Adenocarcinoma of the lung primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2]

Primary Prevention

Interventions Associated With Decreased Risk of Lung Cancer Smoking avoidance

Based on solid evidence, cigarette smoking causes lung cancer and therefore, smoking avoidance results in decreased mortality from primary lung cancers.

Magnitude of Effect: Decreased risk, substantial magnitude.

   Study Design: Cohort and case-control studies.
   Internal Validity: Good.
   Consistency: Good.
   External Validity: Good.

Smoking cessation

Based on solid evidence, long-term sustained smoking cessation results in decreased incidence of lung cancer and of second primary lung tumors.

Magnitude of Effect: Decreased risk, moderate magnitude.

   Study Design: Cohort and case-control studies.
   Internal Validity: Good.
   Consistency: Good.
   External Validity: Good.

Eliminating secondhand smoke

Based on solid evidence, exposure to secondhand smoke causes lung cancer and therefore, preventing exposure to secondhand smoke results in decreased incidence and mortality from primary lung cancers.

Magnitude of Effect: Decreased risk, small magnitude.

   Study Design: Cohort and case-control studies.
   Internal Validity: Good.
   Consistency: Good.
   External Validity: Good.

Reducing or eliminating occupational exposure to lung carcinogens

Based on solid evidence, occupational exposures such as asbestos, arsenic, nickel, and chromium are causally associated with lung cancer. Reducing or eliminating workplace exposures to known lung carcinogens would be expected to result in a corresponding decrease in the risk of lung cancer.

Magnitude of Effect: Decreased risk, with a larger effect, the greater the reduction in exposure.

   Study Design: Cohort and case-control studies.
   Internal Validity: Good.
   Consistency: Good.
   External Validity: Good.

Reducing or eliminating exposure to radon

Based on solid evidence, indoor exposure to radon increases lung cancer incidence and mortality, particularly among cigarette smokers. In homes with high radon concentrations, taking steps to prevent radon from entering homes by sealing the basement would be expected to result in a corresponding decrease in the risk of lung cancer.

Magnitude of Effect: Increased risk that follows a dose-response gradient, with small increases in risk for levels experienced in most at-risk homes to greater increases in risk for high-level exposures.

   Study Design: Cohort and case-control studies.
   Internal Validity: Fair.
   Consistency: Good.
   External Validity: Fair.

Interventions Associated With an Increased Risk of Lung Cancer Beta-carotene supplementation in current smokers

Based on solid evidence, high-intensity smokers who take pharmacologic doses of beta-carotene have an increased lung cancer incidence and mortality that is associated with taking the supplement.

Magnitude of Effect: Increased risk, small magnitude.

   Study Design: Two randomized controlled trials with consistent results.
   Internal Validity: Good.
   Consistency: Good.
   External Validity: Good.

Interventions That Do Not Decrease Risk of Lung Cancer Beta-carotene in nonsmokers

Based on solid evidence, nonsmokers who take pharmacological doses of beta-carotene do not experience significantly different lung cancer incidence or mortality compared with taking a placebo.

Magnitude of Effect: No substantive effect.

   Study Design: Randomized controlled trial.
   Internal Validity: Good.
   Consistency: Good.
   External Validity: Fair.

Vitamin E (Tocopherol)

Based on solid evidence, taking vitamin E supplements does not affect the risk of lung cancer.

Magnitude of Effect: Strong evidence of no association.

   Study Design: Randomized controlled trials.
   Internal Validity: Good.
   Consistency: Fair.
   External Validity: Good.

References

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