusion: Considerably higher numbers of Indian patients with lung cancer are non-smokers, compared to the West. The global trend of rise in adenocarcinoma is paralleled in India. Non-tobacco-related risk factors need further investigation.

The effect of smoking on gingival crevicular fluid levels of myeloperoxidase.

Objectives : To compare the gingival crevicular fluid (GCF) myeloperoxidase (GM) levels in smokers and non-smokers. Materials and methods : This study comprised 45 subjects: (a) 12 smokers with periodontitis, (b) 10 non-smokers with periodontitis, (c) 11 smokers with healthy periodontium, and (d) 12 non-smokers with healthy periodontium were recruited for the study and their GM levels were analyzed. Results and conclusion : GM levels were significantly higher in smokers with periodontitis compared with others. Hence, more incidence of mutagenesis and cytotoxicity were noted at sites of inflammation mediated by GM in smokers compared with non-smokers.