The incidence and patterns of lung cancers in Sri Lanka from 2001 to 2010: Analysis of national cancer registry data.

OBJECTIVES: Epidemiological studies carried out on lung cancer have shown varying incidence patterns in Asia. We aimed to examine the trends in lung cancer incidence and patterns in Sri Lanka. METHODS: All newly diagnosed lung cancer patients in Sri Lanka during 2001-2010 included in the National Cancer Registry were analysed. Trends in incidence were analysed using the Joinpoint regression software. RESULTS: A total of 8482 lung cancer patients (males = 6831, 80.5%, mean age: 60.2 years) were analysed. The WHO age-standardised incidence rate (ASR) has increased from 3.77 per 100,000 in 2001 (95% confidence interval [95% CI]: 3.47-4.07) to 5.74 per 100,000 in 2010 (95% CI: 5.38-6.09; a 1.52-fold increase (p < 0.05 for trend), with an estimated annual percentage change (EAPC) of 5.4 (95% CI: 3.9-7.0). The proportional increase in incidence was higher for females [ASR: 1.2 to 2.3, EAPC = 6.8(95% CI: 4.0-9.7)] than males [ASR: 6.6 to 9.55, EAPC = 5.2(95% CI: 3.8-6.6)] and with similar patterns. CONCLUSIONS: In Sri Lanka, the incidence of lung cancer has shown as increasing trend with a greater proportional rise in females. Although the observed trends could be partly due to better reporting, the greater increase in females who are generally non-smokers is intriguing. Further studies are required to identify reasons for observed incidence trends in lung cancer in Sri Lanka.

Squamous Cell Carcinoma in the Post Tuberculosis Lung after 30 Years of Treatment Completion.

Pulmonary tuberculosis (TB) and lung cancer are becoming increasingly prevalent especially in developing countries. The occurrence of lung cancer after 30 years of completed pulmonary TB treatment is rare. We report a rare occurrence of a squamous cell carcinoma (SCC) in the post TB lung after 30 years of completed pulmonary tuberculosis treatment. A 60-year-old male, an apparently healthy nonsmoker, presented with a community-acquired Klebsiella pneumonia. Imaging revealed a destroyed left lung with cavities with air-fluid levels. An enhancing lesion was noted at the left upper lobe, and a guided biopsy revealed a SCC. He was fit for surgery and underwent an open left pneumonectomy. The left lung was destroyed and cavitatory due to the previous tuberculosis. A peripherally located tumor was noted in the left upper lobe. Histology revealed a moderately differentiated keratinizing type SCC (pT4N0Mx). The negative cultures and histology excluded an active pulmonary tuberculosis. The postsurgical lung function at 1 month showed satisfactory improvement with good functional capacity. He was then referred to the oncologist for adjuvant therapy. The occurrence of post-TB lung cancer after 30 years in an otherwise healthy male without active TB suggests an increased long-term risk of cancer even in the absence of other robust risk factors. Therefore, the chronic inflammatory process in the diseased lung is probably the cause for lung cancer in the absence of active TB. Thus, we suggest long-term surveillance after completed pulmonary TB treatment even in otherwise healthy asymptomatic individuals.